Focus groups in health research: exploring the meanings of health and illness

Recruiting hard-to-reach populations via respondent driven sampling for mobile phone surveys in Colombia: a qualitative study

BACKGROUND

Uptake of mobile phone surveys (MPS) is increasing in many low- and middle-income countries, particularly within the context of data collection on non-communicable diseases (NCDs) behavioural risk factors. One barrier to collecting representative data through MPS is capturing data from older participants.Respondent driven sampling (RDS) consists of chain-referral strategies where existing study subjects recruit follow-up participants purposively based on predefined eligibility criteria. Adapting RDS strategies to MPS efforts could, theoretically, yield higher rates of participation for that age group.

OBJECTIVE

To investigate factors that influence the perceived acceptability of a RDS recruitment method for MPS involving people over 45 years of age living in Colombia.

METHODS

An MPS recruitment strategy deploying RDS techniques was piloted to increase participation of older populations. We conducted a qualitative study that drew from surveys with open and closed-ended items, semi-structured interviews for feedback, and focus group discussions to explore perceptions of the strategy and barriers to its application amongst MPS participants.

RESULTS

The strategy's success is affected by factors such as cultural adaptation, institutional credibility and public trust, data protection, and challenges with mobile phone technology. These factors are relevant to individuals' willingness to facilitate RDS efforts targeting hard-to-reach people. Recruitment strategies are valuable in part because hard-to-reach populations are often most accessible through their contacts within their social network who can serve as trust liaisons and drive engagement.

CONCLUSIONS

These findings may inform future studies where similar interventions are being considered to improve access to mobile phone-based data collection amongst hard-to-reach groups.

Cross-sectoral exchange of nurses: An intervention study

BACKGROUND

In health policy, much attention has been paid to collaboration between the primary and secondary health care sectors, especially in relation to hospitalisation and discharge. Despite ideal plans for collaboration, the research literature shows that inadequate communication is a well-known problem that can be a barrier to a safe trajectory for the citizen. Based on the assumption that better knowledge of each other's work will lead to better collaboration, a cross-sectoral exchange program with nurses was initiated.

AIM

The aim was to investigate which barriers to good patient trajectories the involved nurses attributed to cross-sectoral collaboration and what impact the exchange to the opposite sector had for them.

METHODS

Twenty-eight nurses were exchanged: 14 from a cardiology department and 14 from municipal home care. The nurses shadowed a colleague from the opposite sector in their daily work. Subsequently, six focus group interviews were conducted. The transcribed material was analysed based on Ricoeur's interpretation theory.

RESULTS

Two main themes, including sub-themes emerged: (1) Challenging communicative conditions: (a) Inadequate digital communication, (b) Inadequate care plans and discharge reports, (c) Conversation promotes understanding, and (d) Challenging collaboration and communication with the discharge coordinators. (2) Perceived importance of the exchange: (a) Cross-sectoral relationship, prejudice and gaining respect for each other and (b) Working in two different worlds.

CONCLUSION

Electronic communication is inadequate, and the IT systems do not support sufficient cross-sectoral communication. The organisational model in the municipal care sector is inflexible in terms of allocations for the current needs of citizens, and professionals feel that their professional judgements are not recognised. The nurses gained insight into each other's work and working conditions and respect for each other's professionalism. The exchange has the potential to both improve the relationship and communication between the sectors for the benefit of a better and more coherent patient course.

Maternity healthcare professionals' experiences of supporting women in decision-making for labour and birth: a qualitative study

OBJECTIVES

To explore and characterise maternity healthcare professionals' (MHCPs) experience and practice of shared decision-making (SDM), to inform policy, research and practice development.

DESIGN

Qualitative focus group study.

SETTING

Large Maternity Unit in the Southwest of England.

PARTICIPANTS

MHCPs who give information relating to clinical procedures and pregnancy care relating to labour and birth and are directly involved in decision-making conversations were purposively sampled to ensure representation across MHCP groups.

DATA COLLECTION

A semistructured topic guide was used.

DATA ANALYSIS

Reflexive thematic analysis was undertaken.

RESULTS

Seven focus groups were conducted, comprising a total of 24 participants (3-5 per group). Two themes were developed: contextualising decision-making and controversies in current decision-making. Contextual factors that influenced decision-making practices included lack of time and challenges faced in intrapartum care. MHCPs reported variation in how they approach decision-making conversations and asked for more training on how to consistently achieve SDM. There were communication challenges with women who did not speak English. Three controversies were explored: the role of prior clinical experience, the validity of informed consent when women were in pain and during life-threatening emergencies and instances where women declined medical advice.

CONCLUSIONS

We found that MHCPs are committed to SDM but need better support to deliver it. Structured processes including Core Information Sets, communication skills training and decision support aids may help to consistently deliver SDM in maternity care.

Treatment and Rehabilitation for Esophageal Cancer-Striving to Meet Obstacles and Long-term Impacts: A Qualitative Descriptive Study

BACKGROUND

Following esophagogastric cancer treatment, patients with esophageal cancer and their relatives struggle with adjusting to a new everyday life as they experience various challenges after treatment requiring rehabilitation. Health professionals must address long-term impacts on patients' health, everyday life, family functioning, and support needs.

OBJECTIVE

This qualitative descriptive study aimed to explore patients', relatives', and health professionals' experience with long-term impacts and rehabilitation after treatment for esophageal cancer.

METHODS

A qualitative approach based on a phenomenological-hermeneutical methodology was used. Two methods were selected in the study: focus group interviews with health professionals and individual interviews with patients and relatives. Inductive thematic analysis with inspiration from Braun and Clarke was used for data analysis.

RESULTS

Three main themes emerged from the data analysis: (1) forced into limitations in everyday life, (2) learning and navigating a new everyday life, and (3) rehabilitation accepting new normality.

CONCLUSION

Patients and relatives experience persistent long-term impacts after treatment for esophageal cancer, making rehabilitation strenuous and demanding. Relatives take considerable responsibility for the patients' rehabilitation but feel invisible and unsupported by health professionals. Health professionals acknowledge the severity of long-term impacts but fail to prepare patients and relatives for the impacts and do not see the relatives' need for support.

IMPLICATIONS FOR PRACTICE

The study emphasizes the need for a proactive approach in the healthcare system, addressing patients' and relatives' physical and psychological vulnerability. Cancer nurses need to prepare and involve patients and relatives in treatment, long-term impacts, and rehabilitation.

"You don't put it down to arthritis": A qualitative study of the first symptoms recalled by individuals with knee osteoarthritis

Objective

As part of the first phase of the OARSI Early-stage Symptomatic Knee Osteoarthritis (EsSKOA) initiative, we explored the first symptoms and experiences recalled by individuals with knee osteoarthritis (OA).

Design

This qualitative study, informed by qualitative description, was a secondary analysis of focus groups (n ​= ​17 groups) and one-on-one interviews (n ​= ​3) conducted in 91 individuals living with knee OA as part of an international study to better understand the OA pain experience. In each focus group or interview, participants were asked to describe their first symptoms of knee OA. We inductively coded these transcripts and conducted thematic analysis.

Results

Mean age of participants was 70 years (range 47-92) and 68 ​% were female. We developed four overarching themes: Insidious and Episodic Onset, Diverse Early Symptoms, Must be Something Else, and Adjustments. Participants described the gradual and intermittent way in which symptoms of knee OA developed over many years; many could not identify a specific starting point. Participants described diverse initial knee symptoms, including activity-exacerbated joint pain, stiffness and crepitus. Most participants dismissed early symptoms or rationalized their presence, employing various strategies to enable continued participation in recreational and daily activities. Few sought medical attention until physical functioning was demonstrably impacted.

Conclusions

The earliest symptoms of knee OA are frequently insidious in onset, episodic and present long before individuals present to health professionals. These results highlight challenges to identifying people with knee OA early and support the development of specific classification criteria for EsSKOA to capture individuals at an early stage.

