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Ingram C, Buggy C, MacNamara I, Perrotta C. "Just a knife wound this week, nothing too painful": An ethnographic exploration of how primary care patients experiencing homelessness view their own health and healthcare. PLoS One 2024; 19:e0299761. [PMID: 38980832 PMCID: PMC11232971 DOI: 10.1371/journal.pone.0299761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/24/2024] [Indexed: 07/11/2024] Open
Abstract
Community health needs assessments (CHNA) involving qualitative techniques help tailor health services to the specific needs of the population groups for whom they are designed. In light of increasing health disparities amongst people experiencing homelessness (PEH)-and to ensure the integration of their voices into a larger CHNA-this study used an ethnographic approach grounded in a social constructivist research paradigm to explore the perspectives of PEH attending a primary care and addiction service in Ireland on their priority health and healthcare needs. Participant observations and informal interviews were conducted with clients experiencing homelessness attending the service for three hours every Monday morning between October 2022 and April 2023. Field note data from active participant observation and informal conversations were collected, anonymised, and analysed using inductive thematic analysis in accordance with the Declaration of Helsinki and the researchers' institutional Research Ethics Committee. Three main themes emerged from the analysis: self-identified priorities, satisfaction with health services, and migrant health. Clients' priority concerns relate to their mental health and personal safety, strengthening ties with children and families, finding a sense of purpose, and feeling better physically. These challenges differ from those of the general population in terms of their severity observed both prior to and during experiences of homelessness, coupled with disproportionately high levels of loss, fear, pain, fatigue, social stigma and other barriers to accessing satisfactory housing. In terms of services, clients are satisfied with their ability to access primary care and harm reduction in a social environment where positive exchanges with friends and providers take place. Conversely, barriers to accessing mental health and addiction services persist including the internalised belief that one is beyond help, lack of access to information on available services and their entry requirements, and lingering stigma within a health system that treats addiction as separate to health. Moving forward, health practitioners may consider holding more regular and open conversations with clients experiencing homelessness about the care they are receiving, its rationale, and whether or not changes are desired that can be safely made. The health needs of migrants and asylum seekers entering homelessness in Ireland are urgent and should be prioritised in future research.
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Affiliation(s)
- Carolyn Ingram
- Public Health, School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland
| | - Conor Buggy
- Public Health, School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland
| | - Isobel MacNamara
- Public Health, School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Carla Perrotta
- Public Health, School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland
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Purchase SE, Wademan DT, Tshetu NL, Rafique M, Hoddinott G, Seddon JA, Schaaf HS, Hesseling AC. Holistic acceptability of an adult levofloxacin formulation in children and adolescents on a tuberculosis preventive treatment trial. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003381. [PMID: 38968182 PMCID: PMC11226063 DOI: 10.1371/journal.pgph.0003381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 05/29/2024] [Indexed: 07/07/2024]
Abstract
Drug-resistant tuberculosis (TB) is threatening global TB control. Although formulations designed for children are a priority, adult levofloxacin formulations are widely used in TB treatment and prevention. TB-CHAMP was a cluster-randomised, placebo-controlled trial evaluating the efficacy and safety of 24 weeks of daily levofloxacin to prevent TB in child and adolescent household contacts of adults with infectious multidrug-resistant TB. Nested in-depth longitudinal qualitative work was conducted in a subset of children and their caregivers to understand broader experiences of treatment acceptability. We conducted 41 interviews with 8 caregivers of children <6 years, and with 6 older children responding for themselves. Children who could not swallow the adult formulation whole, found the tablet unpalatable, although they learnt to tolerate the taste over time. Most caregivers and children came from families with substantial experience of TB, but felt they knew little about TB preventive therapy. Many families experienced challenging socio-economic circumstances. Poor acceptability was mitigated by sympathetic study personnel, assistance with transport and financial compensation. The adult formulation of levofloxacin was disliked by many younger children but was acceptable to children able to swallow the tablet whole. In addition to using acceptable drug formulations, TB preventive treatment implementation models should include patient education and should accommodate patients' socioeconomic challenges.
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Affiliation(s)
- Susan E. Purchase
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Dillon T. Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Nosibusiso L. Tshetu
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Mohhadiah Rafique
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - James A. Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - H. Simon Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Anneke C. Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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Huang S, Spicer JG. Developing an Evidence-Based Patient Education Guide on Pain Management for Asian Patients on Hospice. Home Healthc Now 2024; 42:236-245. [PMID: 38975821 PMCID: PMC11224560 DOI: 10.1097/nhh.0000000000001275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
Asian Americans are the fastest-growing racial group in the United States. This article describes the development of a pain management assessment guide for Asian patients on hospice, their families, and their nurses. Thematic analysis was used to evaluate the applicability of research on pain, pain management, and barriers to pain management from primarily Asian countries to Asian patients on hospice in the United States. Thematic analysis of interviews with such patients concurs with research findings. Four themes emerged: enduring pain, preference for Chinese medicine remedies, fear of addiction, and concern about the side effects of pain medications. Interviews with experienced hospice nurses also aligned with these themes. Hospice nurses were asked to share their strategies for assessing and managing pain among their Asian hospice patients. Thematic analysis of their interviews revealed six strategies: focusing on treatment goals, involving family and caregivers, explaining the physiology of pain, explaining the progression of pain medications, addressing concerns about addiction, and managing the side effects of medications. The themes that emerged from patient and hospice nurse interviews were used to develop an evidence-based pain management assessment guide to support Asian patients on hospice, their family, and the nurses who care for them.
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Blackwell J, Ray M. Exploring the Lived Experiences of Physical Activity in Community-Dwelling Adults Living With Dementia and Their Carers. J Aging Phys Act 2024:1-8. [PMID: 38849122 DOI: 10.1123/japa.2023-0195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 06/09/2024]
Abstract
People living with dementia have the same right to well-being as anyone else, including physical activity. Yet, physical activity levels among people with dementia are lower than in the general population, and while the physical activity health benefits are well established, little is known about how people living with dementia experience physical activity. To explore these physical activity experiences, we visited six community settings in one English county and conducted informal interviews with 18 people who were either living with dementia and community dwelling (n = 4), caring for or who had cared for someone with dementia (n = 10), or providing a support service for people living with dementia and their carers (n = 4). Findings highlight both the challenges and facilitators presented by organized groups, service provider skills and qualities, and environmental factors. Additionally, these factors were influential in shaping the physical activity experience of people living with dementia. The findings may be relevant for people providing or planning support services, commissioners, policymakers, and researchers.
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Affiliation(s)
- Joanna Blackwell
- School of Health and Social Care, College of Health and Science, University of Lincoln, Lincoln, United Kingdom
| | - Mo Ray
- School of Health and Social Care, College of Health and Science, University of Lincoln, Lincoln, United Kingdom
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Pocock H, Rees N, Gunson I, Docherty M, Charlton K, Jackson M, Scomparin C, England E, Fothergill R. Facilitators and barriers to the delivery of the PARAMEDIC2 trial. Resusc Plus 2024; 18:100617. [PMID: 38894855 PMCID: PMC11184479 DOI: 10.1016/j.resplu.2024.100617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
Background PARAMEDIC2 was a medicines trial comparing adrenaline with placebo in out-of-hospital cardiac arrest (OHCA). At the time, United Kingdom (UK) Emergency Medical Systems (EMS) were inexperienced in delivering such research. Aim To identify barriers and facilitators to delivery of the PARAMEDIC2 (Adrenaline) trial by five UK NHS EMS. Methods This qualitative study took a grounded theory approach to thematic analysis of workshop data. Members of the trial teams from each service attended a workshop in November 2018 and discussed their experiences in answer to two prompt questions. Data were coded and themes presented. Results Three main themes were identified: professionalism, organisational investment and unique features of EMS. The study provided an opportunity for recruiting paramedics and research paramedics to demonstrate their professionalism. Research paramedics felt it was part of their professional duty to initiate discussions with the patient/family regarding the trial rather than leave this task to the hospital teams as would usually happen. Organisational investment was reflected by prioritising trial training and further development of research paramedics. By these means, research culture was developed. The unique features of EMS such as geographical challenges were often addressed with technological solutions and through building relationships with internal teams. Conclusion Barriers to trial delivery included infrequent exposure to the condition of interest and lack of continuity in research paramedic roles. Facilitators identified included flexibility of the research protocol, and organisational investment in the development of research paramedics.Participating in PARAMEDIC2 was challenging for the EMS involved, but ultimately strengthened their research culture.
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Affiliation(s)
- Helen Pocock
- South Central Ambulance Service NHS Foundation Trust, UK
- Warwick Clinical Trials Unit, University of Warwick, UK
| | | | - Imogen Gunson
- West Midlands Ambulance Service University NHS Foundation Trust, UK
| | - Mark Docherty
- West Midlands Ambulance Service University NHS Foundation Trust, UK
| | - Karl Charlton
- North East Ambulance Service NHS Foundation Trust, UK
| | | | | | - Ed England
- South Central Ambulance Service NHS Foundation Trust, UK
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Heinemann L, Aust F, Peifer C, Holtz M, Miller C, Hagemann V. Development and validation of a questionnaire, the REST-Q Fire, to identify teamwork-related resources and stressors in firefighting operations. PLoS One 2024; 19:e0304326. [PMID: 38809919 PMCID: PMC11135748 DOI: 10.1371/journal.pone.0304326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/08/2024] [Indexed: 05/31/2024] Open
Abstract
In the complex work environments of firefighting teams, it is often human error or difficulties in teamwork that lead to dangerous situations. To prevent these, it is essential to know the teamwork-related stressors and resources in firefighting operations. A measurement tool is needed to evaluate these stressors and resources. A successive instrument development process was conducted to identify the relevant teamwork-related stressors and resources in firefighting operations. First, interviews with experienced firefighters, and second, a document analysis were conducted and evaluated to provide an overview of the teamwork-related stressors and resources. Thereupon, a questionnaire, the REST-Q Fire, was developed asking about the experienced frequency and intensity of the identified teamwork-related stressors and resources in firefighting operations. Afterwards, an online study with firefighters was conducted (N = 491). CFAs confirmed the assumed structure of the REST-Q Fire and a positive correlation of the intensity of stressors with stress was shown (r = .19 - .27). Further, the resources were overall more frequently and intensively perceived than the stressors. The most important stressors were 'behavior of leaders' (M (SD)frequency = 2.80 (0.83), M (SD)intensity = 3.59 (1.12)), and 'behavior of team members' (M (SD)frequency = 2.77 (0.75), M (SD)intensity = 3.59 (1.05)). The most important resources, on the other hand, were 'knowledge about skills and behavior of team members' (M (SD)frequency = 3.96 (0.63), M (SD)intensity = 4.24 (0.78)), 'watch out for/ check on each other' (M (SD)frequency = 3.96 (0.70), M (SD)intensity = 4.20 (0.80)), and 'reliability of team members' (M (SD)frequency = 3.96 (0.51), M (SD)intensity = 4.16 (0.73)). As a result, training needs for trainees in the fire service and experienced firefighters were derived.
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Affiliation(s)
- Lena Heinemann
- Business Psychology and Human Resources, University of Bremen, Bremen, Germany
| | - Fabienne Aust
- Department of Psychology, University of Lübeck, Lübeck, Germany
| | - Corinna Peifer
- Department of Psychology, University of Lübeck, Lübeck, Germany
| | - Maik Holtz
- Cologne Fire Department, Institute for Security Science and Rescue Technology (ISR), Cologne, Germany
| | - Christian Miller
- Cologne Fire Department, Institute for Security Science and Rescue Technology (ISR), Cologne, Germany
| | - Vera Hagemann
- Business Psychology and Human Resources, University of Bremen, Bremen, Germany
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Wiener RC, Waters C, Bhandari R. A theory of oral healthcare decision-making in Appalachia. PLoS One 2024; 19:e0303831. [PMID: 38768179 PMCID: PMC11104657 DOI: 10.1371/journal.pone.0303831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 05/02/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION People make oral healthcare decisions regardless of having partial information, misinformation, sources that deliberately mislead, or information that is culturally influenced. This is particularly true in the Appalachian culture where oral healthcare decision-making practices are not well understood by researchers and dental professionals. Despite efforts to improve dental care utilization, the Appalachia region remains low in oral healthcare utilization. There is a need for a theory to identify concepts in decision-making when seeking oral healthcare. The theory could be useful in creating oral health interventions. The study objective is to develop a theory to identify concepts that influence oral healthcare decision-making in Appalachia (OHDA). METHODS The researchers used a grounded theory qualitative study design to explain data for a theory of OHDA. Participants from Appalachia, in 20-minute interviews, provided insights into concepts that influence OHDA from August 22, 2017 to May 26, 2022. Notes/memos were written during and after the interviews and coding was conducted after the interviews. Open coding categories emerged through constant comparison of responses. RESULTS Five overarching concepts that embody OHDA were discovered: Affect (Level of Pain/Emotion/Stress involvement), Awareness, Trust/belief, Resources, and Risk Perception. All participants discussed the impact of social media toward these concepts. CONCLUSION To influence a person's OHDA, public health officials and researchers need to address the person's affect, level of awareness, trust/belief, available resources, and risk perception. Social media is very important in awareness concerning oral health information. These factors are important to consider for similar research in oral healthcare utilization at the population level.
