Conducting qualitative interviews by telephone: Lessons learned from a study of alcohol use among sexual minority and heterosexual women

Exploring Patient Experiences With and Perceptions of Robotic-Assisted Surgery in Denmark

Although the use of robotic-assisted surgery (RAS) is increasing worldwide, qualitative research on the patient experience with RAS is lacking. To understand patients' perioperative experiences, the authors conducted semi-structured interviews with five elective surgical patients from two regional hospitals. The interviews were structured to explore patient experiences that may reflect the implementation of enhanced recovery after surgery protocols. The transcribed interviews were analyzed, coded, and interpreted within a hermeneutic framework. Findings revealed three themes: perceptions of RAS as a surgical modality, preoperative preparation was soothing, and health care professionals influence the patient experience. The authors noted that although the participants reported limited knowledge of RAS, they generally felt positive about its use. The competence and demeanor of health care professionals may influence patients' experiences and perceptions of outcomes, and positive clinical outcomes may overcome negative perioperative experiences.

Social Work and Sexual Minorities: The Health and Psychosocial Realities of Queer Men in Nigeria and Its Implication for Social Work Practice

BACKGROUND

Nigeria is a nation characterized by diverse cultures, religions, and policies that often foster discrimination, oppression, and violence against sexual minorities. This hostile environment can significantly impact social work practices involving these groups. Consequently, this study aimed to investigate the health and psychosocial realities of queer men in Nigeria and their implications for social work practice.

METHODS

A qualitative phenomenological approach was adopted for the study. Data were collected from 28 participants, including 16 queer men and 12 social workers, and analyzed thematically.

RESULTS

The findings revealed experiences of discrimination and insecurity, which contribute to both physical and psychological health issues. Additionally, the study highlighted a lack of understanding and acceptance among social workers regarding practices involving sexual minorities in Nigeria.

DISCOURSE

The results highlight how queer individuals may experience limited access to healthcare and receive limited support from social workers in advancing their healthcare needs.

CONCLUSION

It is recommended that social work education incorporate discussions around working with sexual minorities, as a better understanding of this population will enhance acceptance, improve practice, and encourage advocacy for reform in discriminatory policies and practices.

Help-seeking among pregnant and parenting women who use drugs: Mitigating stigma through relationships

BACKGROUND

Pregnant and parenting women who use drugs experience high rates of stigma when navigating the health care system, due to the gendered impacts of punitive drug policies and assumptions that conflate substance use with an inability to parent. There is a lack of research examining how stigma uniquely impacts pregnant and parenting women who use drugs, particularly with regards to self-efficacy and motivations to access health and social services, and other personal experiences of help-seeking processes. This study explores how stigma is internalized, anticipated, and embodied in the context of help-seeking, among pregnant and parenting women who use drugs.

METHODS

Semi-structured telephone interviews were conducted from October 2020-February 2021 with current and past clients of integrated treatment programs in Ontario, designed for women who are pregnant and parenting young children (n = 24). Participants were asked to reflect upon their service experiences prior to COVID-19.

RESULTS

Applying an interpretive description approach, the following themes emerged: (1) stigma and avoidance of help-seeking (2) stigma at the structural level: barriers to care and (3) mitigating stigma to enhance help-seeking: facilitating recovery through relationships.

CONCLUSION

Expressions of judgement have negative impacts on self-esteem and can foster internalized stigma, while disclosure of substance use in motherhood can threaten to damage interpersonal relationships. At the same time, supportive relationships can buffer against stigma-related harms. Service invisibility and implicit bias within the medical community further deter help-seeking, with negative past experiences compounding mistrust of the system. To promote conditions that are supportive of help-seeking and healthy outcomes for this population, compassion and empathy are critical.

Exploring views and experiences of childbirth-related perineal trauma: a qualitative study protocol for developing a wound management tool and care pathway

INTRODUCTION

Childbirth-related perineal trauma (CRPT) is the most common complication of childbirth, affecting 80% of women after a vaginal birth. However, there is a lack of evidence regarding the care of women following CRPT. Specifically, there is a lack of understanding regarding appropriate postnatal CRPT management, wound assessment and treatment of complications. To improve maternal outcomes, this qualitative study aims to explore women's and healthcare professionals' (HCPs) views and experiences of current CRPT wound management and healing to understand what they would want from an assessment tool and related care pathway being developed by the Chapter programme of research.

METHODS AND ANALYSIS

A qualitative study guided by an interpretive descriptive approach will be undertaken to explore the views and experiences around CRPT. This will be conducted through individual interviews and focus groups with women (n∼40 participants) who have experienced CRPT within the last 12 months and individual interviews with HCPs (n∼25) who care for women who have experienced CRPT. Supported by specialist interpreters where needed, data collection will be audio recorded and transcribed. Data will initially be analysed using codebook thematic analysis for targeted analysis and then using the Framework Method to facilitate a systematic and flexible exploration of themes within and between groups.

ETHICS AND DISSEMINATION

This study has received ethical approval from the University of Birmingham Science, Technology, Engineering and Mathematical Ethics Review Committee (ERN_23-0666). Supported by a Patient Advisory Group, this study will contribute to the overall outputs and dissemination of the Chapter programme of research, including a core outcome set for trials investigating the care of women experiencing CRPT, the development of a Wound Assessment Tool, professional resources and guidelines for best practice and patient resources. Findings will be disseminated via conference presentations, peer-reviewed publications, the National Institute for Health and Care Research Journals Library, relevant media platforms and plain language summaries, including infographics.

ISRCTN REGISTRATION NUMBER

45172.

Pain Assessment and Management in Dementia Care: Qualitative Perspectives of People With Dementia, Their Families, and Healthcare Professionals

AIM

Pain is under-assessed and under-treated among people living with dementia. This study aims to explore the perspectives of people with dementia, family carers, and healthcare professionals regarding their experiences and needs for pain assessment and management.

DESIGN

A qualitative descriptive approach.

METHODS

Between May and August 2023, people with early-stage dementia (n = 6), their family carers (n = 7), and healthcare professionals (n = 10) from four Australian states participated in semi-structured interviews, online or by telephone. Most of the participants were female. Work experience of healthcare professionals and caring experience of carers ranged from 3-40 and 2-8 years, respectively. Following transcription, the data were analysed using inductive thematic analysis.

RESULTS

Four main themes and 10 subthemes were identified. Main themes were (1) communications to identify pain in people with dementia, (2) pain assessment in people with dementia, (3) pain management strategies, and (4) training in pain and dementia care. Healthcare professionals and family carers reported challenges in pain identification. People with dementia also mentioned their pain being unrecognised by carers. Facilitators included familiarity and communication with people with dementia and family carers. Non-verbal cues and unusual behaviours were commonly used to identify pain, and a personalised pain assessment approach was highlighted. Non-pharmacological strategies were used as the first-line therapy to manage pain. However, a lack of knowledge and training in pain and dementia care indicated the need for a training program (e.g., a self-paced online short course).

CONCLUSIONS

Pain assessment and management in people with dementia is challenging, primarily due to communication barriers and a lack of skill training. Formal pain assessment and management training and efficient, easy-to-use pain assessment tools are needed to address this.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Limited communication capacity in people with dementia and lack of training in carers are key challenges regarding pain assessment and management in people with dementia. Improved training in communication, pain assessment, and management skills may help to address these challenges.

IMPACT

This study addressed a lack of knowledge and skills for healthcare professionals and family carers in effective pain assessment and management in people with dementia. Collaborative communication among different stakeholders and skills training may overcome the challenges and barriers.

REPORTING METHOD

COREQ guidelines were followed when reporting this study.

PATIENT OR PUBLIC CONTRIBUTION

Healthcare professionals, people with dementia, and family carers contributed to the design of interview questions and data collection.