It is not about the destination but the journey: A dive into student-staff partnership processes

Student-staff partnership advocates the active involvement of students' voices in the design of education. Although the concept of student-staff partnership is rapidly gaining momentum in health professions education, the current practices are more outcome-focused and pay less attention to the partnership process itself. Students' involvement in most of the claimed partnerships has been viewed as input information to the educational design process rather than inviting them to the more pronounced role as partners. In this commentary, we elaborate on different levels of students' involvement in educational design, before highlighting the possible dynamics between students and staff in partnership. We propose five key features of dynamics involved in the process of real student-staff partnerships and a Process-Outcome Model for Student-staff Partnership. We advocate that moving beyond outcomes and diving deeper into the partnership processes is the way forward to establishing true student-staff partnerships.

Organisational prerequisites for coordinating the return-to-work process for people with multimorbidity and psychosocial difficulties

PURPOSE

The return-to-work (RTW) process for people with multimorbidity and psychosocial difficulties can be complicated. This study explores the organisational prerequisites for coordinating these patients' RTW processes from the perspective of coordinators in different clinical areas in Sweden.

MATERIAL AND METHODS

Six focus group interviews were conducted with 24 coordinators working in primary healthcare (PHC), psychiatric and orthopaedic clinics. The data were analysed thematically, inspired by organisation theory.

RESULTS

Coordinators described varying approaches to people with multimorbidity and psychosocial difficulties, with more hesitancy among PHC coordinators, who were perceived by other coordinators as hindering patient flows between clinical areas. Most organisational barriers to RTW were identified in the healthcare sector. These were long waiting times, physicians drawing up inadequate RTW plans, coordinators being involved late in the sickness absence process, and lack of rehabilitation programmes for people with multimorbidity. The barriers in relation to organisations such as Social Insurance Agency and Employment Services were caused by regulations and differing perspectives, priorities, and procedures.

CONCLUSION

Our findings indicate what is needed to improve the RTW process for patients with complex circumstances: better working conditions, steering, and guidelines; shorter waiting times; and a willingness among coordinators from different clinical areas to collaborate around patients. Implications for rehabilitationRTW coordinators need sufficient physical and psychosocial working conditions as well as clear leadership.In order to avoid inequalities in access to RTW support, better systems are needed to identify patients who would benefit from rehabilitation and RTW coordination.There is a need for multilevel collaboration between clinical areas so that patients with multiple healthcare contacts and prolonged sickness absence can obtain support during the RTW process.

'It stretches your body but makes you feel good too': A qualitative study exploring young people's perceptions and experiences of yoga

Whilst research suggests that yoga can positively impact physical and psychological wellbeing, understanding of youth's experiences is limited with no non-clinical studies in the UK. Ten focus groups explored perceptions and experiences of yoga among 35 youth (10-18 years). Inductive thematic analysis revealed that yoga was viewed as a holistic mind-body practice cultivating greater awareness and enhanced physical performance. Youth described yoga as providing tools that developed confidence, stress-management and emotional self-regulation. Social and relational impacts of yoga were highly valued. Despite the perceived biopsychosocial benefits of yoga, gendered and media representations of yoga may serve as a barrier to uptake.

A downstream social norms approach for curtailing e-cigarette waste: Promising social marketing interventions from consumer interactions

Irresponsibly disposed electronic cigarette (e-cigarette) waste poses significant public health and environmental harm. This study explores downstream social marketing interventions that can be used to curtail the growth of e-cigarette waste in South Africa through the lenses of the social norms approach. This study harnesses the power of social marketing to identify downstream interventions that can be used by marketers to curb the problem of e-cigarette waste. An exploratory research design and a qualitative method were employed. Six virtual focus groups were conducted to collect cross-sectional data from South African electronic cigarette users. Reciprocal altruism, social orientation value, moral licensing and ecological beliefs were found to be the main normative influences that characterise e-cigarette waste. The results support the proposition that social marketers should employ a downstream approach to develop interventions to curtail the growth of e-cigarette waste. Such measures are envisaged to complement upstream initiatives. This study offers new insights on how to manage e-cigarette waste in the context of an emerging market.

The Perception of Religious Leaders on HIV and Their Role in HIV Prevention: A Case Study of African, Caribbean, and Black (ACB) Communities in Windsor, Ontario

This paper explores the perception of African, Caribbean, and Black (ACB) religious leaders on HIV vulnerability and their role in HIV prevention among ACB communities in Windsor, Ontario. We conducted one semi-structured focus group discussion with nine Black religious leaders, most of whose congregants are members of the ACB community. Most religious leaders in the focus group had a negative perception of the transmission of HIV, but they acknowledged their own important role in HIV prevention strategies. This role is collaborative in nature, from the stage of designing HIV prevention strategies to implementing prevention messages. The religious leaders noted, however, that some challenges, such as church doctrine and congregational culture, are likely to impede their HIV prevention efforts.

Hospital and homecare nurses' experiences of involvement of patients and families in transition between hospital and municipalities: A qualitative study

BACKGROUND

Involving patients and families in nursing care is essential to improve patients' health outcomes. Furthermore, families play an essential role in supporting patients by helping nurses understand the patient's everyday life. However, families also need support. Involvement of patients and families is especially important when patients are transferred between hospital and home as transitions heighten the risk of compromising quality and safety in care. However, no consensus exists on how to involve them. Consequently, this may challenge a systematic approach toward patient and family involvement.

AIM

To describe hospital and homecare nurses' experiences with involving patients and their family members in nursing care in the transition between hospital and municipalities.

METHOD

Focus group interviews were conducted in the Gastro unit at a large university hospital in Denmark. Participants included 10 hospital nurses from three wards at the Gastro unit and six homecare nurses from one of three municipalities in the hospital catchment area (total n = 16). Data were analysed using qualitative content analysis. The study is reported according to the Consolidated Criteria for Reporting Qualitative Research.

FINDINGS

Our analysis revealed one overall theme - "The complexity of involvement" - based on four categories: gap between healthcare sectors increases the need for patient and family involvement, lack of time is a barrier to patient and family involvement, involvement is more than information, and involvement as a balancing act.

CONCLUSION

The nurses experienced patients' and families' involvement as essential, but a discrepancy was found between nurses' intentions and their actions. Aspects related to a gap between healthcare sectors and various understandings of involvement challenged the systematic involvement of patients and families in the transition between healthcare sectors. However, the nurses were highly motivated to achieve a close cross-sectoral collaboration and to show commitment towards patients and families.

A qualitative approach to experiential knowledge identified in focus groups aimed at co-designing a provocation test in the study of electrohypersensitivity

Patients' experiential knowledge is increasingly recognised as valuable for biomedical research. Its contribution can reveal unexplored aspects of their illnesses and allows research priorities to be refined according to theirs. It can also be argued that patients' experiential knowledge can contribute to biomedical research, by extending it to the most organic aspects of diseases. A few examples of collaboration between medicine and patient associations are promising, even if there is no single, simple methodology to apply. This article provides feedback on a project involving the experiential knowledge of electrohypersensitive persons with a view to developing an experimental protocol to study their condition. It presents the participatory approach with focus groups that was implemented and reflects on ways to take advantage of experiential knowledge. It also demonstrates the complexity of the electrohypersensitivity syndrome and reflects on the difficult transition between the experiential knowledge and the experimental design of provocation studies.KEY MESSAGESExperiential knowledge is a valuable source of information for research and the design of investigation protocols.The participatory approach allows co-designing protocols by drawing on experiential knowledge.The controversial dimension of EHS reveals the complexity of translating experiential knowledge into an experimental protocol.