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Affiliation(s)
- R. Constance Wiener
- Department of Dental Public Health and Professional Practice, West Virginia University, Morgantown, West Virginia, United States of America
| | - Christopher Waters
- Department of Dental Research, West Virginia University, Morgantown, West Virginia, United States of America
| | - Ruchi Bhandari
- Department of Epidemiology and Biostatistics, West Virginia University, Morgantown, West Virginia, United States of America
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Tizifa TA, Kabaghe AN, McCann RS, Gowelo S, Malenga T, Nkhata RM, Chapeta Y, Nkhono W, Kadama A, Takken W, Phiri KS, van Vugt M, van den Berg H, Manda-Taylor L. Assessing the implementation fidelity, feasibility, and sustainability of community-based house improvement for malaria control in southern Malawi: a mixed-methods study. BMC Public Health 2024; 24:951. [PMID: 38566043 PMCID: PMC10988826 DOI: 10.1186/s12889-024-18401-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Despite significant success in the fight against malaria over the past two decades, malaria control programmes rely on only two insecticidal methods: indoor residual spraying and insecticidal-treated nets. House improvement (HI) can complement these interventions by reducing human-mosquito contact, thereby reinforcing the gains in disease reduction. This study assessed the implementation fidelity, which is the assessment of how closely an intervention aligns with its intended design, feasibility, and sustainability of community-led HI in southern Malawi. METHODS The study, conducted in 22 villages (2730 households), employed a mixed-methods approach. Implementation fidelity was assessed using a modified framework, with longitudinal surveys collecting data on HI coverage indicators. Quantitative analysis, employing descriptive statistics, evaluated the adherence to HI implementation. Qualitative data came from in-depth interviews, key informant interviews, and focus groups involving project beneficiaries and implementers. Qualitative data were analysed using content analysis guided by the implementation fidelity model to explore facilitators, challenges, and factors affecting intervention feasibility. RESULTS The results show that HI was implemented as planned. There was good adherence to the intended community-led HI design; however, the adherence could have been higher but gradually declined over time. In terms of intervention implementation, 74% of houses had attempted to have eaves closed in 2016-17 and 2017-18, compared to 70% in 2018-19. In 2016-17, 42% of houses had all four sides of the eaves closed, compared to 33% in 2018-19. Approximately 72% of houses were screened with gauze wire in 2016-17, compared to 57% in 2018-19. High costs, supply shortages, labour demands, volunteers' poor living conditions and adverse weather were reported to hinder the ideal HI implementation. Overall, the community described community-led HI as feasible and could be sustained by addressing these socioeconomic and contextual challenges. CONCLUSION Our study found that although HI was initially implemented as planned, its fidelity declined over time. Using trained volunteers facilitated the fidelity and feasibility of implementing the intervention. A combination of rigorous community education, consistent training, information, education and communication, and intervention modifications may be necessary to address the challenges and enhance the intervention's fidelity, feasibility, and sustainability.
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Affiliation(s)
- Tinashe A Tizifa
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, University of Amsterdam, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, The Netherlands.
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
| | - Alinune N Kabaghe
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Robert S McCann
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
- Centre for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, USA
| | - Steven Gowelo
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
| | - Tumaini Malenga
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- National TB and Leprosy Elimination Programme, Ministry of Health, Lilongwe, Malawi
| | - Richard M Nkhata
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Yankho Chapeta
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Biological Sciences Department, Mzuzu University, Mzuzu, Malawi
| | - William Nkhono
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Asante Kadama
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Willem Takken
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
| | - Kamija S Phiri
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Michele van Vugt
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, University of Amsterdam, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Henk van den Berg
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
| | - Lucinda Manda-Taylor
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
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Anthony MG, Hoddinott G, Van Niekerk M, Dewandel I, McKenzie C, Bekker C, Rabie H, Redfern A, van der Zalm MM. The socioeconomic impact of the COVID-19 lockdown on families affected by childhood respiratory illnesses in Cape Town, South Africa. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003020. [PMID: 38547177 PMCID: PMC10977803 DOI: 10.1371/journal.pgph.0003020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 02/22/2024] [Indexed: 04/12/2024]
Abstract
The COVID-19 pandemic impacted families globally, directly and indirectly. Children presenting with respiratory illnesses are affected by emerging health systems and socioeconomic changes in the COVID-19 era. We explored the socioeconomic impacts of the COVID-19 lockdown on families with a respiratory illness diagnosed in their child in Cape Town, South Africa. This study was nested in a prospective observational cohort of children presenting with respiratory symptoms presumptive of COVID-19. We conducted 21 semi-structured interviews to explore the socioeconomic impact of the COVID-19 pandemic on families with a child affected by respiratory illnesses. We used case descriptive analysis and thematically organised common and divergent experiences. We found that socioeconomic challenges in low-income communities were exacerbated: 1) loss of pre-COVID sources of income (loss of income, employment and working hours), 2) shrinking employment opportunities due to business closures and strict preventative measures, 3) family network dependence to cope with financial pressures, 4) impact on education, implicating additional pressures due to lack of resources for adequate home schooling and 5) caregivers' mental health and wellbeing being impacted, causing stress and anxiety due to loss of income. This study shows that the COVID-19 lockdown impacted the socioeconomic aspects of families caring for a child with a respiratory illness. Care became more complicated and adversely impacted the family's emotional well-being and health-seeking behaviour. These impacts should be more carefully considered in order to strengthen health services and global health messaging in future pandemics.
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Affiliation(s)
- Michaile G. Anthony
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Margaret Van Niekerk
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Isabelle Dewandel
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Carla McKenzie
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Carien Bekker
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Helena Rabie
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Andrew Redfern
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Marieke M. van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Best S, Thursky K, Buzza M, Klaic M, Peters S, Guccione L, Trainer A, Francis J. Aligning organisational priorities and implementation science for cancer research. BMC Health Serv Res 2024; 24:338. [PMID: 38486219 PMCID: PMC10938739 DOI: 10.1186/s12913-024-10801-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 02/28/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND The challenge of implementing evidence into routine clinical practice is well recognised and implementation science offers theories, models and frameworks to promote investigation into delivery of evidence-based care. Embedding implementation researchers into health systems is a novel approach to ensuring research is situated in day-to-day practice dilemmas. To optimise the value of embedded implementation researchers and resources, the aim of this study was to investigate stakeholders' views on opportunities for implementation science research in a cancer setting that holds potential to impact on care. The research objectives were to: 1) Establish stakeholder and theory informed organisation-level implementation science priorities and 2) Identify and prioritise a test case pilot implementation research project. METHODS We undertook a qualitative study using semi-structured interviews. Participants held either a formal leadership role, were research active or a consumer advocate and affiliated with either a specialist cancer hospital or a cancer alliance of ten hospitals. Interview data were summarised and shared with participants prior to undertaking both thematic analysis, to identify priority areas for implementation research, and content analysis, to identify potential pilot implementation research projects. The selected pilot Implementation research project was prioritised using a synthesis of an organisational and implementation prioritisation framework - the organisational priority setting framework and APEASE framework. RESULTS Thirty-one people participated between August 2022 and February 2023. Four themes were identified: 1) Integration of services to address organisational priorities e.g., tackling fragmented services; 2) Application of digital health interventions e.g., identifying the potential benefits of digital health interventions; 3) Identification of potential for implementation research, including deimplementation i.e., discontinuing ineffective or low value care and; 4) Focusing on direct patient engagement e.g., wider consumer awareness of the challenges in delivering cancer care. Six potential pilot implementation research projects were identified and the EMBED project, to support clinicians to refer appropriate patients with cancer for genetic testing, was selected using the synthesised prioritisation framework. CONCLUSIONS Using a theory informed and structured approach the alignment between strategic organisational priorities and implementation research priorities can be identified. As a result, the implementation research focus can be placed on activities with the highest potential impact.
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Affiliation(s)
- Stephanie Best
- University of Melbourne; Peter MacCallum Cancer Centre; Australian Genomics, Melbourne, Australia.
| | - Karin Thursky
- Peter MacCallum Cancer Centre; Royal Melbourne Hospital; University of Melbourne, Melbourne, Australia
| | | | | | | | - Lisa Guccione
- Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Australia
| | - Alison Trainer
- Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Australia
| | - Jillian Francis
- University of Melbourne; Peter MacCallum Cancer Centre, Melbourne, Australia
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Chwyl C, Metzler AL, Nguyen JT, France M, Karbassi N, Turner-McGrievy G, Wright N, Forman EM. "Mindset Matters": Perseverance, a balanced approach and structured support as facilitators of whole foods plant-based adoption. Appetite 2024; 194:107163. [PMID: 38141878 DOI: 10.1016/j.appet.2023.107163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 12/25/2023]
Abstract
Whole foods plant-based diets (WFPBD) show potential for preventing and addressing chronic diseases. However, concerns exist about their acceptability and feasibility. Research on firsthand WFPBD adoption experiences is limited but crucial for promoting dietary change. In a 12-week remotely delivered lifestyle modification program using an ad libitum WFPBD, twenty weight-loss seeking adults (ages 18-75) with overweight or obesity completed self-report surveys and semi-structured interviews via Zoom. The study aimed to explore: (1) experiences with WFPBD adoption; (2) factors that helped or hindered adherence; and (3) perceived salient benefits. Interviews were analyzed inductively through a conventional content analysis, and associations between variables examined with correlational analyses. Participants overall reported WFPBD adoption being a positive, new experience, with an equal number (30%) finding it easy/easier than expected as challenging. Key cited challenges included overwhelm, different eating habits in the household, and meal preparation. Key cited facilitators included adopting an incremental approach to dietary change, persisting after setbacks, and having simple go-to meals. Greater self-compassion and family support, and less sabotage from friends and family corresponded to greater dietary change (rs > 0.45, ps < .05). Participants valued accountability, structure, human support, nutrition psychoeducation and recipes in the program. Three categories emerged regarding perceived benefits of following the WFPBD: physical health benefits, improvements to eating habits, and greater perceived control/agency over health. Results indicate that future interventions should include psychological strategies alongside nutrition education to enhance self-efficacy, address household barriers, and combat feelings of overwhelm through sufficient structure, support, and meal preparation guidance. Messaging around WFPBD may benefit from discussing prevailing positive experiences with adoption, common benefits experienced, and options for an incremental approach given that feasibility and acceptability concerns may deter efforts.
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Affiliation(s)
- Christina Chwyl
- Department of Psychological and Brain Sciences, Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, PA, USA.
| | - Abigail L Metzler
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
| | - Jade T Nguyen
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA.
| | - Madelyn France
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Nikoo Karbassi
- Department of Psychological and Brain Sciences, Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, PA, USA.
| | | | - Nicholas Wright
- Royal New Zealand College of General Practitioners, Gisborne, New Zealand.
| | - Evan M Forman
- Department of Psychological and Brain Sciences, Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, PA, USA.
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Zhu J(J, Ma Y, Xia G, Salle SM, Huang H, Sannusi SN. Self-perception evolution among university student TikTok users: evidence from China. Front Psychol 2024; 14:1217014. [PMID: 38440371 PMCID: PMC10911091 DOI: 10.3389/fpsyg.2023.1217014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/05/2023] [Indexed: 03/06/2024] Open
Abstract
The effects of short movies on social media platforms are gaining worldwide popularity and are now attracting global academic attention. Employing self-perception theory and qualitative research methodology, the study examines the influence of short video applications (TikTok) on app-user engagement and evaluates the self-perceived cognitive psychological understanding of Chinese university students. The findings show that identity, attitude change, emotional perception, and civic engagement are the most influential aspects of Chinese youths' self-perceptions. Furthermore, the positive and negative correlated components influence the distribution of short video values. Such tactical use of personality construction contributes to the present psychological research of Chinese university students.