Exploring the experience of people with shoulder osteoarthritis and their perceptions of non-surgical management: A qualitative study

ObjectiveTo investigate the experience of people with shoulder osteoarthritis and their perception of non-surgical management in the U.K. National Health Service (NHS).DesignQualitative design, using semi-structured telephone interviews. Two authors (SL and MM) performed coding and theme development following principles of reflexive thematic analysis.SettingPhysiotherapy services within three NHS trusts in England. Individual interviews were conducted with patients with a diagnosis of shoulder osteoarthritis.ParticipantsTen participants were recruited (age range 57-86 years; six females; five with bilateral shoulder osteoarthritis).ResultsParticipants reported significant pain, functional limitations, and emotional distress. Non-surgical management experiences varied, with some finding relief from steroid injections, analgesia, and physiotherapy, while others reported limited perceived effectiveness. All participants expressed a desire for more information and support. There were divergent views on the need for surgery.ConclusionThis is the first study to explore the experiences of people with symptomatic shoulder osteoarthritis who have received care within an NHS setting. It highlights the significant impact of shoulder osteoarthritis on daily life and the challenges faced in accessing appropriate care. Findings emphasise the need for patient-centred care, including education, support, information provision and consideration of psychosocial factors. Future research is required to develop an evidence-based guideline for non-surgical management of shoulder osteoarthritis.

A Multi-Stakeholder Qualitative Evaluation of ED PLUS: A Physiotherapy-Led Transition to Home Intervention for Older Adults Following Emergency Department Discharge

Introduction

Older adults frequently attend Emergency Departments (EDs) and experience high rates of adverse outcomes, including functional decline, re-presentation, and unplanned hospital admissions. Developing effective interventions to prevent these outcomes is a priority. Healthcare providers (HCPs) are well positioned to create integrated care pathways for older adults discharged from the ED. ED PLUS is a physiotherapy-led, multidisciplinary model that bridges the care transition between the ED and the community. It initiates a Comprehensive Geriatric Assessment (CGA) in the ED and provides multidisciplinary follow-up to the patient for six weeks post-discharge.

Purpose

This study aimed to explore the views and experiences of older adults and HCPs involved in the ED PLUS intervention to inform the design of a future definitive trial.

Methods

A descriptive qualitative design was used. Older adults (n = 9) and HCPs (n = 10) who participated in the intervention arm of the ED PLUS trial were invited to participate in semi-structured interviews exploring their experience and perspective of the ED PLUS intervention. These interviews were audio-recorded, transcribed, and analysed using reflexive thematic analysis.

Results

Nine older adults and six HCPs consented to participate. The evaluation highlighted stakeholders' experiences and suggested modifications for optimising ED PLUS. Four themes emerged: ED PLUS bridged the transition between care settings for older adults.Stakeholder collaboration and investment were key enablers of implementation.Organisational, logistical, and personnel issues impeded the intervention's delivery.There is potential for service optimisation and expansion.

Conclusion

This evaluation emphasises the important role of physiotherapists and other HCPs in transitional care delivery for older adults. The findings will inform future trials of the ED PLUS model, aiming to improve outcomes for this population.

Psychosocial wellbeing and risk perception of older adults during COVID-19 pandemic in Nigeria: perspectives on the role of social workers

Background

The COVID-19 pandemic presented a 'double-edged sword' for older adults: not only were they more susceptible to the virus, but its broader consequences also exacerbated other challenges, particularly those related to psychosocial well-being. Limited evidence exists on how older adults perceive the pandemic and its impact on their well-being and the role of social workers in addressing these challenges, particularly in resource-limited settings like Nigeria.

Aim

This study explored older adults' perceived risks regarding COVID-19, its impact on their psychosocial well-being, and the role of social workers in addressing these challenges in Nigeria.

Methods

A phenomenological and exploratory research design was used. In-depth interviews (IDIs) were conducted with 16 older adults and 4 social workers in Onitsha metropolis, Anambra State, Southeast Nigeria. Data were analyzed through reflexive thematic analysis.

Results

The findings revealed that the COVID-19 restrictive measures negatively impacted the psychosocial well-being of older adults, where social isolation, lack of support, the inability to engage in wellbeing activities, and emotional trauma collectively contributed to a significant decline in their mental and emotional health. Additionally, widespread misconceptions about the origin of COVID-19 led to reluctance in adopting preventive measures. While social workers provided some awareness and counselling sessions, their involvement was limited. Social workers were not recognized as part of the frontline response team, and their efforts were primarily constrained by governmental and institutional neglect.

Conclusion

The findings highlight the need for policy initiatives to enhance social workers involvement in strengthening the psychosocial resilience of older adults and addressing misconceptions during public health emergencies. Comprehensive strategies are essential for safeguarding the psychosocial well-being of older adults in future pandemics or similar crises.

Understanding Older Adults' Intention to Use Telehealth: A Qualitative Study Using the UTAUT Framework

INTRODUCTION/OBJECTIVES

As healthcare embraces telehealth, a need exists to understand factors that promote older adults' telehealth usage, including the influence of age-related sensory impairments. The objective of this study was to describe older adults' perceptions of telehealth and factors they considered before using telehealth within the framework of The Unified Theory of Acceptance and Use of Technology (UTAUT).

METHODS

This descriptive qualitative study collected data through semi-structured interviews. Twenty-four older adults were randomly selected from a pool of 103 participants who completed the initial UTAUT survey study. Individual interviews were conducted by telephone. Reflective thematic analysis was used to identify themes within the UTAUT construct that influence older adults' use of telehealth.

RESULTS

Older adults identified preparedness, receptiveness, and willingness to use telehealth as important overarching factors to consider when using telehealth. These are connected to the UTAUT constructs: facilitating conditions, social influence, effort expectancy, and performance expectancy.

CONCLUSIONS

This study supports UTAUT as an appropriate framework for assessing telehealth readiness and predicting behavioral intention to use telehealth. Our findings provide limited evidence that sensory impairments do not impact telehealth readiness unless the individual lacks appropriate adaptations.

Diabetes distress in Veterans with type 2 diabetes mellitus: Qualitative descriptive study

Diabetes distress (DD) is a negative psychosocial response to living with type 2 diabetes mellitus (T2DM). We sought insight into Veterans' experiences with DD in the context of T2DM self-management. The four domains in the Diabetes Distress Scale (i.e. regimen, emotional, interpersonal, healthcare provider) informed the interview guide and analysis (structural coding using thematic analysis). The mean age of the cohort (n = 36) was 59.1 years (SD 10.4); 8.3% of patients were female and 63.9% were Black or Mixed Race; mean A1C was 8.8% (SD 2.0); and mean DDS score was 2.4 (SD 1.1), indicating moderate distress. Veterans described DD and challenges to T2DM self-management across the four domains in the Diabetes Distress Scale. We found that (1) Veterans' challenges with their T2DM self-management routines influenced DD and (2) Veterans experienced DD across a wide range of domains, indicating that clinical interventions should take a "whole-person" approach.Trial Registration: NCT04587336.

Empowered or challenged? The dual impact of condition-specific electronic Patient-Reported Outcome Measures in the person-centred care of women with breast cancer: A qualitative study

PURPOSE

This study aimed to investigate patients' experiences with electronic Patient-Reported Outcome Measures (ePROMs) during follow-up consultations with registered nurses and surgeons in breast cancer care.

METHODS

A qualitative approach was employed, using focused ethnography with participant observations during patient consultations at a Plastic and Breast Surgery outpatient clinic, followed by individual interviews with the patients. Data were analysed using reflexive thematic analysis by Braun and Clarke. The discussion was informed by theory on person-centred practice.

RESULTS

A total of 38 participants were included. ePROMs strengthened person-centred practice by nudging patients to reflect on their health, voice their concerns and engage in active dialogue during consultations, particularly regarding body image issues. The relevance and impact of ePROMs were highly dependent on the timing of the patient's treatment trajectory. Patients found that ePROMs were more meaningful and contextually appropriate when completed during late follow-up. This could be because patients faced challenges with ePROMs, including not understanding their purpose, the need for assistance from relatives and instances when ePROMs were not integrated into consultations.

CONCLUSION

ePROMs can empower patients by facilitating meaningful discussions about body image and other concerns during postoperative follow-up consultations. However, their effectiveness relies on clear communication and proper integration into clinical practice. The results add to existing litterature by highlighting the dual impact of ePROMs, as they can enhance patient-centred care but also present challenges when their purpose is unclear. The implications for future practice include the need to develop strategies that engage diverse patient groups in the ePROM process, supporting equal access to follow-up care and addressing health disparities.

Identifying and understanding how people living with a lower-grade glioma engage in self-management

PURPOSE

Lower-grade gliomas (LGG) are mostly diagnosed in working-aged adults and rarely cured. LGG patients may face chronic impairments (e.g. fatigue, cognitive deficits). Self-management can improve clinical and psychosocial outcomes, yet how LGG patients self-manage the consequences of their tumour and its treatment is not fully understood. This study, therefore, aimed to identify and understand how LGG patients engage in the self-management of their condition.