‘We Have Guidelines, but We Can Also Be Artists’: Neurologists Discuss Prognostic Uncertainty, Cognitive Biases, and Scoring Tools

Introduction: Ischemic stroke is a leading cause of disability and mortality worldwide. As acute stroke patients often lose decision-making capacity, acute management is fraught with complicated decisions regarding life-sustaining treatment (LST). We aimed to explore (1) the perspectives and experiences of clinicians regarding the use of predictive scores for LST decision making in severe acute stroke, and (2) clinicians’ awareness of their own cognitive biases in this context. Methods: Four focus groups (FGs) were conducted with 21 physicians (13 residents and 8 attending physicians); two FGs in a university hospital and two in a regional hospital in French-speaking Switzerland. Discussions were audio-recorded and transcribed verbatim. Transcripts were analyzed thematically. Two of the four transcripts were double coded to establish coding framework consistency. Results: Participants reported that predictive tools were not routinely used after severe stroke, although most knew about such scores. Scores were reported as being useful in quantifying prognosis, advancing scientific evidence, and minimizing potential biases in decisions. Their use is, however, limited by the following barriers: perception of inaccuracy, general disbelief in scoring, fear of self-fulfilling prophecy, and preference for clinical judgement. Emotional and cognitive biases were common. Emotional biases distort clinicians’ knowledge and are notably: bias of personal values, negative experience, and cultural bias. Cognitive biases, such as availability, confirmation, and anchoring biases, that produce systematic deviations from rational thinking, were also identified. Conclusions: The results highlight opportunities to improve decision making in severe stroke through the promotion of predictive tools, strategies for communicating prognostic uncertainty, and minimizing cognitive biases among clinicians, in order to promote goal-concordant care.

Conducting focus groups in realist evaluation

Focus groups are valuable tools for evaluators to help stakeholders to clarify programme theories. In 1987, R.K. Merton, often attributed with the birth of focus groups, wrote about how these were 'being mercilessly misused'. In the 1940s, his team had conceived focus groups as tools for developing middle-range theory, but through their astonishing success focus groups have metamorphosed and are often an 'unchallenged' choice in many evaluation approaches, while their practice seems to provide a philosophically diverse picture. This article examines what knowledge focus group data generate, and how they support theory development. It starts with an overview of the history of focus groups, establishing a relationship between their emergence as a data collection method and the evaluation profession. Practical lessons for conducting groups in realist evaluation are suggested, while exploring how qualitative data can support programme and middle-range theory development using the example of realist evaluation.

Towards a context-specific understanding of masculinities in Eswatini within voluntary medical male circumcision programming

Compelling evidence from three randomised controlled trials, which showed that voluntary medical male circumcision (VMMC) reduces HIV acquisition from women to men by up to 60%, led to WHO recommending that VMMC be implemented in 14 priority countries. As one of the priority countries, Eswatini aimed to reach 80% VMMC coverage among boys and men aged 10-49 years since programme inception in 2009. By the end of 2019, however, the country had reached a modest 40%. VMMC is intrinsically tied to perceptions of masculinity and male gender identity. Comprehending the role of context-specific masculinity as it relates to VMMC may contribute to our understanding of community attitudes towards VMMC and men's decision-making. Drawing on focus group discussion data, this study aimed to explore the linkage between sexuality, masculinity and health interventions within Eswatini. Using critical discourse analysis, the study identified two discourses: sexuality, masculinity and circumcision, and income, masculinity, and circumcision. In the first discourse, participants constructed discursive linkages between circumcision as an adult and loss of penile sensitivity, decreased libido and sexual performance, and adverse events. The second discourse, income, masculinity, and circumcision located circumcision within the social and material realities faced by Swazi men, gender norms and provision within family structures.

Peer mentors' role in school-based health promotion: qualitative findings from the Young & Active study

Peer-led interventions are highlighted as promising strategies to promote health among adolescents, but little is known about the mechanisms underlying this approach. To better understand the role of peer mentors (PMs) as implementers in school-based health promotion, we combined participant observations, focus group interviews and video recordings to explore high school students' reception of a peer-led intervention component (Young & Active). Young & Active aimed to increase well-being among first-year high school students (∼16 years of age) through the promotion of movement and sense of community and was implemented during the school year 2016-2017 in a larger school-based intervention study, the Healthy High School study in Denmark. The Healthy High School study was designed as a cluster-randomized controlled trial with 15 intervention schools and 15 control schools. At each intervention school, university students in Sports Science and Health (members of the research group) facilitated an innovation workshop aiming at inspiring all first-year students to initiate movement activities at schools. The findings illustrate potentials and challenges implied in the PM role. The peer mentors' profound commitment, as well as their response and sensibility to situational contingencies, were found to be significant for the students' reception and experience of the intervention. In conclusion, the specific job of PMs as implementers seems to consist of simultaneously following a manual and situationally adjusting in an emerging context balancing commitment and identification to the target group and the intervention project.

A Multifunctional Adaptive and Interactive AI system to support people living with stroke, acquired brain or spinal cord injuries: A study protocol

Background

Acquired brain injury and spinal cord injury are leading causes of severe motor disabilities impacting a person’s autonomy and social life. Enhancing neurological recovery driven by neurogenesis and neuronal plasticity could represent future solutions; however, at present, recovery of activities employing assistive technologies integrating artificial intelligence is worthy of examining. MAIA (Multifunctional, adaptive, and interactive AI system for Acting in multiple contexts) is a human-centered AI aiming to allow end-users to control assistive devices naturally and efficiently by using continuous bidirectional exchanges among multiple sensorimotor information.

Methods

Aimed at exploring the acceptability of MAIA, semi-structured interviews (both individual interviews and focus groups) are used to prompt possible end-users (both patients and caregivers) to express their opinions about expected functionalities, outfits, and the services that MAIA should embed, once developed, to fit end-users needs.

Discussion

End-user indications are expected to interest MAIA technical, health-related, and setting components. Moreover, psycho-social issues are expected to align with the technology acceptance model. In particular, they are likely to involve intrinsic motivational and extrinsic social aspects, aspects concerning the usefulness of the MAIA system, and the related ease to use. At last, we expect individual factors to impact MAIA: gender, fragility levels, psychological aspects involved in the mental representation of body image, personal endurance, and tolerance toward AT-related burden might be the aspects end-users rise in evaluating the MAIA project.

Mix-and-Match or Mismatch? Exploring the Perspectives of Older Adults About Zumba Dance and Its Potential Utilization for Dual-Task Training

Despite the popularity of Zumba dancing, research is scarce about its impact on older adults. Meanwhile, the integration of cognitive tasks with physical exercises, also known as dual tasking, is an evolving strategy to facilitate activities for older adults. This study investigated the perceptions of persons aged ≥55 years on Zumba and its potential to be incorporated into a dual-task program. We conducted a descriptive-qualitative study involving 44 Filipino older adults. Using content analysis, four themes were identified: moving toward match or mismatch, balancing benefits with burdens, dual tasking as innovative yet potentially challenging, and overcoming barriers with enablers. Although Zumba was perceived as an inclusive and beneficial activity, individual and contextual limitations could hinder its suitability. Moreover, dual tasking in Zumba was considered an innovative approach, although challenges should be addressed to promote its feasibility. Several strategies could enable the design and implementation of age-appropriate Zumba and dual-tasking programs for older adults.

The Infant Health Study - Promoting mental health and healthy weight through sensitive parenting to infants with cognitive, emotional, and regulatory vulnerabilities: protocol for a stepped-wedge cluster-randomized trial and a process evaluation within municipality settings

Background

Child mental health problems are a major public health concern associated with poor mental and physical health later in development. The study evaluates a new community-based intervention to promote sensitive parenting and reduce enduring mental health problems and unhealthy weight among vulnerable infants aged 9-24 months.