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Affiliation(s)
- Jinsheng (Jason) Zhu
- Faculty of Social Science and Humanities, Centre for Research in Media and Communication, Universiti Kebangsaan Malaysia, Selangor, Malaysia
- Belt and Road International School, Guilin Tourism University, Guilin, China
| | - Yan Ma
- Faculty of Social Science and Humanities, Centre for Research in Media and Communication, Universiti Kebangsaan Malaysia, Selangor, Malaysia
- School of Journalism and Communication, Guangxi University of Finance and Economics, Nanning, China
| | - Guoen Xia
- School of Journalism and Communication, Guangxi University of Finance and Economics, Nanning, China
- School of Business Administration, Guangxi University of Finance and Economics, Nanning, China
| | - Sabariah Mohamed Salle
- Faculty of Social Science and Humanities, Centre for Research in Media and Communication, Universiti Kebangsaan Malaysia, Selangor, Malaysia
| | - Hongye Huang
- School of Journalism and Communication, Nanning Normal University, Nanning, China
| | - Shahrul Nazmi Sannusi
- Faculty of Social Science and Humanities, Centre for Research in Media and Communication, Universiti Kebangsaan Malaysia, Selangor, Malaysia
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13
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Trasancos C, Horey D. Experiences with neonatal jaundice management in hospitals and the community: interviews with Australian health professionals. BMJ Open 2024; 14:e075896. [PMID: 38355169 PMCID: PMC10868246 DOI: 10.1136/bmjopen-2023-075896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 01/09/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Worldwide, neonatal jaundice accounts for considerable morbidity and mortality. Although severe adverse outcomes, such as hyperbilirubinaemia and kernicterus, are uncommon in high-income countries, these outcomes do occur, have enormous lifelong personal, health and social costs, and may be preventable. Evidence-based practice commonly relies on clinical guidelines; however, their implementation can be difficult. Implementation of neonatal jaundice care has been adversely affected by issues with professional boundaries, competing professional priorities and poor understanding of neonatal jaundice. This paper focuses on the perceptions and experiences of Australian health professionals involved in the management of neonatal jaundice. METHODS Using a qualitative descriptive approach, semistructured interviews were undertaken to gain understanding of the experiences of health professionals in Australia across the scope of care for jaundiced newborns through an interpretivist approach and to identify possible gaps in the delivery of evidence-based care. Health professionals from a range of disciplines and care settings were recruited by purposive maximum variation sampling. Interviews were conducted face-to-face or by telephone with detailed notes taken and a field journal maintained. Interview scripts were verified by participants and imported into NVivo software. Data were analysed for major themes according to type and contexts of practice. RESULTS Forty-one health professionals from six broad discipline areas were interviewed. Two major themes and explanatory subthemes were found. The first theme, falling through the gaps, highlighted gaps in evidence-based care, as described by four explanatory subthemes: professional boundaries, blindness to possibility of adverse outcomes, competing professional development priorities and unintended consequences.The second major theme, we know what should happen-but how?, described participant perceptions that it was known what was required to improve care but how to achieve such changes was unclear. The two subthemes are: improvements in education and training, and standardised policies and protocols. CONCLUSIONS Multiple barriers to the provision of evidence-based care related to neonatal jaundice management are experienced by health professionals in Australia. Clinical guidelines are not sufficient to support health professionals deliver evidence-based care in the complex contexts in which they work. Implementation strategies for evidence-based practice need to take account of the experiences of health professionals and the challenges they face. Such strategies need to focus on improving collaboration between different disciplines for the well-being of those needing care. In the case of neonatal jaundice management, consideration is also needed in how to raise awareness of the importance of avoiding severe adverse outcomes, even when they might be rare, and how this might be done. Addressing issues that lead to disjointed care or poor knowledge of neonatal jaundice among health professionals is essential.
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Affiliation(s)
| | - Dell Horey
- La Trobe University, Melbourne, Victoria, Australia
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14
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Braun TD, Bhuptani PH, O’Keefe B, Abrantes AM, Marsh E, Holzhauer CG. Mindful self-compassion for veteran women with a history of military sexual trauma: feasibility, acceptability, potential benefits, and considerations. Eur J Psychotraumatol 2024; 15:2301205. [PMID: 38349003 PMCID: PMC10866049 DOI: 10.1080/20008066.2023.2301205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/08/2023] [Indexed: 02/15/2024] Open
Abstract
Background: Military sexual trauma (MST) is reported by up to 74% of women veterans in the United States and is a driver of poor behavioural and physical health. Self-compassion is a transdiagnostic, protective factor linked with improved posttraumatic stress disorder (PTSD), depression, and health behaviours. Thus, Mindful Self-Compassion training (MSC) may help ameliorate MST-related impacts. However, MSC can also temporarily increase distress (i.e. backdraft). Delivering it with elective trauma-informed yoga (TIY), which regulates acute distress, may help address this issue.Objective: This VA quality improvement project examined feasibility, acceptability, and reported benefits and challenges of a manualized 8-week MSC including within non-randomized subgroups: MSC (n = 4) and MSC+ elective TIY classes (MSC+; n = 4).Methods: Nine women veterans with a history of MST at a Vet Center in the Northeastern U.S.A. enrolled; eight completed, excluding one MSC+ participant. Measures included attrition (n = 9), attendance (n = 8), weekly (n = 8) and posttreatment acceptability (n = 6), validated symptom severity assessments (n = 7), and an exit interview (n = 8).Results: Among completers, MSC attendance was excellent (89%) and higher among in MSC+ vs. MSC (94% vs. 84% sessions completed). On average across the two groups, depressive and PTSD symptom severity decreased by 21% and 30%, respectively. In exit interviews, participants across groups described improved coping with distress and psychiatric symptoms, reduced stress, and improved self-care and health behaviours. Although women in both groups reported backdraft during the programme, MSC+ also reported healthier coping and improved emotional processing.Conclusion: The results of this programme evaluation infer MSC may be feasible, acceptable, and beneficial for women survivors of MST in one Vet Center in the Northeastern USA. Further, temporary elevations in MSC-related distress may be ameliorated with adjunctive TIY. Given requests of women veterans in the USA. for additional complementary and integrative health treatment options, formal research on these approaches is warranted.
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Affiliation(s)
- Tosca D. Braun
- Alpert Medical School of Brown University, Providence, RI, USA
- Butler Hospital, Providence, RI, USA
- VA Central Western Massachusetts, Leeds, MA, USA
| | - Prachi H. Bhuptani
- Alpert Medical School of Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
| | | | - Ana M. Abrantes
- Alpert Medical School of Brown University, Providence, RI, USA
- Butler Hospital, Providence, RI, USA
| | | | - Cathryn Glanton Holzhauer
- VA Central Western Massachusetts, Leeds, MA, USA
- University of Connecticut School of Medicine, Farmington, CT, USA
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Nanyonjo G, Kwena Z, Nakamanya S, Okello E, Oketch B, Bahemuka UM, Ssetaala A, Okech B, Price MA, Kapiga S, Fast P, Bukusi E, Seeley J. Finding women in fishing communities around Lake Victoria: "Feasibility and acceptability of using phones and tracking devices". PLoS One 2024; 19:e0290634. [PMID: 38206982 PMCID: PMC10783786 DOI: 10.1371/journal.pone.0290634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 08/01/2023] [Indexed: 01/13/2024] Open
Abstract
INTRODUCTION Women in fishing communities have both high HIV prevalence and incidence, hence they are a priority population for HIV prevention and treatment interventions. However, their mobility is likely to compromise the effectiveness of interventions. We assessed the acceptability, feasibility and of using phones and global positioning system (GPS) devices for tracking mobility, to inform future health research innovations. METHODS A mult-site formative qualitative study was conducted in six purposively selected Fishing Communities on the shores of Lake Victoria in Kenya, Tanzania, and Uganda. Participants were selected based on duration of stay in the community and frequency of movement. Sixty-four (64) women participated in the study (16 per fishing community). Twenty-four (24) participants were given a study phone; 24 were asked to use their own phones and 16 were provided with a portable GPS device to understand what is most preferred. Women were interviewed about their experiences and recommendations on carrying GPS devices or phones. Twenty four (24) Focus Group Discussions with 8-12 participants were conducted with community members to generate data on community perceptions regarding GPS devices and phones acceptability among women. Data were analyzed thematically and compared across sites/countries. RESULTS Women reported being willing to use tracking devices (both phones and GPS) because they are easy to carry. Their own phone was preferred compared to a study phone and GPS device because they were not required to carry an additional device, worry about losing it or be questioned about the extra device by their sexual partner. Women who carried GPS devices suggested more sensitization in communities to avoid domestic conflicts and public concern. Women suggested changing the GPS colour from white to a darker colour and, design to look like a commonly used object such as a telephone Subscriber Identity Module (SIM) card, a rosary/necklace or a ring for easy and safe storage. CONCLUSION Women in the study communities were willing to have their movements tracked, embraced the use of phones and GPS devices for mobility tracking. Devices need to be redesigned to be more discrete, but they could be valuable tools to understanding movement patterns and inform design of interventions for these mobile populations.
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Affiliation(s)
| | - Zachary Kwena
- Research Care and Training Program (RCTP), Kenya Medical Research Institute, Kisumu, Kenya
| | - Sarah Nakamanya
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Elialilia Okello
- National Institute for Medical Research, Mwanza Intervention Trials Unit (MITU), Mwanza, Tanzania
| | - Bertha Oketch
- Research Care and Training Program (RCTP), Kenya Medical Research Institute, Kisumu, Kenya
| | - Ubaldo M. Bahemuka
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Ali Ssetaala
- UVRI-IAVI HIV Vaccine Program Limited, Entebbe, Uganda
| | - Brenda Okech
- UVRI-IAVI HIV Vaccine Program Limited, Entebbe, Uganda
| | - Matt A. Price
- IAVI, New York, NY, United States of America
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, United States of America
| | - Saidi Kapiga
- National Institute for Medical Research, Mwanza Intervention Trials Unit (MITU), Mwanza, Tanzania
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Pat Fast
- IAVI, New York, NY, United States of America
| | - Elizabeth Bukusi
- Research Care and Training Program (RCTP), Kenya Medical Research Institute, Kisumu, Kenya
| | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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16
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Malika N, Herman PM, Whitley M, Coulter I, Maiers M, Chesney M, Rogers R. Qualitative Assessment CIH Institutions' Engagement With Underserved Communities to Enhance Healthcare Access and Utilization. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2024; 13:27536130241244759. [PMID: 38545335 PMCID: PMC10966973 DOI: 10.1177/27536130241244759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/07/2024] [Accepted: 03/13/2024] [Indexed: 05/26/2024]
Abstract
Background In North America, there is a notable underutilization of complementary and integrative health approaches (CIH) among non-White and marginalized communities. Objectives This study sought to understand how CIH educational instutitions are proactively working to redress this disparity in access and utilization among these communities. Methods We conducted interviews with 26 key informants, including presidents, clinicians, and research deans across 13 CIH educational institutions across the US and Canada. Thematic analysis included deductive codes based on the interview guide during interview scripts review. Results Six themes were identified: (1) CIH institutions often had a long and varied history of community engaged care through partnerships to increase access and utilization; (2) CIH institutions' long-standing community outreach had been intentionally designed; (3) CIH institutions provided an array of services to a wide range of demographics and communities; (4) addressing healthcare access and utilization through community partnerships had a strong positive impact; (5) funding, staffing and COVID-19 were significant challenges that impeded efforts to increase CIH access through community engaged work; (6) identified gaps in community partnerships and services to increase access and utilization were recognized. Conclusion These findings underscore significant efforts made to enhance healthcare access and utilization among marginalized, underserved, and racial and ethnic communities. However, barriers such as funding constraints, resource allocation, and the need for proper measurement and accountability hinder proactive initiatives aimed at redressing disparities in CIH utilization within these communities.