METHODS

A diverse group of 28 LGG patients (age range 22-69 years; male n = 16, female n = 12; mean time since diagnosis = 8.7 years) who had completed primary treatment, were recruited from across the United Kingdom. Semi-structured interviews were conducted. Informed by a self-management strategy framework developed in cancer, directed content analysis identified and categorised self-management types and strategies used by patients.

RESULTS

Overall, 20 self-management strategy types, comprising 123 self-management strategies were reported; each participant detailed extensive engagement in self-management. The most used strategy types were 'using support' (n = 28), 'creating a healthy environment' (n = 28), 'meaning making' (n = 27), and 'self-monitoring' (n = 27). The most used strategies were 'accepting the tumour and its consequences' (n = 26), 'receiving support from friends (n = 24) and family' (n = 24), and 'reinterpreting negative consequences' (n = 24).

CONCLUSIONS

This study provides a comprehensive understanding of the strategies used by LGG patients to self-manage their health and wellbeing, with a diverse, and substantial number of self-management strategies reported.

IMPLICATIONS FOR CANCER SURVIVORS

The findings will inform the development of a supported self-management intervention for LGG patients, which will be novel for this patient group.

EXpanding Technology-Enabled, Nurse-Delivered Chronic Disease Care (EXTEND): Protocol and Baseline Data for a Randomized Trial

BACKGROUND

Approximately 10-15 % of individuals with type 2 diabetes have persistently poorly-controlled diabetes mellitus (PPDM) despite receiving available care, and frequently have comorbid hypertension. Mobile monitoring-enabled telehealth has the potential to improve outcomes in treatment-resistant chronic disease by supporting self-management and facilitating patient-clinician contact but must be designed in a manner amenable to real-world use.

METHODS

Expanding Technology-Enabled, Nurse-Delivered Chronic Disease Care (EXTEND) is an ongoing randomized trial comparing two 12-month interventions for comorbid PPDM and hypertension: 1) EXTEND, a mobile monitoring-enabled self-management intervention; and 2) EXTEND Plus, a comprehensive, nurse-delivered telehealth program incorporating mobile monitoring, self-management support, and pharmacist-supported medication management. Both arms leverage a novel platform that uses existing technological infrastructure to enable transmission of patient-generated health data into the electronic health record. The primary study outcome is difference in HbA1c change from baseline to 12 months. Secondary outcomes include blood pressure, weight, implementation barriers/facilitators, and costs.

RESULTS

Enrollment concluded in June 2023 following randomization of 220 patients. Baseline characteristics are similar between arms; mean age is 54.5 years, and the cohort is predominantly female (63.6 %) and Black (68.2 %), with a baseline HbA1c of 9.81 %.

CONCLUSION

The EXTEND trial is evaluating two mobile monitoring-enabled telehealth approaches that seek to improve outcomes for patients with PPDM and hypertension. Critically, these approaches are designed around existing infrastructure, so may be amenable to implementation and scaling. This study will promote real-world use of telehealth to maximize benefits for those with high-risk chronic disease.

Living With Spasticity During the COVID-19 Pandemic: A Qualitative Study of Patient, Carer and Physician Experiences

BACKGROUND

Approximately 4.4 million people in England (8% of the total population) are living with a long-term neurological condition. Within this group of vulnerable individuals, there will be individuals living with severe spasticity that requires regular outpatient treatment with botulinum toxin injection. The closure of outpatient spasticity services during the pandemic impacted individuals who required spasticity treatment and their carers, as well as the specialist clinicians responsible for service delivery.

OBJECTIVES

We aimed to gain insight into the experiences of individuals living with spasticity, their carers and a clinical spasticity service lead during the pandemic, and to reflect on potential learning for the future.

METHODS

A qualitative study was designed using semi-structured interviews conducted by telephone. Participants comprised patients living with a long-term neurological condition who attended outpatient spasticity clinics before the start of the pandemic in England, primary carers who accompanied patients attending these clinics and a clinical spasticity service lead. Data were audio recorded, transcribed, anonymised and coded. Data analysis utilised the One Sheet of Paper thematic approach to identify themes, which were discussed and analysed by the interdisciplinary research team and two patient and carer participants.

RESULTS

Out of the 11 participants recruited, aged 36-77 years, seven comprised people living with spasticity related to a long-term neurological condition, three were carers and one was a clinical spasticity service lead. Six participants were male and five were female. Among the participants, four were stroke survivors, two were living with spinal cord injury and one was living with multiple sclerosis. Analysis revealed six major themes: experience of living with spasticity during the pandemic; impact of the pandemic on patient, carer and clinician health; access to and experience of outpatient clinic appointments; coping strategies during the pandemic; system improvements; and learning from the pandemic period.

CONCLUSION

These findings contribute research knowledge to a very limited research knowledge base and suggest that there is scope for improving system and service delivery through the allocation of research funding to senior clinicians working in this specialist area.

Nurses' health promotion practices in rural primary health care in Nigeria. A qualitative study

Nurses play a vital role in providing high-quality primary healthcare and health promotion services. The state of research highlights their often complex operational realities and shows the need for an evidence-based understanding of nurses' perspectives on health promotion practices, especially in low-resource settings. This study focuses on how community health nurses in rural primary healthcare centers in Nigeria perceive their health promotion role and the opportunities and challenges of, and potential entry points for strengthening, their practice. A sample of 10 nurses from eight rural primary healthcare centers in eight local government areas of Anambra state, Nigeria, was purposively selected. Data were collected via semistructured telephone and written interviews and analyzed by qualitative content analysis using a deductive-inductive approach. Nurses emphasized their commitment to supporting patients and communities to develop skills and take control of their own lives. Nurses described their role as facilitators of behavioral and environmental change, individual and community empowerment facilitators as well as social activists. Factors that enhance the health promotion practice of nurses include adequate skills, sufficient human and material resources and community support and participation. Inhibiting factors included insufficient funding, poor working conditions, staff shortages, high workload, lack of training opportunities and low participation of community members. Overcoming challenges and facilitating health promotion activities in rural communities require bolstering nurses by providing further training opportunities for enhancing their health promotion competencies and creating supportive environments. Future research should focus on how to strengthen nurses' health promotion efforts through interprofessional and intersectoral collaboration.

Participants' perceptions support the coexistence of benefits and burdens of cancer clinical trial participation

BACKGROUND

To advance oncology treatment for adults, comprehensive understanding of how and why people decide to enroll in, remain in, and withdraw from cancer clinical trials is needed. While quantitative findings provide insights into these benefits and burdens, they provide limited understanding of how adults with cancer appraise their situation and approach decisions to undertake a clinical trial. The goal of this mixed methods analysis was to conceptualize participants' assessment of benefits and burdens related to cancer clinical trial participation.

MATERIALS AND METHODS

This sub-group analysis of 21 participants was part of a larger sequential, explanatory mixed methods study. We used Creamer's integrated approach to linking quantitative and qualitative data to assess convergence, with qualitative data explaining quantitative results. Participants were grouped into four categories based on quantitative benefit/burden scores and thematic analysis of their qualitative data was used to describe these categories.

RESULTS

Across groups participants varied in descriptions of benefits and burdens of cancer clinical trial participation and reasons for participating. Those reporting high benefit/low burden described "seizing the opportunity to participate;" those reporting low benefit/low burden described "taking responsibility" through trial participation; those reporting low benefit/high burden described how they were "willing to endure," and those with high benefit/high burden emphasized "deciding to act."

CONCLUSIONS

Participants' qualitative descriptions of benefits and burdens were more nuanced and dynamic than reflected in their quantitative ratings. Thus, current measures may be missing important concepts, such as logistic challenges of trial participation. Our results have implications for consenting procedures and decisional support guidance offered to patients and their caregivers.

Collaboration in the return-to-work process after sick leave due to common mental disorders: a qualitative study of stakeholders' views on goals and roles

BACKGROUND

This study explores how the goals of collaboration in the return-to-work (RTW) process for people with common mental disorders are described by the stakeholders involved, and how they experience stakeholders' roles and responsibilities in relation to these goals.

METHODS

Interviews were conducted with 41 participants from three Swedish regions. Nine of the participants were workers, six employer representatives, four occupational health professionals, four social insurance officers, 18 RTW coordinators and five physicians. Thematic analysis was conducted.