Methods

We use a step-wedge cluster randomized controlled trial design conducted within a home visiting program offered by community health nurses to infant families in Denmark. Sixteen municipalities are randomly allocated to implement the intervention starting at three successive time points from May 1, 2022 to January 1, 2023. A total of 900-1000 families will be included. A standardized program, Psykisk Udvikling og Funktion (PUF), is used to identify infants with major problems of eating, sleep, emotional or behavioral regulation or developmental problems. The intervention builds on the Video-Feedback Intervention to Promote Positive Parenting (VIPP) program, adapted to the PUF-context and named the VIPP-PUF. Children will be followed up at ages 18 and 24 months. Primary outcome measure is the Strengths and Difficulties Questionnaire (SDQ) at child age 24 months. The other outcome measures include body mass index z-scores, the Ages and Stages Questionnaire Social-Emotional (ASQ:SE2); the Child Behavior Checklist (CBCL 1½ -5); Eating behavior Questionnaires; the Being a Mother-questionnaire (BaM13); the Parental Stress Scale (PSS); and the WHO-5 well-being index (WHO-5). Data on child and family factors are obtained from National registries and the Child Health Database.

Quantitative measures are applied to examine the effectiveness of the VIPP-PUF intervention and the implementation process. Qualitative measures include interviews with CHNs, parents and municipality stakeholders to explore factors that may influence the adherence and effectiveness of the intervention.

Discussion

The study examines a service-setting based intervention building on the promotion of sensitive parenting to vulnerable infants. We use a mixed methods approach to evaluate the intervention, taking into account the influences of COVID-19 pandemic running since March 2020. Overall, the study has potential to add to the knowledge on the possibilities of prevention within the municipality child health care to reduce the risk of mental health problems and unhealthy weight in early childhood.

Trial registration

www.ClinicalTrials.gov; IDNCT04601779; Protocol ID 95-110-21307. Registered 25 June 2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12551-z.

Perceptions of body weight that vary by body mass index: Clear associations with perceptions based on personal control and responsibility

This project aimed to identify the perceptions of body weight that vary by body mass index. First, a qualitative study explored body weight perceptions in 17 individuals with overweight. Second, a questionnaire was developed and completed by a UK sample with body mass index from 16.6 to 59.7 kg/m2 (N = 328). A higher body mass index was associated with perceptions of less personal control and responsibility. Body mass index in females was also associated with three other questionnaire factors and body mass index in males with illness/medication. Thus, body mass index was associated with different perceptions of body weight. Focussing on personal control and responsibility may be useful for treatment and prevention.

Feasibility of Delivering an on-Campus Food Distribution Program in a Community College Setting: A Mixed Methods Sequential Explanatory Investigation

Despite community college students experiencing food insecurity there has been a dearth of research conducted on the feasibility of providing a program designed to increase access to fruits and vegetables among community colleges. This study used a mixed methods sequential explanatory design to examine the feasibility of delivering an on-campus food distribution program (FDP) to community college students and to examine the association between FDP and food insecurity and dietary intake. The study also explored the student's experiences related to barriers and facilitators of program utilization. In phase one, the FDP occurred for eight months and students could attend twice per month, receiving up to 60 pounds of food per visit. Online questionnaires were used to collect students' food security and dietary intake. Among the 1000 students offered the FDP, 495 students enrolled, with 329 students (66.5%) attending ≥ 1. Average attendance = 3.27 (SD = 3.08) [Range = 1-16] distributions. The FDP did not reduce food insecurity nor improve dietary intake. In phase two, a subsample of students (n = 36) discussed their FDP experiences through focus groups revealing three barriers limiting program utilization: program design and organization, personal schedule and transportation, and program abuse by other attendees. Facilitators to greater program utilization included: the type of food distributed and welcoming environment, along with allowing another designated individual to collect food. To maximize program use, it is suggested that reported barriers be addressed, which might positively influence food insecurity and dietary intake.

Using the Medical Research Council framework and public involvement in the development of a communication partner training intervention for people with primary progressive aphasia (PPA): Better Conversations with PPA

Background

Primary progressive aphasia is a language-led dementia resulting in a gradual dissolution of language. Primary progressive aphasia has a significant psychosocial impact on both the person and their families. Speech and language therapy is one of the only available management options, and communication partner training interventions offer a practical approach to identify strategies to support conversation. The aim of this study was to define and refine a manual and an online training resource for speech and language therapists to deliver communication partner training to people with primary progressive aphasia and their communication partners called Better Conversations with primary progressive aphasia.

Methods

The Better Conversations with primary progressive aphasia manual and training program were developed using the Medical Research Council framework for developing complex interventions. The six-stage development process included 1. Exploratory review of existing literature including principles of applied Conversation Analysis, behaviour change theory and frameworks for chronic disease self-management, 2. Consultation and co-production over 12 meetings with the project steering group comprising representatives from key stakeholder groups, 3. Development of an initial draft, 4. Survey feedback followed by a consensus meeting using the Nominal Group Techniques with a group of speech and language therapists, 5. Two focus groups to gather opinions from people with PPA and their families were recorded, transcribed and Thematic Analysis used to examine the data, 6. Refinement.

Results

Co-production of the Better Conversations with primary progressive aphasia resulted in seven online training modules, and a manual describing four communication partner training intervention sessions with accompanying handouts. Eight important components of communication partner training were identified in the aggregation process of the Nominal Group Technique undertaken with 36 speech and language therapists, including use of video feedback to focus on strengths as well as areas of conversation breakdown. Analysis of the focus groups held with six people with primary progressive aphasia and seven family members identified three themes 1) Timing of intervention, 2) Speech and language therapists’ understanding of types of dementia, and 3) Knowing what helps. These data informed refinements to the manual including additional practice activities and useful strategies for the future.

Conclusions

Using the Medical Research Council framework to develop an intervention that is underpinned by a theoretical rationale of how communication partner training causes change allows for the key intervention components to be strengthened. Co-production of the manual and training materials ensures the intervention will meet the needs of people with primary progressive aphasia and their communication partners. Gathering further data from speech and language therapists and people living with primary progressive aphasia and their families to refine the manual and the training materials enhances the feasibility of delivering this in preparation for a phase II NHS-based randomised controlled pilot-feasibility study, currently underway.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02561-8.

Activating Partnership Assets to Produce Synergy in Primary Health Care: A Mixed Methods Study

Partnerships are an important mechanism to tackle complex problems that extend beyond traditional organizational divides. Partnerships are widely endorsed, but there is a need to strengthen the evidence base relating to claims of their effectiveness. This article presents findings from a mixed methods study conducted with the aim of understanding partnership processes and how various partnership factors contribute to partnership effectiveness. The study involved five multi-stakeholder partnerships in Canada and Australia working towards improving accessibility to primary health care for vulnerable populations. Qualitative data were collected through the observation of 14 partnership meetings and individual semi-structured interviews (n = 16) and informed the adaptation of an existing Partnership Self-Assessment Tool. The instrument was administered to five partnerships (n = 54). The results highlight partnership complexity and the dynamic and contingent nature of partnership processes. Synergistic action among multiple stakeholders was achieved through enabling processes at the interpersonal, operational and system levels. Synergy was associated with partnership leadership, administration and management, decision-making, the ability of partnerships to optimize the involvement of partners and the sufficiency of non-financial resources. The Partnership Synergy framework was useful in assessing the intermediate outcomes of ongoing partnerships when it was too early to assess the achievement of long-term intended outcomes.

An exploration of experiences and beliefs about low back pain with Arab Muslim patients

PURPOSE

Pain has psychological, social, physical and spiritual dimensions and therefore this experience is influenced by culture. The aim of this study was to explore the experiences and beliefs of Arab Muslim patients with low back pain (LBP) in Bahrain.

METHODS

We recruited Arab Muslim patients attending physiotherapy with LBP ≥3 months, and ≥18 years of age. Socio-demographic information and a Visual Analogue Scale (VAS) score for pain intensity were collected. Focus groups were conducted between 2013-2014, using pre-determined semi-structured interview questions. Qualitative content analysis was applied with single counting and inclusion of negative instances.

RESULTS

18 participants attended three focus groups (14 females and 4 males) with a mean VAS(SD) = 5.28(±1.97). Five themes were identified; (1) loss of independence, (2)change in identity causes distress, (3) beliefs and attitudes towards low back pain, (4)trying to cope with LBP, and (5)experiences within the healthcare system.