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Affiliation(s)
| | | | | | | | - Michele Maiers
- Northwestern Health Sciences University, Bloomington, MN, USA
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17
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Skedsmo K, Bingen HM, Hofsø K, Steindal SA, Hagelin CL, Hilderson D, Nes AAG, Smis D, Stenseth HV, Olaussen C. Postgraduate nursing students' experiences with simulation-based learning in palliative care education: A qualitative study. Nurse Educ Pract 2023; 73:103832. [PMID: 37948917 DOI: 10.1016/j.nepr.2023.103832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 09/06/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Abstract
AIM The aim of this study was to explore postgraduate palliative care nursing students' experiences with simulation-based learning focusing on communication skills, as a learning method in palliative care education. BACKGROUND Communication is one of several important competencies in palliative care and found to be challenging. Developing appropriate communication skills in palliative care requires education and practice. To provide postgraduate palliative care nursing students with the required knowledge and experience, practical and active learning approaches, such as simulation-based learning, can be applied. Several studies have explored undergraduate nursing students' experiences with simulation-based learning in palliative care. However, to our knowledge no studies have explored postgraduate palliative care nursing students` experiences with simulation-based learning focusing on communication skills in palliative care education. DESIGN An exploratory descriptive design. METHODS A qualitative method was employed. Three focus group interviews were conducted in May 2022 using videoconferencing (Zoom) with 11 postgraduate palliative care nursing students, eight of whom wrote reflective notes. Data were analysed using systematic text condensation. RESULTS Three categories were identified in the data analysis: 1) from uncertain expectations to the real experience of simulation-based learning; 2) being a skilled professional in everyday life versus being observed in the scenarios; and 3) the balance between self-confidence and challenges in experiencing professional development and mastery. CONCLUSIONS Postgraduate palliative care nursing students seemed to experience anxiety towards simulation-based learning in palliative care education, as well as variable expectations for the approach. This could be due to their unfamiliarity with the learning method. The need for repetition was underlined and the students indicated that they would like to be able to participate in several simulation sessions to familiarise themselves with the approach. The contrast between being a skilled professional in everyday life and the pressure of being observed and judged in the scenarios was an important finding. Students outlined the desire to feel safe, but also highlighted the importance of being challenged to experience professional development and enhanced mastery. Generally, the findings indicate that academic and psychological safety should be a focus during simulation-based learning and instructors should understand that students may have varied learning strategies, divergent learning experiences and shifting beliefs in their own competencies.
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Affiliation(s)
| | | | - Kristin Hofsø
- Lovisenberg Diaconal University College, Oslo, Norway; Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo, University Hospital, Oslo, Norway
| | - Simen A Steindal
- Institute of nursing, Faculty of Health Studies, VID Specialized University, Oslo, Norway; Lovisenberg Diaconal University College, Oslo, Norway
| | - Carina Lundh Hagelin
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden
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18
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Shearah Z, Ullah Z, Fakieh B. Intelligent Framework for Early Detection of Severe Pediatric Diseases from Mild Symptoms. Diagnostics (Basel) 2023; 13:3204. [PMID: 37892025 PMCID: PMC10606417 DOI: 10.3390/diagnostics13203204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/05/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Children's health is one of the most significant fields in medicine. Most diseases that result in children's death or long-term morbidity are caused by preventable and treatable etiologies, and they appear in the child at the early stages as mild symptoms. This research aims to develop a machine learning (ML) framework to detect the severity of disease in children. The proposed framework helps in discriminating children's urgent/severe conditions and notifying parents whether a child needs to visit the emergency room immediately or not. The model considers several variables to detect the severity of cases, which are the symptoms, risk factors (e.g., age), and the child's medical history. The framework is implemented by using nine ML methods. The results achieved show the high performance of the proposed framework in identifying serious pediatric diseases, where decision tree and random forest outperformed the other methods with an accuracy rate of 94%. This shows the reliability of the proposed framework to be used as a pediatric decision-making system for detecting serious pediatric illnesses. The results are promising when compared to recent state-of-the-art studies. The main contribution of this research is to propose a framework that is viable for use by parents when their child suffers from any commonly developed symptoms.
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Affiliation(s)
- Zelal Shearah
- Department of Information Systems, Faculty of Computing and Information Technology, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (Z.U.); (B.F.)
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Mcinziba A, Wademan D, Viljoen L, Myburgh H, Jennings L, Decloed E, Orrell C, van Zyl G, van Schalkwyk M, Gandhi M, Hoddinott G. Perspectives of people living with HIV and health workers about a point-of-care adherence assay: a qualitative study on acceptability. AIDS Care 2023; 35:1628-1634. [PMID: 36781407 PMCID: PMC10423296 DOI: 10.1080/09540121.2023.2174928] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 01/22/2023] [Indexed: 02/15/2023]
Abstract
Current antiretroviral therapy (ART) adherence monitoring is premised on patients' self-reported adherence behaviour (prone to recall error) and verified by blood viral load measurement (which can delay results). A newly developed Urine Tenofovir Rapid Assay (UTRA) assesses tenofovir in urine at point-of-care and is a novel tool to test and immediately respond to adherence levels of people living with HIV (PLHIV). We explored PLHIV and health workers' initial perceptions about integrating the UTRA into routine medical care for adherence support. We conducted a series of once-off in-depth qualitative interviews with PLHIV (n = 25) and health workers (n = 5) at a primary care health facility in Cape Town, South Africa. Data analysis involved descriptive summaries of key emergent themes with illustrative case examples. We applied a deductive, outcomes-driven analytic approach to the summaries using the Implementation Outcomes Framework proffered by Proctor et al. (2011). The three relevant concepts from this framework that guided our evaluation were: acceptability, appropriateness, and feasibility. We found positive perceptions about the UTRA from many PLHIV and health worker participants. Many PLHIV reported that the immediate results offered by the UTRA could enable them to have constructive discussions with health workers on how to resolve adherence challenges in real-time. Few PLHIV reported concerns that drinking alcohol could affect their UTRA results. Many health workers reported that the UTRA could help them identify patients at risk of treatment failure and immediately intervene through counselling, though some relayed that they would support the UTRA's implementation if more staff members could be added in their busy facility. Overall, these findings show that the UTRA was widely perceived to be acceptable and actionable by many PLHIV and health workers in the study.
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Affiliation(s)
- Abenathi Mcinziba
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Dillon Wademan
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Lario Viljoen
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Hanlie Myburgh
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
| | - Lauren Jennings
- Desmond Tutu Health Foundation, Institute of Infectious Diseases & Molecular Medicine and the Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Eric Decloed
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Catherine Orrell
- Desmond Tutu Health Foundation, Institute of Infectious Diseases & Molecular Medicine and the Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Gert van Zyl
- Division of Medical Virology, Faculty of Medicine and Health Sciences and National Health Laboratory Service (NHLS) Tygerberg business unit, Stellenbosch University, Cape Town, South Africa
| | - Marije van Schalkwyk
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco (UCSF), San Francisco, United States of America
| | - Graeme Hoddinott
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Stellenbosch University, Cape Town, South Africa
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Kyte EB, Holth Skogan A, Bjøråsen Baklid Å, Malmgren K, Ozanne A, Alfstad KÅ. Patients' long-term perspectives on gains and losses after temporal lobe resection for epilepsy. Epilepsy Behav 2023; 147:109400. [PMID: 37703614 DOI: 10.1016/j.yebeh.2023.109400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/25/2023] [Accepted: 08/19/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To investigate long-term (>10 years) experiences and overall satisfaction with temporal lobe resections (TLB) for epilepsy. METHODS Eligible participants were identified through the administrative epilepsy surgery registry at Oslo University Hospital. Data were collected through individual, semi-structured interviews with fifty participants. Interview records were analyzed using reflexive thematic analysis. RESULTS Participants' answers were divided into two main themes: "looking back on surgery" and"considering gains and losses from surgery". Most participants expressed satisfaction with having undergone surgery. Nevertheless, postsurgical problems had been encountered, and presurgical hopes had only partly been fulfilled. They described memory and naming problems with a major impact on daily life. Further, they had thoughts about effects on employment, independence, and feelings of loneliness, and expressed a need for more and better preoperative information. CONCLUSIONS Presurgical hopes go beyond seizure freedom and memory and naming problems are experienced lasting many years after surgery in the temporal lobe. Better preoperative information, particularly about unwanted cognitive effects, is of prime importance. By exploring patientś presurgical hopes, a common ground for expectations on surgery may be found along with strategies on how to cope with cognitive difficulties and possible negative life changes.
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Affiliation(s)
- Eli B Kyte
- The National Centre for Epilepsy, Member of the ERN EpiCARE, Oslo University Hospital, Postboks 4950, Nydalen, 0424 Oslo, Norway.
| | - Annette Holth Skogan
- The National Centre for Epilepsy, Member of the ERN EpiCARE, Oslo University Hospital, Postboks 4950, Nydalen, 0424 Oslo, Norway.
| | - Åsne Bjøråsen Baklid
- The National Centre for Epilepsy, Oslo University Hospital, Postboks 4950, Nydalen, 0424 Oslo, Norway
| | - Kristina Malmgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Blå stråket 7, SE-413 45 Gothenburg, Sweden; Department of Neurology, Member of ERN EpiCare, Sahlgrenska University Hospital, Blå Stråket 7, 413 46 Gothenburg, Sweden.
| | - Anneli Ozanne
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 100, 405 30 Gothenburg, Sweden; Department of Neurology, Member of ERN EpiCare, Sahlgrenska University Hospital, Blå Stråket 7, 413 46 Gothenburg, Sweden.
| | - Kristin Å Alfstad
- The National Centre for Epilepsy, Member of the ERN EpiCARE, Oslo University Hospital, Postboks 4950, Nydalen, 0424 Oslo, Norway.
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21
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Nyariki E, Wanjiru R, Shah P, Kungu M, Babu H, Weiss HA, Seeley J, Kimani J, Beattie TS. Managing motherhood - the experiences of female sex workers in Nairobi, Kenya. CULTURE, HEALTH & SEXUALITY 2023; 25:1230-1243. [PMID: 36519798 DOI: 10.1080/13691058.2022.2153926] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
Women selling sex often face challenges in raising their children in the context of significant socio-economic difficulties and the social stigma inherent in sex work. This paper is based on a cross-sectional qualitative study that explored the dual roles of motherhood and sex work among female sex workers enrolled for ongoing HIV prevention and treatment services in the Sex Workers Outreach Programme (SWOP) clinics in Nairobi, Kenya. We examined women's experiences and coping in negotiating and managing the dual roles of motherhood and sex work. In-depth interviews were conducted with 39 women randomly selected from 1,000 women included in a baseline behavioural-biological survey conducted in October-November 2020 as part of the Maisha Fiti study. The analysis focused on themes related to motherhood and making a living: (i) entry into sex work; (ii) childcare arrangements; (iii) ensuring respectability for their children; and (iv) pursuit of safety and security. Findings from the study show women's entry into sex work was necessitated by poverty and a lack of reliable sources of livelihood to support their children. While performing their motherhood roles, the women demonstrate agency in navigating through their stigmatised conflicted sex work role to be able to provide for their children.
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Affiliation(s)
- Emily Nyariki
- Partners for Health and Development in Africa (PHDA), UNITID, University of Nairobi, Nairobi, Kenya
| | - Rhoda Wanjiru
- Partners for Health and Development in Africa (PHDA), UNITID, University of Nairobi, Nairobi, Kenya
| | - Pooja Shah
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Mary Kungu
- Partners for Health and Development in Africa (PHDA), UNITID, University of Nairobi, Nairobi, Kenya
| | - Hellen Babu
- Partners for Health and Development in Africa (PHDA), UNITID, University of Nairobi, Nairobi, Kenya
| | - Helen A Weiss
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Joshua Kimani
- Partners for Health and Development in Africa (PHDA), UNITID, University of Nairobi, Nairobi, Kenya
| | - Tara S Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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22
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Lisk S, Sagar-Ouriaghli I, Carter B, Sclare I, Holly J, Brown JSL. Engaging Older Adolescent Boys Into School-Based Mental Health Workshops: Testing Theory-Based Facilitators and Barriers in Focus Groups. Am J Mens Health 2023; 17:15579883231177975. [PMID: 37822122 PMCID: PMC10571706 DOI: 10.1177/15579883231177975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/17/2023] [Accepted: 05/08/2023] [Indexed: 10/13/2023] Open
Abstract
Untreated mental health problems continue from childhood and adolescence into adulthood, meaning accessible early intervention is essential to reduce long-term negative outcomes. However, there is often a reluctance to engage in mental health treatment, with considerable evidence that young men are less likely to seek help than young women. This original research study aimed to explore four areas of interest around facilitating engagement of adolescent boys to a stress workshop intervention for adolescents in U.K. schools. The areas explored were male role models, destigmatizing language, trust building, and using a transparent and collaborative approach. We also sought to understand the main barriers to engagement. To explore these areas of interest, two focus groups were run, with a total of 12 young men, over two regional sites (London and Bath). Content analysis was used to analyze the data. Participants particularly valued transparency and collaboration as strong facilitators to engagement. Building of trust was the next most popular. Use of role models and destigmatizing language were the joint third most popular methods. The main barrier to help-seeking identified was perceived threat to masculine identity (self and social stigma). Given these novel findings, the factors of transparency and collaboration and building trust as facilitators merit further research, among both adults and adolescents.