RESULTS

Three main themes and overarching goals when collaborating on RTW were identified. In the first theme, 'creating an informative environment', all stakeholders emphasised clear roles and responsibilities. The second theme, 'striving for consensus in an environment of negotiations', addressed negotiations about when and how to collaborate, on what and with whom, and reveal different views on stakeholders' goals, roles and responsibilities in collaboration. The third theme identified goals for 'creating a supportive environment' for both workers and other stakeholders. Coordinators are found to have an important role in achieving a supportive environment, and in neutralising power imbalances between workers and their employers and social insurance officers.

CONCLUSIONS

Competing goals and priorities were identified as hindering successful collaboration, contributing to a spectrum of complex versus easy RTW collaboration. This study suggests some basic conditions for achieving a collaborative arena that is neutral in terms of power balance, where all stakeholders can share their views.

Understanding supported self-management for people living with a lower-grade glioma: Implementation considerations through the lens of normalisation process theory

BACKGROUND

Supported self-management can improve clinical and psychosocial outcomes in people with cancer; the considerations required to implement self-management support (SMS) for people living with a lower-grade glioma (LGG)-who often have complex support needs-are not known. We aimed to identify and understand these implementation considerations through the lens of normalisation process theory (NPT), from the perspectives of healthcare professionals (HCP) and people with LGG.

METHODS

We conducted semistructured interviews with HCPs who support adults with brain tumours (n = 25; 12 different healthcare professions), and people with LGG who had completed primary treatment (n = 28; male n = 16, mean age 54.6 years, mean time since diagnosis 8.7 years), from across the United Kingdom. Interviews were transcribed and inductive open coding conducted, before deductively mapping to constructs of NPT. We first mapped HCP data, then integrated data from people with LGG to explore alignment in experiences and perspectives.

RESULTS

We generated supporting evidence for all four NPT constructs and related subconstructs, namely: 'Coherence', 'Cognitive participation', 'Collective action' and 'Reflexive monitoring'. Data from HCPs and people with LGG clearly demonstrated that effective SMS constitutes a collective activity. Key implementation considerations included: ensuring awareness of, and access to, support; building strong HCP-support recipient relationships; and careful inclusion of close family and friends. We identified pertinent challenges, such as identifying support needs (influenced by the extent to which those with LGG engage in help-seeking), resistance to support (e.g., technology literacy), training for HCPs and HCP cooperation.

CONCLUSIONS

This study demonstrates the collective nature of, and provides insight into the individual roles within, supported self-management. We outline considerations to operationalise, sustain and appraise the implementation of SMS for people with LGG.

PATIENT OR PUBLIC CONTRIBUTION

People with brain tumours, and informal caregivers, were involved in the development of information materials and topic guides to ensure accessibility and pertinence. They also had opportunities to comment on interview findings.

"It changes everything": Understanding how people experience the impact of living with a lower-grade glioma

Background

Quantitative studies show people living with a lower-grade glioma (LGG) often report low health-related quality of life. However, it is unclear how this impact is experienced; resulting supportive care needs are also poorly understood. We explored how people experience the impact of living long-term with an LGG, to help identify potential supportive care needs.

Methods

We conducted semi-structured interviews with a diverse group of people with LGG (n = 28) across the United Kingdom, who had completed primary treatment (male n = 16, female n = 12, mean age 54.6 years, mean time since diagnosis 8.7 years). Interviews were transcribed and inductive thematic analysis was conducted.

Results

Four themes relating to the impact experiences of people with LGG were generated: "Emotional response to the diagnosis," "Living with the 'What ifs'," "Changing relationships," and "Faltering independence." These reflect participants' experiences with symptoms (eg, fatigue, seizures) and impairments (eg, motor dysfunction, cognitive deficits), and how these, in turn, drive impacts on daily living (including on work, relationships, social activities, and transport). Participants spoke about their experiences with profound emotion throughout.

Conclusions

People with LGG can experience wide-ranging everyday impacts and may have extensive supportive care needs. This study highlights how this impact is experienced and what it means to people with LGG. Best practice suggestions for conducting comprehensive needs assessments tailored to those with LGG, and the development of personalized plans to meet those needs, would be a critical step to ensure that people with LGG are best supported in living with their condition.

Lessons Learned From Telephone-Based Data Collection for Health and Demographic Surveillance Systems During the COVID-19 Pandemic in Indonesia

The Sleman Health and Demographic Surveillance System (HDSS) is a longitudinal survey held routinely since 2014 to collect demographic, social, and health changes in Sleman Regency, Special Region of Yogyakarta, Indonesia. During the COVID-19 pandemic in Indonesia, we needed to adjust our method of conducting data collection from in-person to telephone interviews. We describe the Sleman HDSS data collection strategy used and the opportunities it presented. First, the Sleman HDSS team completed a feasibility study and adjusted the standard operational procedures to conduct telephone interviews. Then, the Sleman HDSS team collected data via a telephone interview in September-October 2020. Ten interviewers were equipped with an e-HDSS data collection application installed on an Android-based tablet to collect data. The sample targeted was 5,064 households. The telephone-based data collection successfully interviewed 1,674 households (33% response rate) in 17 subdistricts. We changed the data collection strategy so that the Sleman HDSS could still be conducted and we could get the latest data from the population. Compared to in-person interviewing, data collection via telephone was sufficiently practical. The telephone interview was a safe and viable data collection method. To increase the response rate, telephone number activation could be checked, ways of building rapport could be improved, and engagement could be improved by using social capital.

Experiences and perceptions of nurses and air ambulance service providers in carrying out aeromedical evacuations in Indonesia: A qualitative research

Background

Basic non-military flight nurse training is essential for enhancing nurses' competency in conducting aeromedical evacuations. Trained nurses possessing flight nurse proficiency are indispensable for ensuring stable patient conditions amidst the unique physical, physiological, and psychological challenges encountered during flights.

Objective

This study aimed to describe the experiences and perceptions of nurses and air ambulance service providers regarding aeromedical evacuations.

Methods

This study employed a qualitative descriptive design. Data were gathered from February to July 2023 through semi-structured online interviews with seven nurses and air ambulance service providers engaged in aeromedical evacuation. Content analysis was utilized to interpret the interview data.

Results

Seven themes were generated: 1) Experiences in aeromedical evacuation experiences, 2) Challenges faced by nurses and air ambulance service providers during aeromedical evacuations, 3) Essential knowledge for nurses involved in aeromedical evacuations, 4) Efforts to improve nurses' knowledge and skills, 5) Leveling of flight nurse training, 6) Flight nurse training methods, and 7) Flight nurse training evaluation strategies.

Conclusion

Nurses and air ambulance service providers acknowledge the significant influence of the flight environment on changes in patient conditions during aeromedical evacuations. To effectively manage alterations in patient conditions during flights, healthcare workers equipped with aviation health competency are imperative. One approach to enhancing the competency of healthcare workers is through flight nurse training. The findings from this study serve as a valuable resource for policymakers and health-related institutions endeavoring to formulate aeromedical evacuation strategies.

"We thought we were stronger than we were": adopters' narratives about the adoption journey and disruption

Introduction

Although the majority of adoptive families remain stable, some of them break up prematurely.

Methods

Adopting a qualitative approach, this study gave voice to seven adoption applicants who began the adoption journey with one or more children but did not complete the legal process. Our goal was to understand their experiences throughout the adoption process and disruption.

Results

The results show how adoption applicants went, in a short period, from the excitement of finding a child or sibling group to disillusionment and trauma. The main risk factors that hinder adoption stability include unrealistic expectations, intuitive choice of the child in the absence of accurate information, challenges posed by the child's particular characteristics, and lack of professional support.

Discussion

Our study highlights the need for adopters to be assisted throughout the entire process by specialists, to be better prepared to deal with the complex needs of children in the protection system, and to facilitate their access to a complex of specialized services to meet the different needs of every family.

Assistive products to support daily time management of older persons with dementia in India: experiences and views of informal caregivers and occupational therapists

PURPOSE

The present study aimed to understand how informal caregivers and occupational therapists support daily time management (DTM) of older persons with dementia (PwD) and their views regarding assistive products for DTM, i.e., time management products (TMPs).

METHODS

The study involved a qualitative descriptive approach rooted in principles of naturalistic inquiry. Twelve caregivers of PwD and eight occupational therapists were interviewed. Conventional content analysis was performed.