CONCLUSIONS

Religious and cultural beliefs influenced pain-related beliefs, fear-avoidance beliefs and catastrophizing. We recommend addressing cultural gender roles and using "active" forms of religious coping to inform treatment. Participants' experiences within and experiences of the healthcare system were similar to Western cultures. This encourages the application of Western findings into practice to facilitate the management of these patients.IMPLICATIONS FOR REHABILITATIONA qualitative exploration was undertaken to explore the experiences of Muslim and/or Arab patients with LBP.Our findings show that females have prioritised family needs over their own, primarily due to perceived gender roles.Contrary to previous findings labelling religious coping as a passive strategy, our findings suggest that religious coping strategies can be both positive and active strategies; such as participation in religious occasions and frequenting mosques.We support recommendations from Western literature to manage LBP; such as prioritising patient education and joint decision-making.

'Overnight, things changed. Suddenly, we were in it': a qualitative study exploring how surgical teams mitigated risks of COVID-19

OBJECTIVES

COVID-19 presents a risk of infection and transmission for operating theatre teams. Guidelines to protect patients and staff emerged and changed rapidly based on expert opinion and limited evidence. This paper presents the experiences and innovations developed by international surgical teams during the early stages of the pandemic to attempt to mitigate risk.

DESIGN

In-depth, semistructured interviews were audio recorded, transcribed and analysed thematically using methods of constant comparison.

PARTICIPANTS

43 participants, including surgeons from a range of specialties (primarily general surgery, otolaryngology, neurosurgery, cardiothoracic and ophthalmology), anaesthetists and those in nursing roles.

SETTING

The UK, Italy, Spain, the USA, China and New Zealand between March and May 2020.

RESULTS

Surgical teams sought to mitigate COVID-19 risks by modifying their current practice with an abundance of strategies and innovations. Communication and teamwork played an integral role in how teams adapted, although participants reflected on the challenges of having to improvise in real time. Uncertainties remained about optimal surgical practice and there were significant tensions where teams were forced to balance what was best for patients while contemplating their own safety.

CONCLUSIONS

The perceptions of risks during a pandemic such as COVID-19 can be complex and context dependent. Management of these risks in surgery must be driven by evidence-based practice resulting from a pragmatic and novel approach to collation of global evidence. The context of surgery has changed dramatically, and surgical teams have developed a plethora of innovations. There is an urgent need for high-quality evidence to inform surgical practice that optimises the safety of both patients and healthcare professionals as the COVID-19 pandemic unfolds.

Factors influencing complementary feeding practices in rural and semi-urban Rwanda: a qualitative study

The aim of the present study was to identify and describe the factors influencing feeding practices of children aged 6–23 months in Rwanda. This is a cross-sectional descriptive qualitative study. A total of ten focus group discussions were conducted separately with mothers, fathers, grandmothers and community health workers (CHWs) from five different districts in Rwanda. The discussions were recorded, transcribed verbatim, and thematically analysed using qualitative data analysis software, Atlas.ti. The study participants were mothers, fathers and grandmothers of children aged 6–23 months and CHWs in charge of child health. Caregivers’ knowledge and beliefs about the benefits of breast-feeding and timely introduction of complementary food were found to be the primary individual factors facilitating good infant and young child feeding practices. The common belief of caregivers that infants should be given liquids (thin gruel, fruit juices and meat broth) as first foods instead of semi-solid foods was a barrier to good feeding practices. The community-based nutrition education and counselling programmes were facilitators of good complementary practices at the group level. At the society level, poverty in rural agrarian households was a barrier to optimal feeding practices. The study shows that there is a need to empower caregivers with more specific guidelines, especially on complementary feeding.

Silent Voices: Exploring Narratives of Women's Experiences of Health Care Professional Responses to Domestic Violence and Abuse

The impact of domestic violence and abuse (DVA) is far reaching not least in terms of both the immediate and longer term physical and mental wellbeing of those who have experienced abuse. DVA also exerts a considerable detrimental impact on the wider family including children. While professional perspectives of working with DVA survivors is increasingly well documented, there remains a paucity of accounts of encounters with healthcare services and/or healthcare professionals from survivors of DVA themselves. A central aim of this study was the exploration of women's experiences of healthcare encounters told purely as personal narrative rather than framed in more traditional research terms. The focus of this paper therefore is unedited personal stories of encounters with healthcare professionals. The position of narrative as research method and the presentation of narratives in this particular instance are also considered.

Exploring physiotherapists' and occupational therapists' perceptions of the upper limb prediction algorithm PREP2 after stroke in a rehabilitation setting: a qualitative study

OBJECTIVE

To explore how physiotherapists (PTs) and occupational therapists (OTs) perceive upper limb (UL) prediction algorithms in a stroke rehabilitation setting and identify potential barriers to and facilitators of their implementation.

DESIGN

This was a qualitative study.

SETTING

The study took place at a neurorehabilitation centre.

PARTICIPANTS

Three to six PTs and OTs.

METHODS

We conducted four focus group interviews in order to explore therapists' perceptions of UL prediction algorithms, in particular the Predict Recovery Potential algorithm (PREP2). The Consolidated Framework for advancing Implementation Research was used to develop the interview guide. Data were analysed using a thematic content analysis. Meaning units were identified and subthemes formed. Information gained from all interviews was synthesised, and four main themes emerged.

RESULTS

The four main themes were current practice, perceived benefits, barriers and preconditions for implementation. The participants knew of UL prediction algorithms. However, only a few had a profound knowledge and few were using the Shoulder Abduction Finger Extension test, a core component of the PREP2 algorithm, in their current practice. PREP2 was considered a potentially helpful tool when planning treatment and setting goals. A main barrier was concern about the accuracy of the algorithm. Furthermore, participants dreaded potential dilemmas arising from having to confront the patients with their prognosis. Preconditions for implementation included tailoring the implementation to a specific unit, sufficient time for acquiring new skills and an organisation supporting implementation.

CONCLUSION

In the present study, experienced neurological therapists were sceptical towards prediction algorithms due to the lack of precision of the algorithms and concerns about ethical dilemmas. However, the PREP2 algorithm was regarded as potentially useful.

Identity cues influence sexual minorities' anticipated treatment and disclosure intentions in healthcare settings: Exploring a multiple pathway model

The present work experimentally examines how identity cues that signal minority inclusion contribute to sexual minorities' (SM) healthcare visit expectations. We find that minority representation cues reduced SM's (N = 188) expectations of a healthcare provider's bias and increased perceived provider cultural competency which was, in turn, associated with lower anticipated identity-based devaluation and greater sexual orientation disclosure comfort. Providers' diversity-valuing statements had mixed effects highlighting the importance of more concrete indicators of inclusion in this context. This work suggests that a lack of identity safety cues in healthcare settings may contribute to disparate health outcomes for sexual minority populations.

Places to Smoke: Exploring Smoking-Related Practices among Danish Adolescents

Several established school smoking prevention initiatives involve restrictions on places to smoke. The focus on tobacco control in schools is due to the risk of smoking initiation during adolescence and the perception of this life stage as a period of time when health behavior is established. Hence, this period of time is considered to be ideal for health-promoting initiatives. This paper is part of an ethnographic study on adolescents' perceptions of tobacco use. Focus groups and field observations were used to explore adolescents' smoking-related practices related to smoking bans at schools. The findings show that smoking, as a place-based practice, is influenced by locally embedded rules and carries social implications resulting in a distinction between smokers and non-smokers. The distinction between smokers and non-smokers contributes to the retention of a stereotypical view of smokers and, moreover, stigmatizes smokers. According to this, restrictions on places to smoke within the school should be considered carefully in order to avoid stigma or ethical issues.

Qualitative research methods in medical dissertations: an observational methodological study on prevalence and reporting quality of dissertation abstracts in a German university

Background

Qualitative methods offer a unique contribution to health research. Academic dissertations in the medical field provide an opportunity to explore research practice. Our aim was to assess the use of qualitative methods in dissertations in the medical field.