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Affiliation(s)
- Stephen Lisk
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Ilyas Sagar-Ouriaghli
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Irene Sclare
- Southwark CAMHS Clinical Academic Group, South London & Maudsley NHS Foundation Trust, London, UK
| | - Jennifer Holly
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - June S. L. Brown
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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23
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Boucher NA, Tucker MC, White BS, Ear B, Dubey M, Byrd KG, Williams JW, Gierisch JM. Frontline Clinician Appraisement of Research Engagement: "I feel out of touch with research". J Gen Intern Med 2023; 38:2671-2677. [PMID: 37072534 PMCID: PMC10112825 DOI: 10.1007/s11606-023-08200-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/05/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Health services research can benefit from frontline clinician input across all stages of research, yet their key perspectives are often not meaningfully engaged. OBJECTIVE How can we improve clinician engagement in research? DESIGN Convenience sampling and semi-structured interviews followed by descriptive content analysis with an inductive approach, followed by group participatory listening sessions with interviewees to further contextualize findings. PARTICIPANTS Twenty-one multidisciplinary clinicians from one healthcare system. KEY RESULTS We identified two major themes: perceptions of research (how research fits within job role) and characterizing effective engagement (what works and what does not work in frontline clinician engagement). "Perceptions of Research" encompassed three subthemes: prior research experience; desired degree of engagement; and benefits to clinicians engaging in research. "Characterizing Effective Engagement" had these subthemes: engagement barriers; engagement facilitators; and impact of clinician's racial identity. CONCLUSIONS Investing in frontline clinicians as research collaborators is beneficial to clinicians themselves, the health systems that employ them, and those for which they care. Yet, there are multiple barriers to meaningful engagement.
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Affiliation(s)
- Nathan A Boucher
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System HSR&D, Durham, NC, USA.
- Sanford School of Public Policy, Duke University, Durham, NC, USA.
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA.
- Department of Medicine (Geriatrics), School of Medicine, Duke University, Durham, NC, USA.
- Duke-Margolis Center for Health Policy, Durham, NC, USA.
| | - Matthew C Tucker
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System HSR&D, Durham, NC, USA
| | - Brandolyn S White
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System HSR&D, Durham, NC, USA
| | - Belinda Ear
- Cooperative Studies Program Epidemiology Center - Durham, Durham, NC, USA
| | - Manisha Dubey
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System HSR&D, Durham, NC, USA
| | - Kaileigh G Byrd
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System HSR&D, Durham, NC, USA
| | - John W Williams
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System HSR&D, Durham, NC, USA
- Division of General Internal Medicine, School of Medicine, Duke University, Durham, NC, USA
| | - Jennifer M Gierisch
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System HSR&D, Durham, NC, USA
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA
- Division of General Internal Medicine, School of Medicine, Duke University, Durham, NC, USA
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Caruso CG, Warren JB, Carney PA. Parent experiences of a remote patient monitoring program enabling early discharge from the neonatal intensive care unit with nasogastric tube feeding. J Neonatal Perinatal Med 2023:NPM221181. [PMID: 37092242 DOI: 10.3233/npm-221181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND This exploratory study examined parents' experiences with "Growing at Home" (G@H), a remote patient monitoring program for stable infants discharged from the Neonatal Intensive Care Unit (NICU) with continued need for nasogastric tube feeding. METHODS We used classical content analysis to identify and refine emergent themes from 13 semi-structured key informant interviews. RESULTS The primary emergent theme was the desire to return to normalcy, which was expressed as a primary motivator for participating in G@H. Parents reported G@H assisted them in transitioning from the NICU's highly medicalized setting to establishing a new normal with incorporation of their infant into their lives and families. Parental preparation is important, as some parents experienced challenges that indicate the program may not be suitable for all families. CONCLUSIONS Parental experiences offer insight into benefits and challenges of early discharge from the NICU and highlight opportunities to support families beginning in the NICU and as they transition home.
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Affiliation(s)
- C G Caruso
- Division of Neonatology, Oregon Health & Science University, Portland, OR, USA
| | - J B Warren
- Division of Neonatology, Oregon Health & Science University, Portland, OR, USA
| | - P A Carney
- Professor of Family Medicine, Oregon Health & Science University, Portland, OR, USA
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25
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Mang JC, Chen MY, Ho CS, Ng HC, Yeung ST. Knowledge, attitudes and practices of food handlers in restaurants that serve undercooked burgers in Hong Kong: A mixed methods study. Food Control 2023. [DOI: 10.1016/j.foodcont.2022.109543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Richards S. Faculty Perception of Student Engagement in Online Anatomy Laboratory Courses During the COVID-19 Pandemic. MEDICAL SCIENCE EDUCATOR 2023; 33:465-480. [PMID: 37251200 PMCID: PMC9990041 DOI: 10.1007/s40670-023-01762-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 05/31/2023]
Abstract
When the social distancing guidelines, as a result of the COVID-19 pandemic, caused universities to close campuses, there was a rapid shift in the course delivery methods of human gross anatomy laboratory sessions. Courses were delivered online, and this change created new challenges for anatomy faculty to engage students effectively. This profoundly impacted student-instructor interactions, the quality of the learning environment, and successful student outcomes. Because of the importance of student interaction and engagement for hands-on laboratory courses like anatomy, which rely on cadaver dissections and in-person learning communities, as well as the novel opportunity, this qualitative study sought to explore the faculty perspectives of transitioning their in-person laboratory sessions online and unearth their experience with student engagement in this new teaching format. The Delphi technique was used to explore this experience in two rounds of qualitative inquiry using questionnaires and semi-structured interviews, and thematic analysis was used to analyze the data, identifying codes and building themes. The study utilized indicators of student engagement in online courses to formulate four themes: instructor presence, social presence, cognitive presence, and reliable technology design and access. These were constructed based on the factors faculty used to maintain engagement, new challenges they faced, and strategies deployed to overcome these challenges and engage students in the new learning format. These are supported by strategies such as using video and multimedia, ice-breaker activities, chat and discussion features, immediate and personalized feedback, and virtual meeting via synchronous sessions. These themes highlight important lessons that faculty designing online anatomy laboratory courses can use to guide their course design, and institutions and instructional design faculty can use to inform best practices and faculty development efforts. Additionally, the study calls for further research to design a standardized and global assessment tool that measures student engagement in the online learning environment.
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Affiliation(s)
- Sherese Richards
- Bio-Medical Education (Anatomy) Department, California Health Sciences University, Clovis, CA 93611 USA
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27
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Hiadzi RA, Agyeman JA, Akrong GB. 'Baby mamas' in Urban Ghana: an exploratory qualitative study on the factors influencing serial fathering among men in Accra, Ghana. Reprod Health 2023; 20:37. [PMID: 36859283 PMCID: PMC9976522 DOI: 10.1186/s12978-023-01585-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/19/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Biological fathering, especially in patrilineal societies, was traditionally acceptable only in the context of marriage to the mother of the child. Many men were polygynous, often staying in one household with all their wives and children. However, this phenomenon has been on the decline in recent times, mainly due to Christianity, which encourages monogamy while frowning on polygyny. The Ghanaian family has for the past few years been undergoing changes due to migration, urbanization, and industrialization. With an increase in non-marital births and the dissolution of marital unions, multi-partner fertility is likely to increase. Contemporary Ghanaian perspectives on the circumstances that lead men to engage in paternal multi-partner fertility, otherwise referred to in this study as serial fathering, are scanty, hence this study examines the factors that lead to serial fathering among Ghanaian men. METHODS The study employed the qualitative method, using in-depth interviews with twenty (20) serial fathers and a focus group discussion with seven (7) women. RESULTS It was found that factors such as the attitude of women in relationships, the duolocal post-marital residential pattern, and the age at first birth are some of the reasons why some men father children with multiple partners. CONCLUSION The study concludes that both situational and personal factors account for the phenomenon of serial fathering amongst men in Prampram, Ghana, and these factors bring about distinctions in serial fathering as occurring either within or outside of marriage.
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Affiliation(s)
| | - Jemima Akweley Agyeman
- grid.8652.90000 0004 1937 1485Department of Sociology, University of Ghana, Accra, Ghana
| | - Godwin Banafo Akrong
- grid.54549.390000 0004 0369 4060School of Management and Economics, University of Electronic Science and Technology of China, Chengdu, 611731 China
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28
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A Qualitative Study of 11 World-Class Team-Sport Athletes' Experiences Answering Subjective Questionnaires: A Key Ingredient for 'Visible' Health and Performance Monitoring? Sports Med 2023; 53:1085-1100. [PMID: 36763237 PMCID: PMC10115681 DOI: 10.1007/s40279-023-01814-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Athlete monitoring trends appear to be favouring objective over subjective measures. One reason of potentially several is that subjective monitoring affords athletes to give dishonest responses. Indeed, athletes have never been systematically researched to understand why they are honest or not. OBJECTIVE Because we do not know what motivates professional athletes to be honest or not when responding to subjective monitoring, our objective is to explore the motives for why the athlete may or may not respond honestly. METHODS A qualitative and phenomenological approach was used, interviewing 11 world-class team-sport athletes (five women, six men) about their experiences when asked to respond to subjective monitoring questionnaires. Interview transcripts were read in full and significant quotations/statements extracted. Meanings were formulated for each interviewees' story and assigned codes. Codes were reflected upon and labelled as categories, with similar categories grouped into an overall theme. Themes were examined, articulated, re-interpreted, re-formulated, and written as a thematic story, drawing on elements reported from different athletes creating a blended story, allowing readers a feel for what it is like to live the experience. RESULTS Overall, four key themes emerged: (i) pursuit of the ideal-self, (ii) individual barriers to athlete engagement, (iii) social facilitators to athlete engagement; and (iv) feeling compassion from performance staff. CONCLUSIONS Our main insight is that athletes' emotions play a major role in whether they respond honestly or not, with these emotions being driven at least in part by the performance staff asking the questions.
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Diop ZB, Bernays S, Tumwesige E, Asiimwe A, Kawuma R, Seeley J. Youth migration and access to health services in a trading centre in southern Uganda: A qualitative exploration. Glob Public Health 2023; 18:2191689. [PMID: 36973188 DOI: 10.1080/17441692.2023.2191689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Impeded access to health services is a major factor influencing migrant health. In Uganda, previous research has shown lower utilisation of health services for young rural-urban migrants compared to their non-migrant counterparts. However, access to health services does not start at utilisation, but can be hampered by being able to identify a need for care. Using qualitative methods, we aimed to explore young rural-urban migrants' perceptions of health and patterns of engagement with health services. We analysed, using thematic analysis, a purposive sample of 18 in-depth interviews with 10 young people who had recently migrated within Uganda. Our results are presented through a framework conceptualising access at the intersection between abilities of people and characteristics of services. Participants perceived a need for care mostly through serious crises. Their ability to obtain care was hindered by a lack of resources, as well as the relative social isolation brought by migration. Our study highlights other barriers to accessing care such as the role of social norms and HIV-related stigma in health issues prioritisation, and healthcare workers' attitudes. This knowledge can inform approaches to ensure that community-based services are able to support healthcare access and improved health outcomes for this vulnerable group.
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Affiliation(s)
- Zeynab B Diop
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Bernays
- School of Public Health, University of Sydney, Sydney, Australia
| | | | - Allen Asiimwe
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Rachel Kawuma
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Janet Seeley
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
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Habib M, Korman M, Aliasi-Sinai L, den Otter-Moore S, Gotlib Conn L, Murray A, Carno Jacobson M, Enepekides D, Higgins K, Ellis J. Understanding compassionate care from the patient perspective: Highlighting the experience of head and neck cancer care. Can Oncol Nurs J 2023; 33:74-86. [PMID: 36789223 PMCID: PMC9894371 DOI: 10.5737/2368807633174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objectives To address the knowledge gap in the practice of compassionate healthcare by elucidating patient perspectives on compassion, empathy, and sympathy. Methods Semi-structured telephone interviews were conducted at two time points with patients undergoing head and neck cancer treatment. Questions explored participants' understanding of compassion, sympathy, and empathy, as they relate to each other and to healthcare. Interviewers manually recorded responses. Qualitative exploratory methods were used to analyze data; inductive line-by-line coding was conducted to develop primary codes. Themes emerged through categorization of codes. Results Ninety-five interviews conducted with 63 participants across two time points revealed four major themes - Compassion-vs-Empathy-vs-Sympathy, Coping Methods, Showing Care, and Nature of Interaction - encompassing seven categories, with a total of 24 codes. Codes were consistent across time points, except for two new codes, "positivity" and "personalized" emerging during follow-up interviews. Conclusions Patient narrative from this study supported the concept that compassion is multidimensional and enabled several dimensions to be identified, highlighting the importance of patient perspectives in improving the provision of compassionate healthcare. Findings should be considered in future training and practice.