RESULTS

Findings are described in three categories. The first category "current strategies to support DTM" described the low-tech strategies used for specific cognitive functions. The second category "factors influencing DTM and TMP" entailed factors related to the PwD (especially premorbid time management), the caregiver (multiple caregivers, attitude towards technology), the occupational therapist (impairment-oriented practice, limited resources and training in DTM) and the context (attitude towards time, poor awareness and knowledge of dementia, an expectation of recovery, negative societal attitudes towards devices, affordability/access). The third category "expectations from TMP" described the participants' expectations regarding device-related features (low-cost, easy to use, portable, low maintenance, customisable and useable across the disease continuum) and support for device use (maintenance, caregiver education).

CONCLUSIONS

The study provides contextually relevant recommendations and strategies to inform the provision, acceptance and adherence to DTM interventions and guide the development and prescription of indigenous TMP for PwD in India. Implications for rehabilitationAdoption of time management products (TMPs) for people with dementia in India requires an understanding of contextual factors, especially culturally influenced attitudes of persons with dementia and their family members towards time, assistive products and elders.Contextually relevant approaches and strategies are suggested to guide the provision of daily time management (DTM) interventions including TMPs for people with dementia and their families in India.It is imperative to assess the relevance, acceptance and feasibility of available TMPs for people with dementia and their families living in India and develop contextually relevant indigenous products.Occupational therapists working with people with dementia and their families would benefit from more opportunities for training and access to resources (including contextually relevant standardized assessments) to implement DTM interventions.

Barriers and facilitators to self-management in people living with a lower-grade glioma

PURPOSE

Self-management can have clinical and quality-of-life benefits. However, people with lower-grade gliomas (LGG) may face chronic tumour- and/or treatment-related symptoms and impairments (e.g. cognitive deficits, seizures), which could influence their ability to self-manage. Our study aimed to identify and understand the barriers and facilitators to self-management in people with LGG.

METHODS

We conducted semi-structured interviews with 28 people with LGG across the United Kingdom, who had completed primary treatment. Sixteen participants were male, mean age was 50.4 years, and mean time since diagnosis was 8.7 years. Interviews were audio-recorded and transcribed. Following inductive open coding, we deductively mapped codes to Schulman-Green et al.'s framework of factors influencing self-management, developed in chronic illness.

RESULTS

Data suggested extensive support for all five framework categories ('Personal/lifestyle characteristics', 'Health status', 'Resources', 'Environmental characteristics', 'Healthcare system'), encompassing all 18 factors influencing self-management. How people with LGG experience many of these factors appears somewhat distinct from other cancers; participants described multiple, often co-occurring, challenges, primarily with knowledge and acceptance of their incurable condition, the impact of seizures and cognitive deficits, transport difficulties, and access to (in)formal support. Several factors were on a continuum, for example, sufficient knowledge was a facilitator, whereas lack thereof, was a barrier to self-management.

CONCLUSIONS

People with LGG described distinctive experiences with wide-ranging factors influencing their ability to self-manage.

IMPLICATIONS FOR CANCER SURVIVORS

These findings will improve awareness of the potential challenges faced by people with LGG around self-management and inform development of self-management interventions for this population.

Key stakeholders' perspectives: A gap analysis of hospital-acquired pressure injuries

INTRODUCTION

Hospital-acquired pressure injuries (HAPIs) are a global high-stakes patient safety issue. Key stakeholder perspectives regarding their role and experiences with pressure injuries is critical as part of the solution to minimizing HAPI occurrence and attain sustainability.

DESIGN

A qualitative, descriptive approach provided multiple perspectives of key stakeholders to support the complexity of HAPI care. The qualitative data are a part of a mixed method convergent research study examining pressure injury prevention and management practices.

METHODS

Nursing system theory, mixed method convergent design, and participatory action research methodologies were chosen to address both the gap analysis development and results, achieve collaborative comprehensiveness, and enable key stakeholder involvement throughout this HAPI prevention and management initiative. Participants were recruited and enrolled from a large Level I trauma hospital and the key stakeholders. Demographic information were collected prior to the individual interview. Focused interviews were conducted virtually using zoom technology. Qualitative data were analyzed using NVivo software and thematic analysis was confirmed across the co-investigators for congruence and applicability to the research questions.

RESULTS

Qualitative interviews with 26 key stakeholders provided data to support and integrate a link with gap analysis results on the complex health issue of HAPIs. Specific barrier and recommendation themes identified interventions that could be prioritized. The 52 barrier and 52 recommendation themes/sub-theme(s) respectively were organized by Donabedian (structure, process, and outcome) with structure elements the majority. The top three structure barrier themes involved equipment and standards for use, staff prevention education, and specialized health professionals. The top three structure recommendation themes involved specialized health professionals, equipment and standards for use, and an educational plan for those at risk or with HAPIs.

CONCLUSION

The article provides findings from the qualitative portion of a mixed method study related to HAPIs. The qualitative findings associated with the gap analysis quantitative results, achieved the goal of the participatory action research key stakeholders' input into HAPI care and can be replicated internationally.

CLINICAL RELEVANCE

The benefit of key stakeholder's involvement in solving a clinical problem is sustainability. A quantitative approach and integrating qualitative stakeholders' perspectives provide an in-depth solution that will advance nursing capacity toward health care delivery and HAPI nursing science and policy development on a global level.

The association of sexual minority status and bullying victimization is modified by sex and grade: findings from a nationally representative sample

BACKGROUND

Sexual minority status is associated with face-to-face bullying and cyberbullying victimization. However, limited studies have investigated whether such a relationship differs by sex or grade in a nationally representative sample.

METHODS

We concatenated the national high school data from the Youth Risk Behavior Surveillance System (YRBSS) chronologically from 2015 to 2019, resulting in a sample of 32,542 high school students. We constructed models with the interaction term between sexual minority status and biological sex assigned at birth to test the effect modification by sex on both the multiplicative and additive scales. A similar method was used to test the effect modification by grade.

RESULTS

Among heterosexual students, females had a higher odds of being bullied than males, while among sexual minority students, males had a higher odds of being bullied. The effect modification by sex was significant on both the multiplicative and additive scales. We also found a decreasing trend of bullying victimization as the grade increased among both heterosexual and sexual minority students. The effect modification by the grade was significant on both the multiplicative and the additive scale.

CONCLUSIONS

Teachers and public health workers should consider the difference in sex and grade when designing prevention programs to help sexual minority students.

Exploring the experiences and perceptions of patients awaiting rotator cuff repair surgery: An integrated qualitative study within the POWER pilot and feasibility trial

BACKGROUND

As waiting times for orthopaedic surgery increase, there have been calls to move from 'waiting lists' to 'preparation lists', to better prepare patients for surgery. In this context, a pilot randomised controlled trial (POWER) was conducted, comparing physiotherapist-led exercise to waiting-list control (usual care), for patients awaiting rotator cuff repair surgery. This qualitative study was integrated within the pilot trial.

OBJECTIVES

Explore the experiences of adults awaiting rotator cuff repair surgery in the NHS. Explore the acceptability of the physiotherapist-led exercise intervention. Explore the barriers and enablers to recruitment, retention, and adherence.

DESIGN

Integrated qualitative study with semi-structured telephone interviews.

METHODS

Adults awaiting rotator cuff repair, consenting to participate in the trial were eligible. Sampling was purposive regarding age, gender, randomised allocation, and hospital site. Interviews were audio-recorded and transcribed. Data were analysed using Reflexive Thematic Analysis.

RESULTS

20 participants were recruited (age range 49-81 years; 12 male, 10 randomised to physiotherapist-led exercise). Many participants were unable to recall their experiences of trial processes; nonetheless, three themes were identified from the data: experience of shoulder pain and pathway to treatment; communication and decision-making in the context of rotator cuff repair surgery; and experiences of the POWER physiotherapist-led exercise intervention and processes.

CONCLUSIONS

Patients experience significant burden due to shoulder pain. Their journey to surgery can be long, confusing, and associated with perceived abandonment. In a future trial, the intervention should offer opportunity for shared decision-making, optional exit from the surgical pathway, and an individualised exercise programme.