Methods

By means of a methodological observational study, an analysis of all academic medical dissertations’ abstracts between 1998 and 2018 in a repository databank of a large medical university faculty in Germany was performed. This included MD dissertations (Dr. med. (dent.)) and medical science dissertations (Dr. sc. hum.). All abstracts including “qualitativ*” were screened for studies using qualitative research methods. Data were extracted from abstracts using a category grid considering a) general characteristics (year, language, degree type), b) discipline, c) study design (mixed methods/qualitative only, data conduction, data analysis), d) sample (size and participants) and e) technologies used (data analysis software and recording technology). Thereby reporting quality was assessed.

Results

In total, 103 abstracts of medical dissertations between 1998 and 2018 (1.4% of N = 7619) were included, 60 of MD dissertations and 43 of medical sciences dissertations. Half of the abstracts (n = 51) referred to dissertations submitted since 2014. Most abstracts related to public health/hygiene (n = 27) and general practice (n = 26), followed by medical psychology (n = 19). About half of the studies (n = 47) used qualitative research methods exclusively, the other half (n = 56) used mixed methods. For data collection, primarily individual interviews were used (n = 80), followed by group interviews (n = 33) and direct observation (n = 11). Patients (n = 36), physicians (n = 36) and healthcare professionals (n = 17) were the most frequent research participants. Incomplete reporting of participants and data analysis was common (n = 67). Nearly half of the abstracts (n = 46) lacked information on how data was analysed, most of the remaining (n = 43) used some form of content analysis. In summary, 36 abstracts provided all crucial data (participants, sample size,; data collection and analysis method).

Conclusion

A small number of academic dissertations used qualitative research methods. About a third of these reported all key aspects of the methods used in the abstracts. Further research on the quality of choice and reporting of methods for qualitative research in dissertations is recommended.

Social inequalities in breast cancer screening: evaluating written communications with immigrant Haitian women in Montreal

Background

The province of Quebec (Canada) has implemented a breast cancer screening program to diagnose this cancer at an early stage. The strategy is to refer women 50 to 69 years old for a mammogram every two years by sending an invitation letter that acts as a prescription. Ninety per cent (90%) of deaths due to breast cancer occur in women aged 50 and over. Numerous studies have shown social inequalities in health for most diseases. With breast cancer, a significant paradox arises: its incidence is lower among disadvantaged women and yet, more of them die from this disease. The health care system might play a role in this inequality. The scientific literature documents the potential for creating such inequalities when prevention does not consider equity among social groups. Immigrant women are often disadvantaged. They die of breast cancer more than non-immigrants. Studies attribute this to late-stage diagnosis due to poor adherence to mammography screening programs.

Purpose of the study

The main objective of our research is to assess how Haitian immigrant women in Montreal are reached by the Quebec Breast Cancer Screening Program, and specifically how they perceive the mammogram referral letter sent by the program.

Methods

The study uses a two-step qualitative method: i) In-depth interviews with influential community workers to identify the most relevant issues; ii) Focus groups with disadvantaged women from Montreal’s Haitian community.

Results

A mammogram referral letter from the Breast Cancer Screening Program may be a barrier to compliance with mammography by underprivileged Haitian women in Montreal. This might be attributable to a low level of literacy, poor knowledge of the disease, and lack of financial resources.

Conclusion

Barriers may be underestimated in underprivileged immigrant and non-immigrant communities. A preventive strategy must be adapted to different sub-groups and must also take into account lower literacy levels. To increase mammography uptake, it is crucial that the benefits of prevention be clearly identified and described in understandable terms. Finally, economic access to follow-up measures should be considered.

Undertaking responsibility and a new role as a relative: a qualitative focus group interview study

BACKGROUND

Being a relative of a patient with oesophageal cancer can evoke strong emotions and uncertainty about the future. As a consequence of the treatment course for oesophageal cancer and an increase in outpatient treatment, relatives are becoming increasingly responsible for patients' physical and emotional care. There is a lack of research exploring relatives' experiences with illness, treatment and decision-making.

AIMS AND OBJECTIVES

To explore relatives' experiences with illness, treatment of the patient and decision-making in the context of oesophageal cancer.

DESIGN

A qualitative explorative design was chosen.

METHODS

We conducted two focus group interviews with 11 relatives. The analysis was based on Ricoeur's theory of interpretation.

RESULTS

Throughout illness and treatment, relatives faced the fear of loss, leading to distress and anxiety. Relatives were simultaneously taking responsibility and asserting a new role during treatment as they regarded treatment as a joint affair. Regarding decision-making, relatives positioned themselves on the sidelines, awaiting the authority of the patients and healthcare professionals to give them space for participation.

CONCLUSION

Relatives of patients with oesophageal cancer undergoing treatment are suppressing their anxiety and doubt about the future. As they are undertaking responsibility during treatment, they are claiming control in new areas, which leads to changing roles within the family. However, they do not feel empowered in decision-making because they recognise patients' decision-making authority. This study highlights the complexity of balancing patients' authority with acknowledgement of relatives' role as active collaborators.

Exploring self-management within hospital-based stroke care: current and future opportunities

PURPOSE

This study explored stroke self-management within a tertiary hospital setting from the perspectives of health professionals working across the continuum of stroke care.

MATERIALS AND METHODS

A qualitative descriptive design guided five focus groups in the acute stroke service (n = 2), inpatient rehabilitation (n = 2), and outpatient day hospital service (n = 1). Focus groups were transcribed verbatim and analysed using thematic analysis.

RESULTS

Twenty-eight health professionals participated representing medical, nursing, and allied health services. Two themes emerged from the data: Pieces of the puzzle illustrates the inconsistent understanding about self-management with elements of the puzzle described but rarely within the full concept of self-management; Readiness for self-management highlighted that although self-management should commence in the acute setting, there were many factors influencing why this was not always happening.

CONCLUSIONS

A consistent conceptualisation and approach to stroke self-management in the hospital setting is required. Interprofessional education and shared intentional language can enhance understanding and practice.IMPLICATIONS FOR REHABILITATIONUnderstanding and application of stroke self-management varies among members of hospital-based stroke teams.Health professionals working in hospital-based stroke care should use the term self-management with their patients.Education of healthcare teams is necessary to develop knowledge about self-management and develop consistent practices across the continuum of care.

Body therapy versus treatment as usual among Danish veterans with PTSD: Study protocol for a randomised controlled trial combined with a qualitative study

BACKGROUND

Many veterans suffer from Post-Traumatic Stress Disorder (PTSD) after returning from military missions. This implies complex physical and psychosocial problems for veterans and their families. Treatment options today are primarily medically and psychologically founded but treatment response is incomplete. Body therapy for PTSD is scarcely researched though subject of increased attention. In 2015, a Danish pilot study was conducted exploring body therapy for PTSD. The study showed positive results and formed basis for a randomised controlled trial. This paper outlines the protocol for this trial.

METHODS

The intervention will be evaluated in a two-arm randomised controlled trial (1:1). The trial will include 42 veterans with PTSD recruited by the Danish Military Psychiatric Centre. The intervention group receives treatment as usual and weekly body therapy treatment as add-on. The control group receives treatment as usual (TAU). Participants will complete four questionnaires assessing PTSD, depression, quality of life, function level and body awareness: at baseline, and at 3 months, 6 months and 12 months post baseline. Linear regression models and mixed effects models will be used to assess intervention effects. Furthermore, an ethnographic study will examine how the participants experience the treatment and changes in their everyday life. The ethnographic study is based on in-depth interviews, participant observations and focus groups. A mixed method, convergent parallel design will be applied.

DISCUSSION

This study examines the efficacy of body therapy for veterans with PTSD and how the treatment is experienced and affects daily life. The study will contribute with important knowledge on an alternative treatment for PTSD.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03777800.