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Berg KA, Ishler KJ, Lytle S, Kaplan R, Wang F, Olgac T, Miner S, Edguer MN, Biegel DE. "Don't Promise Something You can't Deliver:" Caregivers' Advice for Improving Services to Adolescents and Young Adults with Autism. AUTISM RESEARCH AND TREATMENT 2023; 2023:6597554. [PMID: 36998713 PMCID: PMC10049841 DOI: 10.1155/2023/6597554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 02/01/2023] [Accepted: 02/14/2023] [Indexed: 04/01/2023]
Abstract
Approximately 50,000 youths with autism spectrum disorders (ASD) exit U.S. high schools yearly to enter adult systems of care, many of whom remain dependent on family for day-to-day care and service system navigation. As part of a larger study, 174 family caregivers for adolescents or young adults with ASD were asked what advice they would give service providers about how to improve services for youth with ASD. Reflexive thematic analysis identified a framework of five directives: (1) provide a roadmap to services; (2) improve service access; (3) fill gaps to address unmet needs; (4) educate themselves, their families, and society about autism; and (5) operate from a relationship-building paradigm with families. Education, health, and social service providers, as well as policymakers, can use these directives to better assist youth with ASD and their families in the transition to adulthood.
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Affiliation(s)
- Kristen A. Berg
- 1Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA
- 2Center for Health Care Research and Policy, The MetroHealth System, 2500 MetroHealth Dr, Cleveland, OH 44109, USA
| | - Karen J. Ishler
- 1Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA
| | - Sarah Lytle
- 3University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106, USA
| | - Ronna Kaplan
- 4Cleveland State University, College of Health, 2121 Euclid Ave, Cleveland, OH 44115, USA
| | - Fei Wang
- 1Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA
| | - Tugba Olgac
- 1Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA
| | - Stacy Miner
- 3University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106, USA
- 5Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA
| | - Marjorie N. Edguer
- 1Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA
| | - David E. Biegel
- 1Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA
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Shah J, Kovacs M, Mori D. An Open Group for Patients with Various Chronic Illnesses: A Qualitative Case Evaluation. Int J Group Psychother 2023; 73:44-68. [PMID: 38446577 DOI: 10.1080/00207284.2022.2154674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Many self-management and support groups for medical patients target a specific medical condition or diagnosis and are often time-limited. Presented is the Medical Issues Group (MIG), which is an integration of a self-management program and a therapist-led supportive psychotherapy group. This ongoing group is open to individuals with any significant chronic medical condition. Findings from our qualitative evaluation (n = 9) revealed that this group is positively received and can provide individuals who are experiencing challenges associated with living with medical illness a forum to receive high quality social support, address feelings of social isolation and loneliness, and develop adaptive coping strategies to adjust to medical illness. The inclusive structure of the group appears to provide enhanced access to high quality support and intervention for a vulnerable population. Limitations and implications are discussed.
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Habib M, Korman M, Aliasi-Sinai L, den Otter-Moore S, Gotlib Conn L, Murray A, Carno Jacobson M, Enepekides D, Higgins K, Ellis J. Étude des soins compatissants du point de vue du patient dans l’optique particulière des soins du cancer de la tête et du cou. Can Oncol Nurs J 2023; 33:87-100. [PMID: 36789210 PMCID: PMC9894365 DOI: 10.5737/2368807633187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objectifs Améliorer les connaissances sur la pratique des soins compatissants en mettant en lumière le point de vue des patients sur la compassion, l’empathie et la sympathie. Méthodes Des entretiens téléphoniques semi-structurés ont été menés à deux moments précis avec des patients suivant un traitement contre le cancer de la tête et du cou. Les questions visaient à explorer la compréhension qu’ont les participants de la compassion, de la sympathie, de l’empathie et des relations mutuelles entre ces notions dans un contexte de soins de santé. Les chercheurs ont consigné manuellement les réponses. Des méthodes exploratoires qualitatives ont été utilisées pour analyser les données et un codage inductif ligne par ligne a été effectué pour développer des codes primaires. Une catégorisation des codes a ensuite permis de faire ressortir des thèmes récurrents. Résultats Quatre-vingt-quinze entretiens menés avec 63 participants à deux moments différents ont fait ressortir quatre thèmes principaux: 1) manifestations de bienveillance; 2) nature des interactions; 3) compassion, empathie et sympathie; 4) méthodes d’adaptation. Ces thèmes se subdivisaient en sept catégories, conduisant à un total de 24 codes. Les codes étaient cohérents d’un point de vue temporel, à l’exception de deux nouveaux codes, « positivité » et « personnalisé », apparus lors des entretiens de suivi. Conclusions Les témoignages des patients de cette étude ont conforté le concept selon lequel la compassion est multidimensionnelle et ont permis de définir plusieurs dimensions de ce sentiment, soulignant l’importance de tenir compte du point de vue des patients pour améliorer la prestation de soins compatissants. Les conclusions devraient être intégrées dans les formations et les pratiques futures.
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Nakamanya S, Okello ES, Kwena ZA, Nanyonjo G, Bahemuka UM, Kibengo FM, Ssetaala A, Bukusi EA, Kapiga S, Fast PE, Seeley J. Social networks, mobility, and HIV risk among women in the fishing communities of Lake Victoria. BMC Womens Health 2022; 22:555. [PMID: 36578062 PMCID: PMC9798550 DOI: 10.1186/s12905-022-02144-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Population mobility is a demonstrated barrier to reducing HIV incidence. A clear understanding of social networks and their influence on mobility among women in the fishing communities of Lake Victoria may contribute to tailoring effective interventions that suit the needs of these mobile women. METHODS A cross-sectional qualitative methods study was conducted to understand mobility patterns among women resident and or working in fishing communities of Lake Victoria in Kenya, Tanzania, and Uganda. The study was conducted in six fishing communities from March 2018 to June 2019. The communities were purposively selected, based on population size (1000 people or more) and HIV prevalence of > 15% among women aged 18 years or older who had lived in the fishing community for at least six months. In-depth interviews were conducted with 24 key informants and 72 women from the sites in the three countries. Questions focused on women's social networks and other factors that fuelled or facilitated women's mobility as well as challenges they faced due to mobility. Data analysis followed a thematic framework approach. RESULTS Different social groupings/networks existed among women in the fishing communities of Lake Victoria. These included female sex workers, women fish processors/traders, women bar workers/owners, restaurant workers, and family networks. Networks encouraged mobility, supporting finding work opportunities, but also increased sexual risks through partner changes. The benefits of networks included information sharing, financial support, and group protection, especially against violence. CONCLUSION Social networks and groupings among women in the fishing communities of Lake Victoria could be useful in tailoring HIV prevention and HIV care interventions to suit the needs of these highly mobile populations.
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Affiliation(s)
- Sarah Nakamanya
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM), Uganda Research Unit, P.O. Box 49, Entebbe, Uganda.
| | - Elialilia S Okello
- Mwanza Intervention Trials Unit (MITU), National Institute for Medical Research, Mwanza, Tanzania
| | - Zachary A Kwena
- Research Care and Training Program (RCTP), Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | | | - Ubaldo M Bahemuka
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM), Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Freddie M Kibengo
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM), Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | | | - Elizabeth A Bukusi
- Research Care and Training Program (RCTP), Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit (MITU), National Institute for Medical Research, Mwanza, Tanzania
| | - Patricia E Fast
- International AIDS Vaccine Initiative (IAVI), New York, USA
- Pediatric Infectious Diseases, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM), Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Military Response to Medical Crises-Consensus Recommendations for Military-Civilian Transitions of Care. Disaster Med Public Health Prep 2022; 17:e281. [PMID: 36503604 DOI: 10.1017/dmp.2022.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The threat that New York faced in 2020, as the COVID-19 pandemic unfolded, prompted an unprecedented response. The US military deployed active-duty medical professionals and equipment to NYC in a first of its kind response to a "medical" domestic disaster. Transitions of care for patients surfaced as a key challenge. Uniformed Services University and the Icahn School of Medicine at Mount Sinai hosted a consensus conference of civilian and military healthcare professionals to identify care transition best practices for future military-civilian responses. METHODS We performed individual interviews followed by a modified Delphi technique during a two-day virtual conference. Patient transitions of care emerged as a key theme from pre-conference interviews. Twelve participants attended the two-day virtual conference and generated best practice recommendations from an iterative process. RESULTS Participants identified 19 recommendations in 10 "sub-themes" related to patient transitions of care: needs assessment and capability analysis; unified command; equipment; patient handoffs; role of in-person facilitation; dynamic updates; patient selection; patient tracking; daily operations; and resource typing. CONCLUSIONS The COVID-19 pandemic resulted in an unprecedented military response. This study created 19 consensus recommendations for care transitions between military and civilian healthcare assets that may be useful in future military-civilian medical engagements.
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Ligita T, Francis K, Wicking K, Harvey N, Nurjannah I. Developing codes from the interview: reading versus listening. Nurse Res 2022; 30:31-38. [PMID: 36453436 DOI: 10.7748/nr.2022.e1851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Interviewing is a vital and common method of collecting data in qualitative research. The interview is usually recorded and a written transcription is created from the recording. The transcription document is then analysed by reading and re-reading to fracture the data and develop initial codes, as in grounded theory methodology. However, this method has disadvantages. AIM To report on how the authors used the process of generating initial codes during their analysis in a research study. DISCUSSION The authors compare the rigour and efficiency of generating initial codes from reading written transcripts with generating initial codes from listening to recordings. The most notable difference between the two methods is the length of time needed to transcribe the recording before coding can start. The authors discuss the lessons they learned from their pragmatic decision to expedite initial coding by listening to rather than reading the interview data. CONCLUSION Grounded theory requires concurrent data generation and analysis. Audio analysis is efficient in developing initial codes from interview recordings. IMPLICATIONS FOR PRACTICE Nurse researchers can use the audio method of analysing interview data.
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Affiliation(s)
- Titan Ligita
- School of Nursing, Faculty of Medicine, Universitas Tanjungpura, Pontianak, Indonesia
| | - Karen Francis
- College of Healthcare Sciences, University of Tasmania, Hobart Tasmania, Australia
| | - Kristin Wicking
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - Nichole Harvey
- College of Medicine and Dentistry, Townsville, Queensland, Australia
| | - Intansari Nurjannah
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Tilley L, Schuler K, Cole R, Fahlsing C, Rudinsky S, Peters S, Goolsby C. Military Medical Provider Perspectives During the New York COVID-19 Response. Mil Med 2022; 188:e1260-e1267. [PMID: 36369894 DOI: 10.1093/milmed/usac338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/13/2022] [Accepted: 10/18/2022] [Indexed: 11/15/2022] Open
Abstract
ABSTRACT
Introduction
The response to the coronavirus disease 2019 pandemic in New York City (NYC) included unprecedented support from the DoD—a response limited primarily to medical and public health response on domestic soil with intact infrastructure. This study seeks to identify the common perspectives, experiences, and challenges of DoD personnel participating in this historic response.
Materials and Methods
This is a phenomenological qualitative study of 16 military health care providers who deployed to NYC in March 2020. This study was approved by the Institutional Review Board at the USU (No. DBS.2020.123). All participants served on either the United States Naval Ship Comfort or at the Javits Center. We conducted semi-structured interviews exploring the participants’ experiences while deployed to NYC. These interview scripts were then independently coded by five research team members.
Results
We identified four common themes and 12 subthemes from the participants’ responses. The themes (subthemes) were lack of preparation (unfamiliar mission and inadequate resources); confusion about integration with civilian health care (widespread, dynamic situation, and NYC overwhelmed), communication challenges (overall, misunderstanding and miscommunication resulting in tension, and patient handoffs); and adaptation and success (general, military–civilian liaison service, positive experience, and military support necessity).
Conclusions
This study provides unique insight into the DoD’s initial response to the coronavirus disease 2019 pandemic in NYC. Using this experiential feedback from the DoD’s pandemic responders could aid planners in improving the rapidity, effectiveness, and safety of military and civilian health care system integrations that may arise in the future.