Parents' experiences of parenting a child with profound intellectual and multiple disabilities in France: A qualitative study

INTRODUCTION

Parents of persons with profound intellectual and multiple disabilities (PIMD) play a major and often lifelong role in the care and support of their child. A better understanding of parents' perspectives regarding their experiences of parenting their child with PIMD is essential to support them more effectively. Although this topic has been explored extensively in Anglo-Saxon and Northern European countries, little is known about the experience of these parents in a highly institutionalized context such as that in France.

OBJECTIVE

We explored parents' experiences of the activities they performed to care for their child with PIMD (namely, the 'parenting work') in the French context.

METHOD

Qualitative semistructured interviews were conducted by telephone with 34 parents of persons with PIMD aged 8-35. The resulting data were analyzed using thematic analysis.

RESULTS

The analysis highlighted the diversity of activities performed by parents as well as the influence of context on the forms of this parenting work. Five themes were developed: (1) navigating the challenges of obtaining medical recognition; (2) negotiating a concealed domain and becoming an expert; (3) unfolding medical and medicosocial care management; (4) navigating the challenges of daily living and (5) shaping one's child's possibilities.

CONCLUSION

This study offers a better understanding of the challenges, levers and expectations of parents of children with PIMD in France. Contextual factors such as the lack of knowledge of PIMD among health professionals, access to knowledge and know-how associated with care management, the administrative complexity of access to care and equipment, institutional issues (e.g., professional turnover) and societal ableism (e.g., access to infrastructures, interpersonal discrimination) shape the work parents perform to support their child's needs. It is necessary to consider contextual aspects to better support these parents and their children. Suggestions for applications are provided in the discussion.

PATIENT OR PUBLIC CONTRIBUTION

One of the researchers, a parent of a child with PIMD, supported the research design and provided feedback on the study's procedures and manuscript.

Challenges and Recommendations for Improving Cancer Research and Practice in Nigeria: A Qualitative Study With Multi-Stakeholders in Oncology Research and Practice

BACKGROUND

Cancers, with increasing incidence and mortality rates, constitute a leading public health problem in Nigeria. As the burden of cancer in Nigeria increases, research and quality service delivery remain critical strategies for improved cancer control across the continuum of care. This study contextualizes the challenges and gaps in oncology research and practice in Nigeria, and presents recommendations to address the gaps.

METHODS

This qualitative study was conducted among interprofessional and interdisciplinary stakeholders in oncology healthcare practice and research in academic settings, between July and September 2021. Key-informant interviews were held with six stakeholders and leaders in nursing, pharmacy, and medicine across the six geopolitical zones of Nigeria, and twenty-four in-depth interviews with early- or mid-career researchers or healthcare professionals involved in cancer prevention and treatment were conducted. The data were analyzed using a deductive thematic analysis approach and coded using the NVIVO 12 software.

RESULTS

Five sub-themes were identified as major challenges to oncology research, including poor funding, excessive workload, interprofessional rivalry, weak collaboration, and denial of cancer diagnosis by patients. Challenges identified for oncology practice were poor governance and financing, high costs of oncology treatments, poor public awareness of cancer, workforce shortage, and interprofessional conflicts. Recommended strategies for addressing these challenges were improved financing of oncology research and practice by government and relevant stakeholders, increasing interest of medical, nursing, and pharmaceutical students in oncology research through curricula-based approach and mentorship, increased oncology workforce, and improved intra- and inter-professional collaboration.

CONCLUSION

These data highlight the challenges and barriers in oncology practice and research in Nigeria, and underscore the urgent need for increased investments in infrastructure to provide interdisciplinary and interprofessional research training for high-quality care. Only then can Nigeria effectively tackle the current and impending cancer burden in the country.

Nurse Reports of Moral Distress During the COVID-19 Pandemic

Background

COVID-19 was devastating for many frontline nurses embroiled in health care's response. Most media outlets reported from several large metropolitan areas in New York, California, and Florida, leaving other regions to wonder about the extent to which their nurses were suffering.

Objective

The purpose of this article was to understand the specific needs and experiences of Northeast Ohio nurses caring for patients with COVID-19 before designing interventions targeting negative mental outcomes.

Methods

This phenomenological study interviewed 16 Northeast Ohio nurses to understand their experiences of caring for patients with COVID-19.

Results

Although not asked about it directly, the participants' stories consistently included details that could be linked to moral distress. Two themes describing their lived experiences included "acquiring moral distress" and "living with moral distress." Additional findings are also reported separately because although they do not represent the lived experience of COVID-19 nursing, they did represent significant concerns that participants had for the future and are reported here to assist other researchers with the intervention design. Furthermore, these participants thought that participation in support groups with other nurses who cared for COVID-19 patients and possibly led by mental health advanced practice nurses offered the best intervention to process their trauma from the pandemic.

Conclusions

The long-term effects of moral distress have been discussed routinely in recent literature and are further complicated by the effects of the COVID-19 pandemic. Threats to the shrinking workforce of nurses must be taken seriously and interventions to improve the mental health and morale of frontline nurses must be prioritized and tested.

Adapting a pregnancy app (HealthyMoms) to support healthy habits in migrant women-a qualitative study on women's preferences and perceived needs to support health behaviors during pregnancy

Background

Healthy lifestyle behaviors in pregnancy are important for maternal and offspring health. Mobile health (mHealth) tools have potential to provide support for lifestyle behaviors at scale but such tools are commonly developed only in native languages, limiting reach in migrant populations.

Objectives

This qualitative study, in two of the largest migrant populations in Sweden (Arabic- and Somali-speaking women), aimed to explore (a) perceptions and needs of knowledge and support related to pregnancy and lifestyle behaviors and (b) needs of and attitudes towards a pregnancy app and how features and content in the app can be adapted to support healthier lifestyle behaviors in migrant women.

Method

Individual semi-structured interviews were conducted with Arabic (n = 10) and Somali-speaking women (n = 9). Data was analyzed using content analysis (inductive latent approach).

Results

Arabic- and Somali-speaking women described an increased need of knowledge regarding pregnancy and lifestyle behaviors. The social environment could both motivate behavior change and be a source of misinformation. Women expressed great trust in maternity healthcare but requested more information related to lifestyle behaviors. A pregnancy app was perceived as a helpful tool to support healthy lifestyle behaviors. Mere translations were suggested to be valuable, however, audio- and video-format to deliver content and inclusion of women's partners in the app were described as desirable adaptations.

Conclusion

Our findings can guide maternity healthcare on what support migrant women need and inform future development of mHealth tools for pregnant migrant populations. Future research should disentangle the degree of cultural adaptations required for mHealth lifestyle interventions provided by healthcare.

Thematic Daily Sleep Routine Analysis of Adults Not in Employment Living with Type 2 Diabetes Mellitus

BACKGROUND

Day-to-day variations in sleep timing have been associated with poorer glycemic control in type 2 diabetes mellitus, although the factors that influence this sleep timing variability are poorly understood.

METHODS

Daily routines of sleep in a sample of seventeen adults with type 2 diabetes mellitus who were either retired or not currently working were examined qualitatively through the application of semi-structured interviews and a thematic analysis of the resulting transcripts.

RESULTS

Four themes were identified: "Consistent Sleeping Patterns", "Fluctuating Sleep Timing", "Night-Time Disruptions" and "Lasting Effort Needed with Type Two Diabetes Mellitus". The subthemes reflected that many participants had consistent sleep schedules across the seven-day week, but that a desire to maintain a sense of normality, household routines, television schedules and socializing were associated with different sleep timing on weekends. Active disease monitoring and timed medication taking were not identified as important factors in shaping sleep timing. Nocturia, stress and rumination were identified as important factors linked to disrupted sleep. Sleep was not reported as an issue discussed during routine clinical care.

CONCLUSION

Sleep timing in participants appears to be driven by interacting psychosocial and physiological factors, although active disease management does not emerge as a major influence on sleep schedules.

Experiences of discharge planning practices among Indonesian nurses: A qualitative study

Background

Discharge planning is vital to preventing hospital readmission, and nurses play a key role. The COVID-19 pandemic has posed challenges to hospital services that may persist or recur. Therefore, exploring nurses' experiences with discharge planning practices before and during this pandemic is crucial.

Objective

This study aimed to describe the experiences of discharge planning practices among nurses at an Indonesian tertiary hospital before and during the COVID-19 pandemic.

Methods

A qualitative descriptive study design was used. Telephone interviews were conducted to collect data among ten nurses from March 2019 and continued between December 2020 and August 2021. Content analysis was done for data analysis.