Walking together: women with the severe symptoms of menopause propose a platform for a walking program; outcome from focus groups

Background

Menopause and midlife are stages in a woman’s life that can be marked by debilitating symptoms and increasing risks for cancer, cardiovascular, metabolic, and bone health issues. Walking represents a simple, low cost, and widely accessible activity with proven health benefits, though its therapeutic effect on alleviating menopause symptoms is not well characterized. Women are generally not opposed to exercise programs; however, increasing or maintaining exercise levels remains a challenge. We undertook a qualitative descriptive study to explore features of a walking program that would be conductive to menopausal women’s participation, as well as to inform the development of such a program.

Methods

We conducted focus groups with women recruited from two menopause clinics and who suffered from moderate to severe menopause symptoms. The focus groups were audio recorded and transcribed. Women were prompted to talk about their menopause experience and exercise practice and how they would envision a walking exercise program that would keep them engaged. Qualitative content analysis was used to analyze the data and to identify characteristics of a walking exercise program.

Results

Twenty women participated in 5 focus groups. Women were very interested in trying walking as a means of staying healthy and possibly reducing menopause symptoms. Four major characteristics emerged as important for a walking program: (a) sensitivity to health realities of menopausal women, (b) inclusivity of various needs/levels of physical ability, (c) attentiveness to the need for mutual social support, (d) flexibility in planning of locations and scheduling.

A restricted social network platform with features catering to women in menopause was suggested as suitable to initiate and sustain an adequate walking program.

Conclusions

The findings of this study will be essential in designing a program that would be attractive for women to start and maintain a walking habit. The program would assist in elucidating whether walking is a useful and valuable alternative therapy for menopausal symptoms and, ultimately, might help women staying fit in midlife and postmenopausal.

Being Heard, Exerting Influence, or Knowing How to Play the Game? Expectations of Client Involvement among Social and Health Care Professionals and Clients

Contemporary social and health care services exhibit a significant movement toward increasing client involvement in their own care and in the development of services. This major cultural change represents a marked shift in the client’s role from a passive patient to an active empowered agent. We draw on interaction-oriented focus group research and conversation analysis to study workshop conversations in which social and health care clients and professionals discussed “client involvement”. Our analysis focuses on the participants’ mutually congruent or discrepant views on the topic. The professionals and clients both saw client involvement as an ideal that should be promoted. Although both participant groups considered the clients’ experience of being heard a prerequisite of client involvement, the clients deviated from the professionals in that they also highlighted the need for actual decision-making power. However, when the professionals invoked the clients’ responsibility for their own treatment, the clients were not eager to agree with their view. In addition, in analyzing problems of client involvement during the clients’ and professionals’ meta-talk about client involvement, the paper also shows how the “client involvement” rhetoric itself may, paradoxically, sometimes serve to hinder here-and-now client involvement.

Parental perspectives on early childhood caries: A qualitative study

BACKGROUND

Early childhood caries (ECC) affects about 621 million children worldwide, causing chronic pain, infections, sleeping disorders, and tooth extraction.

AIM

To determine perspectives of parents and caregivers of preschoolers regarding ECC.

DESIGN

Three focus groups were conducted with attendees of the Clinics of Paediatric Dentistry from the Bauru School of Dentistry. The meetings were video- and audio-recorded, and the contents were transcribed verbatim. Then, textual passages were examined and coded using the software NVivo 12 Plus.

RESULTS

The participants associated the presence of dental caries lesions with negative consequences for children, such as problems for permanent dentition, discrimination, and psychological damages. Although regular oral hygiene and healthy diet were recognized as important factors for the prevention of ECC, specific doubts about feeding, toothpaste usage, oral hygiene, and dental eruption were detected among parents. Additionally, they declared that their children brush teeth alone, intake fermentable carbohydrates frequently, and sleep during breastfeeding without dental plaque removal, because uncooperativeness, permissiveness, and convenience.

CONCLUSIONS

Based on these results, parents and caregivers understand the unfavourable effects of ECC on children's quality of life; however, their attitudes against the disease seemed to be inaccurate, influenced by their daily routines, doubts, and beliefs.

A Facilitated Web-Based Self-Management Tool for People With Type 1 Diabetes Using an Insulin Pump: Intervention Development Using the Behavior Change Wheel and Theoretical Domains Framework

BACKGROUND

Type 1 diabetes (T1D) requires intensive self-management (SM). An insulin pump is designed to better support personal T1D management, but at the same time, it exacerbates the complexity and requirements of SM. Research shows that people with diabetes are likely to benefit from navigating and connecting to local means of social support and resources through web-based interventions that offer flexible, innovative, and accessible SM. However, questions remain as to which behavior change mechanisms within such resources benefit patients most and how to foster engagement with and endorsement of SM interventions.

OBJECTIVE

The aim of this study was to evaluate the perspectives and experiences of people with T1D using an insulin pump and specialist health care professionals (HCPs) and determine what behavior change characteristics and strategies are required to inform the optimization of an existing web-based social network (SN) intervention to support SM.

METHODS

Focus groups with insulin pump users (n=19) and specialist HCPs (n=20) in 6 National Health Service (NHS) trusts across the south of England examined the barriers and enablers to incorporating and self-managing an insulin pump. An analysis was undertaken using the Behavior Change Wheel and Theoretical Domains Framework, followed by a taxonomy of behavior change techniques (BCTs) to identify the contents of and strategies for the implementation of a complex health intervention.

RESULTS

A total of 4 themes represent the SM perspectives and experiences of stakeholders: (1) a desire for access to tailored and appropriate resources and information-the support and information required for successful SM are situational and contextual, and these vary according to time and life circumstances, and therefore, these need to be tailored and appropriate; (2) specific social support preferences-taking away isolation as well as providing shared learnings and practical tips, but limitations included the fear of judgment from others and self-pity from peers; (3) the environmental context, that is, capacity and knowledge of pump clinic HCPs-HCPs acknowledge the patient's need for holistic support but lack confidence in providing it; and (4) professional responsibility and associated risks and dangers, whereas HCPs are fearful of the consequences of promoting non-NHSSM support, and they question whether SM support fits into their role. BCTs were identified to address these issues.

CONCLUSIONS

The use of behavioral theory and a validated implementation framework provided a comprehensive approach for systematically identifying barriers and enablers of self-managing T1D with an insulin pump. A web-based SN intervention appears to offer additional forms of SM support while complementing NHS services. However, for intervention implementation, HCPs' apprehensions about responsibility when signposting to non-NHS SM support would need to be addressed, and opportunistic features would need to be added, through which pump users could actively engage with other people living with T1D.

How do doctors perceive and use patient quality of life? Findings from focus group interviews with hospital doctors and general practitioners

PURPOSE

While studies on patients' quality of life (QoL) are numerous, to date few have addressed the issue of what QoL means for doctors and how they use patient-reported QoL. This study aimed to explore how doctors define the concept of "patient QoL" and how they use QoL assessments in clinical practice.

METHODS

Focus group (FG) interviews were conducted with French hospital doctors and general practitioners. Transcripts of the FGs were explored using inductive thematic and lexical analyses.

RESULTS

Twenty-one clinicians participated in four FGs. They all agreed that QoL was a subjective and unstable concept, different from that of health status. In practice, the assessment of patient QoL was conducted using an intuitive and non-structured approach. Most participants thought that it would give them more confidence in making decisions and provide better patient care. But it was also seen in some cases as putting them in an uncomfortable position. The assessment of QoL requires a favourable work and organizational setting.

CONCLUSIONS

Patient QoL provides useful data for clinicians. Yet assessments are made without standardized tools. The use of such tools could be very valuable for some practitioners or in some situations, and a real source of problems for others. These problems could, however, be easily overcome with experience-sharing and training clinicians.

Clinical genomic testing: what matters to key stakeholders?