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Affiliation(s)
- Laura Tilley
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA
| | - Keke Schuler
- National Center for Disaster Medicine and Public Health , Rockville, MD 20852, USA
- The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc. , Bethesda, MD 20817, USA
| | - Rebekah Cole
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA
| | - Christopher Fahlsing
- School of Medicine, Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA
| | - Sherri Rudinsky
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA
| | - Sidney Peters
- School of Medicine, Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA
| | - Craig Goolsby
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA
- National Center for Disaster Medicine and Public Health , Rockville, MD 20852, USA
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Kliewer A, Farrar HM, Scott KE, Clark JK. Social Model Hospice Homes: Bridging the Gap in End-of-Life Care Delivery. J Palliat Med 2022; 26:503-508. [PMID: 36251828 DOI: 10.1089/jpm.2022.0228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: People prefer to die at home, if given a choice. However, data show that less than half of hospice patients get to do so, as many lack the social resources needed for end-of-life (EOL) care to be supported at home. The Social Model Hospice Home (SMHh) is an emerging model of care and offers an option for individuals whose EOL care cannot be fully supported by their available social network. An SMHh is a community-supported home staffed with round the clock caregivers dedicated to closing this social gap in EOL care delivery. Objective: This study aimed to enhance and clarify the reasons for successful outcomes of the SMHh concept. Methods: This study used a qualitative descriptive approach. Twenty-three semistructured interviews were conducted with the participants. Located throughout North America, participants consisted of staff, volunteers, guests, family members of previous guests, board members, and administrators of SMHh programs. Results: Over the course of the study, five major themes were developed: (1) physical attributes of the home, (2) volunteer base, (3) attention to detail, (4) structure of accountability, and (5) practice of compassionate honesty. These themes reveal the beginning of an explanatory theory of why the SMHh concept can support the delivery of effective, high-quality EOL care. Conclusions: The result of this study substantiates SMHh as a viable alternative to traditional in-home or institution-based EOL care. As the SMHh movement develops, more research is needed to explore and understand how this emerging model of care can be implemented on a larger scale.
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Affiliation(s)
- Amy Kliewer
- University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
| | - Helen M. Farrar
- University of Oklahoma Fran and Earl Ziegler College of Nursing, Oklahoma City, Oklahoma, USA
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Mackworth-Young CRS, Dringus S, Dauya E, Dziva Chikwari C, Mavodza C, Tembo M, Doyle A, McHugh G, Simms V, Wedner-Ross M, Apollo T, Mugurungi O, Ferrand RA, Bernays S. Putting youth at the centre: co-design of a community-based intervention to improve HIV outcomes among youth in Zimbabwe. Wellcome Open Res 2022; 7:53. [PMID: 38264344 PMCID: PMC10804048 DOI: 10.12688/wellcomeopenres.17531.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 01/25/2024] Open
Abstract
Background: Youth have disproportionately poor HIV outcomes. We aimed to co-design a community-based intervention with youth to improve HIV outcomes among 16-24 year-olds, to be trialled in Zimbabwe. Methods: We conducted 90 in-depth interviews with youth, family members, community gatekeepers and healthcare providers to understand the barriers to uptake of existing HIV services. The interviews informed an outline intervention, which was refined through two participatory workshops with youth, and subsequent pilot-testing. Results: Participants considered existing services inaccessible and unappealing: health facilities were perceived to be for 'sick people', centred around HIV and served by judgemental providers. Proposed features of an intervention to overcome these barriers included: i) delivery in a youth-only community space; ii) integration of HIV services with broader health services; iii) non-judgemental skilled healthcare providers; iv) entertainment to encourage attendance; and v) tailored timings and outreach. The intervention framework stands on three core pillars, based on optimizing access (community-based youth-friendly settings); uptake and acceptability (service branding, confidentiality, and social activities); and content and quality (integrated HIV care cascade, high quality products, and trained providers). Conclusions: Ongoing meaningful youth engagement is critical to designing HIV interventions if access, uptake, and coverage is to be achieved.
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Affiliation(s)
- Constance RS. Mackworth-Young
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Stefanie Dringus
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Ethel Dauya
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Chido Dziva Chikwari
- Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Constancia Mavodza
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Mandikudza Tembo
- Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Aoife Doyle
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Grace McHugh
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Victoria Simms
- Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Tsitsi Apollo
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Owen Mugurungi
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Rashida A. Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Bernays
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- School of Public Health, University of Sydney, Sydney, Australia
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Mackworth-Young CRS, Dringus S, Dauya E, Dziva Chikwari C, Mavodza C, Tembo M, Doyle A, McHugh G, Simms V, Wedner-Ross M, Apollo T, Mugurungi O, Ferrand RA, Bernays S. Putting youth at the centre: co-design of a community-based intervention to improve HIV outcomes among youth in Zimbabwe. Wellcome Open Res 2022; 7:53. [PMID: 38264344 PMCID: PMC10804048 DOI: 10.12688/wellcomeopenres.17531.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 01/29/2024] Open
Abstract
Background: Youth have disproportionately poor HIV outcomes. We aimed to co-design a community-based intervention with youth to improve HIV outcomes among 16-24 year-olds, to be trialled in Zimbabwe. Methods: We conducted 90 in-depth interviews with youth, family members, community gatekeepers and healthcare providers to understand the barriers to uptake of existing HIV services. The interviews informed an outline intervention, which was refined through two participatory workshops with youth, and subsequent pilot-testing. Results: Participants considered existing services inaccessible and unappealing: health facilities were perceived to be for 'sick people', centred around HIV and served by judgemental providers. Proposed features of an intervention to overcome these barriers included: i) delivery in a youth-only community space; ii) integration of HIV services with broader health services; iii) non-judgemental skilled healthcare providers; iv) entertainment to encourage attendance; and v) tailored timings and outreach. The intervention framework stands on three core pillars, based on optimizing access (community-based youth-friendly settings); uptake and acceptability (service branding, confidentiality, and social activities); and content and quality (integrated HIV care cascade, high quality products, and trained providers). Conclusions: Ongoing meaningful youth engagement is critical to designing HIV interventions if access, uptake, and coverage is to be achieved.
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Affiliation(s)
- Constance RS. Mackworth-Young
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Stefanie Dringus
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Ethel Dauya
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Chido Dziva Chikwari
- Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Constancia Mavodza
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Mandikudza Tembo
- Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Aoife Doyle
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Grace McHugh
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Victoria Simms
- Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Tsitsi Apollo
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Owen Mugurungi
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Rashida A. Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Bernays
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- School of Public Health, University of Sydney, Sydney, Australia
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Laird P, Burr C, Gill FJ, Schultz A. Spring-infusors: How a simple and small solution can create king-sized complexity. Nurs Open 2022; 10:1125-1134. [PMID: 36166454 PMCID: PMC9834515 DOI: 10.1002/nop2.1380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/11/2022] [Accepted: 09/06/2022] [Indexed: 01/16/2023] Open
Abstract
AIM The aims of the study were to investigate family and hospital staff views about the use of spring-infusor devices for administration of intravenous antibiotic medications, to examine if the device is acceptable and feasible and to map a process for implementation. DESIGN A qualitative study with a pragmatist approach, within a larger, mixed methods knowledge translation study. METHODS Data were collected by semi-structured interviews with patients who have cystic fibrosis and their parents and focus groups and interviews with hospital staff. Interviews were concluded when no new themes were identified. Thematic analysis and process mapping was undertaken. RESULTS Six parents, nine children and 30 staff were interviewed. Families preferred spring-infusors. Staff knowledge, experience and attitudes toward spring-infusor use was varied. All staff acknowledged that their role is to support patient-centred care. Spring-infusors are preferred by families and clinicians above other IV administration devices but misconceptions about spring-infusor use and numerous procedural challenges reduced their use.
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Affiliation(s)
- Pamela Laird
- Wal‐yan Respiratory Research Centre, Telethon Kids InstituteUniversity of Western Australia, Perth Children's HospitalNedlandsWestern AustraliaAustralia,Department of PhysiotherapyPerth Children's HospitalNedlandsWestern AustraliaAustralia,Division of Paediatrics, Faculty of MedicineUniversity of Western AustraliaCrawleyWestern AustraliaAustralia
| | - Charlotte Burr
- Department of Respiratory and Sleep MedicinePerth Children's HospitalNedlandsWestern AustraliaAustralia
| | - Fenella J. Gill
- Nursing ResearchPerth Children's HospitalNedlandsWestern AustraliaAustralia,School of Nursing, Faculty of Health SciencesCurtin UniversityPerthWestern AustraliaAustralia
| | - André Schultz
- Wal‐yan Respiratory Research Centre, Telethon Kids InstituteUniversity of Western Australia, Perth Children's HospitalNedlandsWestern AustraliaAustralia,Division of Paediatrics, Faculty of MedicineUniversity of Western AustraliaCrawleyWestern AustraliaAustralia,Department of Respiratory and Sleep MedicinePerth Children's HospitalNedlandsWestern AustraliaAustralia
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42
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Zhu J(J, Wang S. Internationalization, cultural appreciation and institutional governmentality for quality control in transnational higher education cooperation: An empirical assessment. PLoS One 2022; 17:e0274989. [PMID: 36136964 PMCID: PMC9498945 DOI: 10.1371/journal.pone.0274989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/07/2022] [Indexed: 11/18/2022] Open
Abstract
This article examines the dynamic mechanism of cultural appreciation and institutional governmentality to ensure successful quality control in a transnational higher education collaboration context. Adopting participatory action research and a case study approach, this paper investigates the quality control system in a Chinese tourism university. The present study finds that mutual cultural appreciation, responsible government guidance and institutional governmentality are essential quality control measures for transnational higher education cooperation. The quality control system is suggested to be established to enrich and improve the quality standards of joint international higher education collaboration. This study proposes to expand the international influence and recognition of China-foreign education collaboration through quality international exchange and cooperation.
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Affiliation(s)
- Jinsheng (Jason) Zhu
- Scholar, Belt and Road International School, Guilin Tourism University, Guilin, Guangxi, China
- Visiting Scholar, School of Politics and Public Administration, Guangxi Normal University, Guilin, Guangxi, China
| | - Shushu Wang
- Scholar, International Exchange & Cooperation Department, Guilin Tourism University, Guilin, Guangxi, China
- * E-mail:
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O'Donnell CA, Macdonald S, Browne S, Albanese A, Blane D, Ibbotson T, Laidlaw L, Heaney D, Lowe DJ. Widening or narrowing inequalities? The equity implications of digital tools to support COVID-19 contact tracing: A qualitative study. Health Expect 2022; 25:2851-2861. [PMID: 36063060 PMCID: PMC9538145 DOI: 10.1111/hex.13593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/07/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022] Open
Abstract
Background As digital tools are increasingly used to support COVID‐19 contact tracing, the equity implications must be considered. As part of a study to understand the public's views of digital contact tracing tools developed for the national ‘Test and Protect’ programme in Scotland, we aimed to explore the views of groups often excluded from such discussions. This paper reports on their views about the potential for contact tracing to exacerbate inequalities. Methods A qualitative study was carried out; interviews were conducted with key informants from organizations supporting people in marginalized situations, followed by interviews and focus groups with people recruited from these groups. Participants included, or represented, minority ethnic groups, asylum seekers and refugees and those experiencing multiple disadvantage including severe and enduring poverty. Results A total of 42 people participated: 13 key informants and 29 members of the public. While public participants were supportive of contact tracing, key informants raised concerns. Both sets of participants spoke about how contact tracing, and its associated digital tools, might increase inequalities. Barriers included finances (inability to afford smartphones or the data to ensure access to the internet); language (digital tools were available only in English and required a degree of literacy, even for English speakers); and trust (many marginalized groups distrusted statutory organizations and there were concerns that data may be passed to other organizations). One strength was that NHS Scotland, the data guardian, is seen as a generally trustworthy organization. Poverty was recognized as a barrier to people's ability to self‐isolate. Some participants were concerned about giving contact details of individuals who might struggle to self‐isolate for financial reasons. Conclusions The impact of contact tracing and associated digital tools on marginalized populations needs careful monitoring. This should include the contact tracing process and the ability of people to self‐isolate. Regular clear messaging from trusted groups and community members could help maintain trust and participation in the programme. Patient and Public Contribution Our patient and public involvement coapplicant, L. L., was involved in all aspects of the study including coauthorship. Interim results were presented to our local Public and Patient Involvement and Engagement Group, who commented on interpretation and made suggestions about further recruitment.