Results

Two main themes emerged: 1) Challenges in discharge planning practices and 2) Perceived discharge planning as a professional responsibility. Implementing the inpatient ward fusion policy as part of the hospital's pandemic response presented greater challenges to nurses in coordinating care and performing discharge planning. Fear of COVID-19 infection, social distancing measures, and using personal protective equipment also affected how nurses delivered discharge education during the pandemic. However, the nurses sensed a greater responsibility to ensure the maintenance of essential components of discharge planning procedures to guarantee the patient's capability to perform self-care at home.

Conclusion

Nurses viewed discharge planning practices as their responsibility and continued them during the pandemic despite facing various challenges. In addition to recognizing the significance of nurses' roles in discharge planning practices and overall patient care, it is crucial to anticipate and address the diverse working patterns and styles among healthcare professionals in unified wards, ensuring effective coordination.

Postpartum follow-up of women with preeclampsia: facilitators and barriers - A qualitative study

BACKGROUND

Pregnancy causes physiological changes to the maternal organ systems that can be regarded as a cardiometabolic stress test for women. Preeclampsia, a pregnancy complication characterized by new onset of hypertension in combination with proteinuria or end-organ dysfunction, affects approximately 2-8% of pregnancies. Adverse pregnancy outcomes, including preeclampsia, have been described as a failed stress test and have been consistently linked with increased risk of cardiovascular disease later in life. The postpartum period is therefore often regarded as a window of opportunity for cardiovascular disease prevention. However, we lack knowledge about how women with preeclampsia experience current postpartum care in the Norwegian health system. The aim of this qualitative study is to uncover women's perspectives and preferences regarding postpartum follow-up.

METHODS

Semi-structured telephone interviews were conducted with 17 women following a six-month lifestyle intervention study. Participants were 9-20 months postpartum, following a pregnancy complicated by preeclampsia. Data were analyzed using Malterud's systematic text condensation.

RESULTS

We identified five themes, each with 2-3 subthemes, that demonstrate how women with recent preeclampsia experience postpartum follow-up: (1) fear and uncertainty (a body out of balance and facing an uncertain future), (2) a conversation on lifestyle - not really that difficult (preeclampsia as a gateway, a respectful approach, and a desire for more constructive feedback), (3) when your own health is not a priority (a new everyday life, out of focus, and lack of support), (4) motivation for lifestyle changes (an eye opener, lack of intrinsic motivation, and a helping hand), and (5) lack of structured and organized follow-up (there should be a proper system, a one-sided follow-up care, and individual variation in follow-up care).

CONCLUSIONS

Findings from this study highlight the need for more systematic postpartum follow-up for women after a pregnancy complicated by preeclampsia. Further research is required to explore the potential use of standardized guidelines and routine invitations to postpartum care. Furthermore, exploring health care professionals' experiences is crucial to ensure their engagement in postpartum care after complicated pregnancies.

Parents' experiences of living with a child with Paediatric Feeding Disorder: An interview study in Sweden

INTRODUCTION

Children affected by Paediatric Feeding Disorder (PFD) cannot consume enough nourishment by mouth. PFD is highly prevalent and can affect the child's growth and development as well as family life.

AIM

To illuminate Swedish parents' experiences of living with a child with PFD.

METHOD

Semi-structured interviews via telephone or video calls were conducted with 14 purposefully recruited mothers and six fathers. The interviews were analysed using content analysis. Ethics approval was obtained, and the parents all gave informed consent.

RESULTS

Four overarching themes emerged: Living with stress; Advocating for the child; Adapting family life; and Gaining hope. Parents described fearing for their child's life and health, feeling pressure over meals and being emotionally affected. They told of experiencing a lack of understanding from healthcare professionals, friends and family. Parents expressed a struggle for help, the need for early interventions and more effective treatment, and developed strategies for coping with the demands of feeding and caring for their child, accepting their living reality. Finding support from a network helped, but the adaptation of daily life affected their family relations. They felt gratitude towards helpful professionals and relief and joy when their child was doing better.

CONCLUSIONS

A more cohesive chain of care is important for children with PFD, and guidelines and educational support for healthcare providers are needed. Parental experiences provide a base for knowledge for further development of early detection and intervention for children with PFD.

Exploring the Impact of Social Identity on the Bullying of Construction Industry Apprentices

BACKGROUND

There is a lack of literature specifically examining the workplace bullying of apprentices and trainees in traditional, male-dominated sectors such as the Australian building and construction industry. Using social identity theory (SIT), the aim of this study was to gather the attitudes, thoughts, and feelings of construction industry leaders to better understand how social identification (i.e., group membership) impacts bullying on targets and perpetrators and the willingness to report bullying to targets and bystanders.

METHOD

One-on-one, semi-structured interviews using a purposive sample of eight leaders from construction and blue-collar industries. Qualitative data were analysed using reflexive thematic analysis.

RESULTS

Four overarching themes were identified: difficulties for apprentices transitioning into industry, the need for continued improvement in industry culture, reluctance to report bullying, and rethinking apprenticeships to empower. Each theme provides insight into the psychosocial phenomenon of the bullying of trade apprentices and suggests that an apprentice's level of social identification with work groups shapes how bullying is identified, interpreted, and prevented.

CONCLUSION

Findings from this study will be important for tailoring evidence-based interventions, human resource policies, and initiatives for education and awareness training. Themes also highlight systemic inadequacies impacting apprentices' mental health and skill development, with implications for the future sustainability of apprenticeship training agreements.

Process-related Factors Are as Important as Outcomes for Patients Undergoing Nonsurgical Root Canal Treatment, Nonsurgical Root Canal Retreatment, and Endodontic Microsurgery

INTRODUCTION

There is considerable variation in the reporting of treatment outcomes in endodontics. Patient-centered outcomes are often inadequately reported in endodontic outcome studies. This paper explores patients' expectations and reported outcomes in nonsurgical root canal treatment (NS-RCT), nonsurgical root canal retreatment (NS-ReTx), and endodontic microsurgery (EMS).

METHODS

We used a qualitative description approach and conducted telephone and virtual semi-structured interviews with participants who had the following treatments within the preceding 3-12 months: NS-RCT (n = 10), NS-ReTx (n = 10), or EMS (n = 10). Half of these treatments were performed by senior endodontic residents in an academic setting and the other half by a community-based endodontist at a private practice.

RESULTS

Participants identified several outcomes that were important to them and integral to treatment success, such as tooth survival, resolution of symptoms, aesthetics, and radiographic healing. Process-related factors were as important as treatment outcomes for participants. Communicating with and educating patients during treatment increased participants' satisfaction and lowered their stress. Dissatisfaction was linked to the lack of a comprehensive treatment and follow-up plan. Thorough planning ensured that patients were fully informed and had a structured approach to achieving their desired outcomes.

CONCLUSIONS

This study provides a list of outcomes that are important for patients undergoing NS-RCT, NS-ReTx, and EMS. These outcomes should be considered when developing a core outcome set related to endodontic treatments. Additionally, this study reports patients' expectations regarding process-related factors that are essential for providing patient-centered care and improving patient experience.

Virtual interviewing with marginalized young adult mothers: appreciating the New Norm

BACKGROUND AND OBJECTIVE

Virtual interviewing in qualitative research may promote inclusion, diversify samples, and maximize participation, but there is limited research regarding methodological best practices for marginalized study populations. Emerging adult (ages 18-29) and young adult (through age 40) mothers have ongoing stressors and competing responsibilities that may preclude participation with in-person interviews. The purpose of this article is to describe the processes and experiences of virtual interviewing among young adult mothers living in under-resourced communities, based on their responses to specific interview questions.

DESIGN AND SAMPLE

As part of an explanatory sequential mixed methods study, qualitative interviews were conducted with a sample of young adult mothers who had previously participated in randomized controlled trials testing an intensive early home visiting intervention. Thirty-one participants (M = 29.7 years, SD = 2.5) who identified as Black (39%), Hispanic (55%), and White (7%), were interviewed using Zoom.

RESULTS

The overarching theme was Zoom: Appreciating the New Norm. Identified categories were Practical Benefits of Virtual Interviewing, Sharing Stories, and Drawbacks of Virtual Interviewing.

CONCLUSION

Findings support virtual interviewing as a feasible and potentially ideal method for qualitative studies with emerging/young adults. Further research to examine this approach with other marginalized populations may lead to more inclusive representation in qualitative research.