Beyond a narrow focus on cost and outcomes, robust evidence of what is valued in genomic medicine is scarce. We gathered views on value from key stakeholders (clinical genomic staff, operational genomic staff and community representatives) in relation to three testing contexts (General Healthcare, Acute Care and Neurodevelopmental Conditions). We conducted an iterative focus group in three stages over a week using a multiphase mixed methods study, i.e. quantitative ratings and qualitative discussion. For each testing context, the characteristics of genomic testing were generated and ranked by the group using a co-productive approach. Up to 17 characteristics were identified in one scenario with several characteristics featuring in all three testing contexts. The likelihood of getting an answer was consistently reported as most highly valued, followed by the potential for the test to impact on clinical management (or wellbeing/health for Neurodevelopmental Conditions). Risk of discrimination did not feature highly across the different settings (and not at all in Acute Care). While cost was an issue in the general health setting, it was one of the least-valued characteristics in the other two testing contexts. In conclusion, co-producing an understanding of what is valued in different testing contexts, and identifying the areas of differences or commonalities, is important to maximise value provision and inform future policy to ensure that clinical genomic services meet the needs of the community and service providers.

"They're always in a hurry" - Older people´s perceptions of access and recognition in health and social care services

The article examines older people's perceptions of quality of life from the perspective of access and use of health and social care services. The data include focus group discussions with older people living alone. The data were analysed using thematic analysis focusing on the older people's collective views on health and social care services as supportive or restrictive factors for their quality of life. Two central themes were present in all the focus group discussions: the importance of accessing services and information regarding the services, and need for recognition within the services/by the professionals. Both themes were connected to the older people's desire to maintain autonomy in their everyday life despite increasing functional disabilities, which was seen as an important factor of quality of life. The older people felt that accessing and finding information about the services was difficult, and dependent on the professional's good will and the older person's own financial resources. Within the services, older people experienced a lack of recognition of their own personhood and individual needs. The participants felt that they were easily bypassed and left out of negotiations regarding their own care. The article highlights the importance of developing health and social care services and practices towards a more holistic approach recognising older people's individual needs.

Using a Human-Centered Design Approach to Determine Consumer Preferences for Long-Lasting Insecticidal Nets in Ghana

BACKGROUND

A human-centered design approach, paired with traditional research methods, was used to explore consumer preferences of middle-class Ghanaians for a long-lasting insecticidal net (LLIN) to be designed for the private-sector retail market.

METHODS

In March 2017, we conducted 9 focus groups with urban and rural middle-class Ghanaians across Ashanti, Greater Accra, and Western regions. A total of 78 participants (51 adults and 27 boarding school students) were involved in the focus groups. Participants were asked for their input on topics related to malaria prevention, LLIN perceptions and use behavior, as well as general consumer preferences related to the home and bedroom. They participated in a variety of exercises, such as rank ordering their preferences of various accessories that might be bundled with an LLIN and interacting with actual LLINs of different sizes and designs. The data were gathered and analyzed, using micro-interlocutor analysis framework to capture emergent themes.

RESULTS

LLINs are currently available through free distribution channels, but in most accounts, participants reported that the nets were inconvenient, uncomfortable, and not aesthetically pleasing, thus they were undesirable to use. For example, several participants described the process of hanging as well as entering and exiting the LLIN as challenging, stressful, and/or tedious. In addition, use of LLINs was considered to make people feel even hotter in an already warm climate as well as to leave users feeling confined within a small space. Finally, many participants discussed how to improve the look of LLINs including suggestions for additional colors, shapes, and hanging mechanisms to make the LLINs more compatible with their desired bedroom and home décor. Based on the participants' responses, we concluded that they would prefer LLINs that better reflect contemporary sensibilities. We devised and tested different LLIN attributes to address these points, focusing on a more convenient way to hang the net, a more attractive silhouette, and a zipper that allows the user to enter and exit with ease while still maintaining a sealed, mosquito-free space. A separate discrete choice experiment confirmed the attractiveness of these attributes by capturing the target population's willingness to pay for LLINs with said preference-congruent attributes.

CONCLUSION

Our human-centered design approach yielded consumer insights and preferences for novel LLIN designs for the private-sector retail market in Ghana. If this net design is successful, it could increase LLIN use among the middle class and catalyze the purchase of LLINs to support ongoing malaria control efforts.

Adolescent’s use of the Nutrition Information Panel for Food Choice: A Content Validation of Focus Group Discussions

Qualitative research methods are receiving increasing recognition in healthcare-related studies. Nonetheless, the debate among scholars continues regarding validity in qualitative research; that is, whether the tools, processes, and data used are appropriate. Therefore, this study aims to describe the development and content validation of a focus group discussion (FGD) interview guide, which was utilized to explore practices and factors that influence adolescents’ usage of the Nutrition Information Panel (NIP) for food choices. A methodological study was carried out to assess the content validity of the FGD interview guide through a two-stage process (i.e., development and validation). The FGD interview guide for this study was developed by the researchers following five essential steps: identification of research objectives, selection of topics and questions, development of the guide, expert evaluations, and a pilot test. The developed FGD guide was assessed by five content experts representing a range of disciplines, including nutritionists, academicians, a qualitative researcher, and a teacher. A pilot FGD was conducted using a setting and participant criteria similar to those that will be employed in the main study. The content validity index (CVI) value for the developed FGD guide is 0.938. Seven out of 13 questions were modified based on the experts’ recommendations, such as reviewing an item, splitting it into two if necessary, retaining its original syntax if it was already suitable, or adding some new items. Subsequently, the researchers refined the questions’ wording and structure based on the analysis from the pilot FGD. Probes were also added to several questions to elicit in-depth responses from the participants. The final version of the FGD guide consisted of 13 main items and probes. The content validity of the FGD interview guide used in the pilot study was affirmed by a panel of experts; hence, it was deemed to be a valid instrument for measuring adolescents’ use of the NIP in future studies. Further investigation is needed to improve assessments of procedural knowledge and to test the interview guide in other populations.

Factors influencing surgical treatment decisions for breast cancer: a qualitative exploration of surgeon and patient perspectives

Background

The rate of mastectomy is much higher in Newfoundland and Labrador than in any other province in Canada, even for women diagnosed at an early stage. In this paper, we present qualitative data from women who have made a decision for surgical treatment and from breast surgeons in an effort to better explicate factors influencing breast cancer (bca) surgical decision-making.

Methods

The study's descriptive, qualitative design involved holding interviews with breast surgeons and holding focus groups and interviews with women who were offered the choice of breast-conserving surgery (bcs) or mastectomy (mt).

Results

Participants included 35 women and 13 surgeons. High interest in mt and increasing requests for prophylactic contralateral mt were evident. A host of factors-clinical, demographic, psychosocial, education-related, and cultural-influenced the decisions. A key factor for women was fear of recurrence and a need to "just get rid of it," but the experiences of others also influenced the decisions. Life stage and family considerations also factored prominently into women's decisions.

Conclusions

Women with early-stage bca more often chose mt and often demanded prophylactic removal of the healthy breast. Findings highlight the importance of ensuring that women at average risk are appropriately counselled about the low likelihood of a subsequent contralateral bca and the lack of survival benefit associated with prophylactic contralateral mt. Findings also revealed other areas of presurgical discussion that might help women think through their personal circumstances and values so as to encourage informed surgical decisions.

Focus Group in Community Mental Health Research: Need for Adaption

The article presents an analysis of the use of focus groups in researching community mental health users, starting with the reasons for using them, their implementation in mental health service users' research, and the adaptations of focus group use when researching the experiences of users. Based on personal research experience and a review of scientific publications in the Google Scholar, Web of Science, ProQuest, EBSCOhost, and Scopus databases, 20 articles published between 2010 and 2016 were selected for targeted content analysis. A checklist for reporting on the use of focus groups with community mental health service users, aiming to improve the comparability, verifiability and validity was developed. Adaptations of the implementation of focus groups in relation to participants' characteristics were suggested. Focus groups are not only useful as a scientific research technique, but also for ensuring service users' participation in decision-making in community mental health and evaluating the quality of the mental health system and services .