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Affiliation(s)
- Catherine A O'Donnell
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Sara Macdonald
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Susan Browne
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Alessio Albanese
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - David Blane
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Tracy Ibbotson
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland.,Public and Patient Involvement and Engagement Group, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland
| | - Lynn Laidlaw
- Public and Patient Involvement and Engagement Group, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland
| | - David Heaney
- Rossall Research and Consultancy, Ullapool, Scotland
| | - David J Lowe
- NHS Greater Glasgow and Clyde, Digital Health and Care Institute, University of Glasgow, Glasgow, Scotland
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Gichunge C, Jepkemoi G, Kidwaro F. “Sitawahi Sahau Hasara Nilipata” (I Will Never Forget the Losses I Incurred): Impact of Covid-19 on Food System Actors at the Eldoret Food Market in Kenya. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2022. [DOI: 10.1080/19320248.2022.2119118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
| | - Gladys Jepkemoi
- Department of Human Nutrition and Dietetics, Kabarak University, Kabarak, Kenya
| | - Fanson Kidwaro
- Department of Agriculture, Illinois State University, Clarence,Normal, Illinois, USA
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Mbonye M, Siu G, Seeley J. The meaning of fatherhood to men in relationships with female sex workers in Kampala, Uganda: The struggle to model the traditional parameters of fatherhood and masculinity. PLoS One 2022; 17:e0273298. [PMID: 36044520 PMCID: PMC9432681 DOI: 10.1371/journal.pone.0273298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/05/2022] [Indexed: 11/20/2022] Open
Abstract
Many women who engage in sex work in sub-Saharan Africa become pregnant, often unintentionally. There is limited attention paid to the experiences of fathers of children born to women engaged in sex work. We examine the meaning of fatherhood to these men, the significance of children, and how they navigate the economic and cultural challenges of fatherhood in this context. Analysis is based on ethnographic data from 13 men who identified as intimate long-term partners of female sex workers (FSW) in Kampala City, Uganda. Our findings illustrate how men who have children with FSW struggled to model the traditional parameters of fatherhood and masculinity. We found that men who had children with FSW faced hurdles fitting within the social construction of ideal fatherhood. Accepting fatherhood often started with doubts over the pregnancy because of the multiple partnerships of women. Men who only saw themselves as clients struggled to adjust to being fathers because of their perceptions of the social implications of fathering a child with a FSW. Integration of mothers who were also sex workers into the man's extended family was a challenge because of the fear of negative reactions from family members. However, when men accepted their roles as fathers, they started seeing value in their children. Due to poverty, most of the men fell short of the societal measures of masculinity, but children transformed their social status before their society and family. The provider role often used to define good fathering was a challenge for men. However, the financial support from FSW partners softened the burden and facilitated the creation of a family environment constructed to the perceived standards of the broader society. Our findings provide insights into the state of parenting among FSW and their partners which can guide interventions that are tailored to their unique circumstances.
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Affiliation(s)
- Martin Mbonye
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Godfrey Siu
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Global Health and Development Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Janet Seeley
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Global Health and Development Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Factors influencing the preparedness for the implementation of the national health insurance scheme at a selected hospital in Gauteng Province, South Africa. BMC Health Serv Res 2022; 22:1006. [PMID: 35933346 PMCID: PMC9357321 DOI: 10.1186/s12913-022-08367-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/25/2022] [Indexed: 11/25/2022] Open
Abstract
Research studies as well as anecdotal evidence suggest that there are challenges regarding the NHI plan implementation. These include problems such as an increase in illnesses and a shortage of personnel to drive the project in South African public hospitals. This is exacerbated by the existing situation of most government-funded healthcare institutions, which are characterized by bad administration, insufficient budget, inadequate infrastructure, and insufficient drug supply, as highlighted in several studies. The hospital under investigation is one such facility, with a history of patients sleeping on the floor and people being turned away owing to a shortage of experts and an overburdened staff. This situation is concerning, given that the government claims to be providing appropriate funds to the institution. The hospital under research is highly regarded by the surrounding community. However, a visit by the Health MEC in 2014 revealed that the facility had insufficient sanitary standards and a high complaint rate. Based on the foregoing, as well as the difficulties that both employees and patients are confronted with at the selected hospital, the question that emerges is whether the hospital is fit for the implementation of the NHI. Aim: The aim of this study was to assess the preparation for the launch of the national health insurance scheme at a Johannesburg hospital. Setting: The study was conducted at a hospital situated in eastern suburbs of Johannesburg, Gauteng, South Africa. Method: The study employed a qualitative method with an explorative, descriptive, qualitative study design. The population consisted of selected hospital employees, such as doctors, dispensary officers, hospital managers, human resources workers, facility managers, and administration record officials who were employed at the selected hospital. Purposive sampling was used to select participants. Sample size: Category saturation was used to determine the sample size. The participants for the study were chosen using purposeful sampling, with the researcher aiming for those who were familiar with the NHI scheme at the institution. Semi structured interviews and a focus group discussion were used to gather data. The data from the focus group discussion and semi-structured interviews were analysed using thematic analysis. Results: The investigation found that the hospital was preparing to for the NHI implementation, but that was riddled with lack of resources, poor infrastructure, lack of training, delays in development and poor technological advances. Recommendations: The paper suggests that human resources be increased, infrastructure be upgraded, medicines and equipment be increased, and enough training on NHI implementation be provided. Contribution: The paper adds to the body of knowledge regarding the NHI in South Africa.
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Patients' experiences of home-based psychotherapy via videoconference: A qualitative study. Arch Psychiatr Nurs 2022; 39:91-96. [PMID: 35688550 DOI: 10.1016/j.apnu.2022.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 01/09/2022] [Accepted: 03/08/2022] [Indexed: 11/21/2022]
Abstract
The aim of this study is to explore adult outpatients' experiences with home-based psychotherapy via videoconferencing in a Danish mental health service. Participants found videoconferencing-based psychotherapy for preventive relapse sessions very useful, and they believed that it was possible to maintain a good therapeutic relationship via videoconferencing when they knew their therapist in advance. However, experiences with more in-depth psychotherapy are more unclear as some felt alienated and preferred other ways to communicate. In general, participants found videoconferencing-based psychotherapy to be less personal but worth considering when travel hassles outweigh the need for meeting in person.
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Tizifa TA, Gowelo S, Kabaghe AN, McCann RS, Malenga T, Nkhata RM, Kadama A, Chapeta Y, Takken W, Phiri KS, van Vugt M, van den Berg H, Manda-Taylor L. Community-based house improvement for malaria control in southern Malawi: Stakeholder perceptions, experiences, and acceptability. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000627. [PMID: 36962454 PMCID: PMC10021647 DOI: 10.1371/journal.pgph.0000627] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/23/2022] [Indexed: 11/18/2022]
Abstract
House improvement (HI) refers to the full screening or closing of openings such as windows, doors, and eaves, as well as the installation of ceilings, to reduce mosquito-human contact indoors. HI is a viable supplementary intervention that reduces malaria transmission further than the existing strategies alone. In Malawi, HI has not been widely implemented and evaluated for malaria control. Concerns about lack of local evidence, durability in different epidemiological and cultural settings, and the cost of large-scale implementation are among the reasons the strategy is not utilised in many low-income countries. This study assessed community perceptions, experiences, and acceptability of community-led HI in Chikwawa district, southern Malawi. This was a qualitative study where separate focus group discussions were conducted with members from the general community (n = 3); health animators (n = 3); and HI committee members (n = 3). In-depth interviews were conducted with community members (n = 20), and key-informant interviews were conducted with health surveillance assistants and chiefs (n = 23). All interviews were transcribed and coded before performing a thematic content analysis to identify the main themes. Coded data were analysed using Nvivo 12 Plus software. Study participants had a thorough understanding of HI. Participants expressed satisfaction with HI, and they reported enabling factors to HI acceptability, such as the reduction in malaria cases in their villages and the safety and effectiveness of HI use. Participants also reported barriers to effective HI implementation, such as the unavailability and inaccessibility of some HI materials, as well as excessive heat and darkness in HI houses compared to non-HI houses. Participants indicated that they were willing to sustain the intervention but expressed the need for strategies to address barriers to ensure the effectiveness of HI. Our results showed the high knowledge and acceptability of HI by participants in the study area. Intensive and continued health education and community engagement on the significance of HI could help overcome the barriers and improve the acceptability and sustainability of the intervention.
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Affiliation(s)
- Tinashe A. Tizifa
- Division of Internal Medicine, Department of Infectious Diseases, Center for Tropical Medicine and Travel Medicine, University of Amsterdam, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, The Netherlands
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Steven Gowelo
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
| | - Alinune N. Kabaghe
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Robert S. McCann
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
- Centre for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Tumaini Malenga
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
- African Institute for Development Policy, Lilongwe, Malawi
| | - Richard M. Nkhata
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Asante Kadama
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Yankho Chapeta
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
- Biological Sciences Department, Mzuzu University, Mzuzu, Malawi
| | - Willem Takken
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
| | - Kamija S. Phiri
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Michele van Vugt
- Division of Internal Medicine, Department of Infectious Diseases, Center for Tropical Medicine and Travel Medicine, University of Amsterdam, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Henk van den Berg
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
| | - Lucinda Manda-Taylor
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
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Beksinska A, Nyariki E, Kabuti R, Kungu M, Babu H, Shah P, Nyabuto C, Okumu M, Mahero A, Ngurukiri P, Jama Z, Irungu E, Adhiambo W, Muthoga P, Kaul R, Seeley J, Weiss HA, Kimani J, Beattie TS. Harmful Alcohol and Drug Use Is Associated with Syndemic Risk Factors among Female Sex Workers in Nairobi, Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7294. [PMID: 35742558 PMCID: PMC9223659 DOI: 10.3390/ijerph19127294] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/31/2022] [Accepted: 06/08/2022] [Indexed: 02/04/2023]
Abstract
Background: Female Sex Workers (FSWs) are at high risk of harmful alcohol and other drug use. We use quantitative data to describe the prevalence of alcohol and other drug use and identify associated occupational and socio-economic risk factors, and aim to elucidate patterns of alcohol and drug use through information drawn from qualitative data. Methods: Maisha Fiti was a mixed-method longitudinal study conducted in 2019 among a random sample of FSWs in Nairobi, Kenya. We used baseline date from the behavioural−biological survey, which included the WHO Alcohol, Smoking and Substance Involvement Screening Test that measures harmful alcohol and other drug use in the past three months (moderate/high risk score: >11 for alcohol; >4 for other drugs). In-depth interviews were conducted with 40 randomly selected FSWs. Findings: Of 1003 participants, 29.9% (95%CI 27.0−32.6%) reported harmful (moderate/high risk) alcohol use, 21.5% harmful amphetamine use (95%CI 19.1−24.1%) and 16.9% harmful cannabis use (95%CI 14.7−19.2%). Quantitative analysis found that harmful alcohol, cannabis and amphetamine use were associated with differing risk factors including higher Adverse Childhood Experience (ACE) scores, street homelessness, food insecurity (recent hunger), recent violence from clients, reduced condom use, depression/anxiety and police arrest. Qualitative interviews found that childhood neglect and violence were drivers of entry into sex work and alcohol use, and that alcohol and cannabis helped women cope with sex work. Conclusions: There is a need for individual and structural-level interventions, tailored for FSWs, to address harmful alcohol and other drug use and associated syndemic risks including ACEs, violence and sexual risk behaviours.
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Affiliation(s)
- Alicja Beksinska
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK; (P.S.); (J.S.); (T.S.B.)
| | - Emily Nyariki
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Rhoda Kabuti
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Mary Kungu
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Hellen Babu
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Pooja Shah
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK; (P.S.); (J.S.); (T.S.B.)
| | - The Maisha Fiti Study Champions
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Chrispo Nyabuto
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Monica Okumu
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Anne Mahero
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Pauline Ngurukiri
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Zaina Jama
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Erastus Irungu
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Wendy Adhiambo
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Peter Muthoga
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada;
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK; (P.S.); (J.S.); (T.S.B.)
| | - Helen A. Weiss
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | - Joshua Kimani
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Tara S. Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK; (P.S.); (J.S.); (T.S.B.)
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Mbonye M, Siu G, Seeley J. Conflicted masculinities: understanding dilemmas and (re)configurations of masculinity among men in long-term relationships with female sex workers, in Kampala, Uganda. CULTURE, HEALTH & SEXUALITY 2022; 24:856-869. [PMID: 33821770 PMCID: PMC7612843 DOI: 10.1080/13691058.2021.1891569] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 02/14/2021] [Indexed: 06/12/2023]
Abstract
This ethnographic study explores the experience of men in long-term relationships with sex workers and their construction of masculine identities in Kampala, Uganda. Data were collected in 2019 and comprise in-depth interviews with 13 male partners and two group discussions of women with long-term male partners. Thematic analysis used an intersectional lens to frame reconfigurations of gender and masculinity in the context of relationships with sex workers. All men had been clients of sex workers before progressing to become long-term partners. We discuss the complex ways in which men participated in value systems of respectability and reputation to (re)configure gender relations that made sense of their long-term relationships with sex workers. Men viewed their relationships with women through the normative lens of traditional masculine roles associated with monopoly over a partner's sexuality, provider and father. However, poverty, HIV, the failure to have exclusive sexual rights over a partner, and the shame associated with sex work intersected and disrupted masculinities. Despite this, men found meaning in these relationships through the woman's commitment to the relationship, her financial support, her help in accessing HIV services, and the children from the relationship, thereby attaining respectability and avoiding a crisis of masculinity.
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Affiliation(s)
- Martin Mbonye
- College of Health Sciences, School of Medicine, Makerere University, Kampala, Uganda
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Godfrey Siu
- College of Health Sciences, School of Medicine, Makerere University, Kampala, Uganda
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Global Health and Development Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Global Health and Development Department, London School of Hygiene and Tropical Medicine, London, UK
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