A qualitative exploration of reunification post alienation from the perspective of adult alienated children and targeted parents

Introduction

The aim of this study was to explore the experiences of voluntary reunification from the perspectives of adult alienated children and targeted parents.

Methods

Nine adult alienated children and 12 targeted parents participated in semi-structured interviews which were transcribed verbatim and analyzed thematically.

Results

Six themes emerged in the data from the adult alienated children including catalysts for reunification, factors influencing reunification, adult alienated child relationships, the role of communication in reunification, adult alienated child understandings of alienation post reunification, and the role of therapy in reunification. Three themes emerged from the targeted parents including what is reunification, factors impacting reunification, and life after reunification.

Discussion

Findings from the present study offer novel insights into the experience of voluntary reunification from the perspectives of both adult alienated children and targeted parents. They illustrate that voluntary reunification is a process that takes time. This process can span decades and can include periods of connection and rejection.

Patient-Assessed Quality of Virtual Consultations as Follow-Up on Long-Term Oxygen Therapy for Patients With COPD

BACKGROUND

Long-term oxygen therapy (LTOT) can increase survival time and relieve symptom burden in patients with COPD and chronic hypoxemia. The Department of Respiratory Medicine at Odense University Hospital invites patients with LTOT and COPD to the out-patient clinic for treatment evaluation every 6 months to regulate or terminate treatment and support patients' treatment adherence. The out-patient clinic, however, experiences many absences or cancellations from patients. For that reason, patients were offered virtual consultation as an alternative to physical attendance. This study was initiated to uncover reasons for absences and the patients' experiences of virtual consultation to promote a more patient-centered clinical practice for patients with COPD and LTOT.

METHODS

A qualitative study encompassing semi-structured interviews with 20 subjects was conducted in the winter of 2021. The subjects had tried or been given the opportunity of virtual consultation. Data were analyzed inspired by Kvale and Brinkmann focusing on the subject's perspectives on virtual consultation.

RESULTS

The analysis resulted in 3 main themes: limitations and vulnerabilities, independence and quality of life, and personal strategies. Subjects expressed that everyday life with LTOT and COPD was characterized by limited resources in terms of energy, oxygen, and time. LTOT was perceived as a necessary means to maintain a sense of independence and quality of life. However, LTOT also meant additional limitations due to cumbersome equipment and feelings of isolation. Most subjects considered the virtual consultation to be oxygen-, energy-, and time-preserving, as it meant avoiding stressful transportation and handling of oxygen cylinders, COVID-19 exposure, waiting time, and not having to involve others for help.

CONCLUSIONS

The subjects' perspective showed that follow-up on LTOT as a virtual consultation was considered a valuable offer. The chosen method was found to be relevant in uncovering subjects' attitudes toward clinical practice procedures.

A framework for selecting data generation strategies in qualitative health research studies

BACKGROUND

Qualitative health research has the potential to answer important applied health research questions to inform nutrition and dietetics practice, education and policy. Qualitative health research is a distinct subdiscipline of qualitative inquiry that purposefully draws upon the context of healthcare and emphasises health and wellness.

METHODS

Qualitative health research is defined by two parameters: (1) the focus of the study and (2) the methods used. When considering the methods to be used, decisions are required about the type of data to be generated (e.g., transcripts, images and notes) and the process involved in data generation (e.g., interviews, elicitation strategies and observations) to answer the research question(s). Drawing upon examples from nutrition and dietetics literature, this paper provides a framework to support decision-making for nutrition and dietetics researchers and clinician researchers designing conducting qualitative health research.

RESULTS

The guiding questions of the framework include: What types of data will be generated? Who is involved in data generation? Where will data generation occur? When will data generation occur? How will data be recorded and managed? and How will participants' and researchers' emotional safety be promoted?

CONCLUSION

Questions about the types of data, those involved, where and when, as well as how safety can be maintained in data generation, not only support a more robust design and description of data generation methods but also keep the person at the centre of the research.

Pan-Canadian study of psychiatric care (PCPC): protocol for a mixed-methods study

INTRODUCTION

The Canadian population has poor and inequitable access to psychiatric care despite a steady per-capita supply of psychiatrists in most provinces. There is some quantitative evidence that practice style and characteristics vary substantially among psychiatrists. However, how this compares across jurisdictions and implications for workforce planning require further study. A qualitative exploration of psychiatrists' preferences for practice style and the practice choices that result is also lacking. The goal of this study is to inform psychiatrist workforce planning to improve access to psychiatric care by: (1) developing and evaluating comparable indicators of supply of psychiatric care across provinces, (2) analysing variations and changes in the characteristics of the psychiatrist workforce, including demographics and practice style and (3) studying psychiatrist practice choices and intentions, and the factors that lead to these choices.

METHODS AND ANALYSIS

A cross-provincial mixed-methods study will be conducted in the Canadian provinces of British Columbia, Manitoba, Ontario and Nova Scotia. We will analyse linked-health administrative data within three of the four provinces to develop comparable indicators of supply and characterise psychiatric services at the regional level within provinces. We will use latent profile analysis to estimate the probability that a psychiatrist is in a particular practice style and map the geographical distribution of psychiatrist practices overlayed with measures of need for psychiatric care. We will also conduct in-depth, semistructured qualitative interviews with psychiatrists in each province to explore their preferences and practice choices and to inform workforce planning.

ETHICS AND DISSEMINATION

This study was approved by Ontario Tech University Research Ethics Board (16637 and 16795) and institutions affiliated with the study team. We built a team comprising experienced researchers, psychiatrists, medical educators and policymakers in mental health services and workforce planning to disseminate knowledge that will support effective human resource policies to improve access to psychiatric care in Canada.

Factors influencing adherence to clinical practice guidelines in patients with suspected chronic coronary syndrome: a qualitative interview study in the ambulatory care sector in Germany

BACKGROUND

Chronic coronary syndrome (CCS) is a potentially progressive clinical presentation of coronary artery disease (CAD). Clinical practice guidelines (CPGs) are available for prevention, diagnosis, and treatment. Embedded in the "ENLIGHT-KHK" healthcare project, a qualitative study was conducted to identify factors that influence guideline adherence from the perspective of general practitioners (GPs) and cardiologists (CA) in the ambulatory care sector in Germany.

METHODS

GPs and CAs were surveyed via telephone using an interview guide. The respondents were first asked about their individual approach to caring for patients with suspected CCS. Subsequently, the accordance of their approach with guideline recommendations was addressed. Finally, potential measures for assisting with guideline adherence were discussed. The semi-structured interviews were transcribed verbatim and analysed using a qualitative content analysis in accordance with Kuckartz and Rädiker. Factors influencing adherence to CPGs were categorised by assessing whether they (i) inhibited or facilitated guideline adherence, (ii) played a role in patients at risk of CCS or with suspected or known CCS, (iii) were mentioned in implicit or explicit thematic reference to CPGs, and (iv) were declared a practical problem.

RESULTS

Based on interviews with ten GPs and five CAs, 35 potential influencing factors were identified. These emerged at four levels: patients, healthcare providers, CPGs, and the healthcare system. The most commonly cited barrier to guideline adherence among the respondents was structural aspects at the system level, including reachability of providers and services, waiting times, reimbursement through statutory health insurance (SHI) providers, and contract offers. There was a strong emphasis on interdependencies between factors acting at different levels. For instance, poor reachability of providers and services at the system level may result in inexpedience of guideline recommendations at the CPG level. Likewise, poor reachability of providers and services at the system level may be aggravated or alleviated by factors such as diagnostic preferences at the patient level or collaborations at the provider level.

CONCLUSIONS

To assist with adherence to CPGs regarding CCS, promoting measures may be needed that account for interdependencies between barriers and facilitators at various healthcare levels. Respective measures should consider medically justified deviations from guideline recommendations in individual cases.

TRIAL REGISTRATION

German Clinical Trials Register: DRKS00015638; Universal Trial Number (UTN): U1111-1227-8055.

Psychological Impact and Coping Strategies of Hispanic Parents of Children with Cancer: A Qualitative Study

Throughout the cancer trajectory, parents of childhood cancer survivors (CCSs) may experience mental and social challenges requiring continual adaptation to cancer-induced stress. Using Lazarus and Folkman's Transactional Model of Stress and Coping framework, this qualitative study aimed to describe Hispanic parents' psychological health and explore their coping strategies. Purposive sampling was used to recruit 15 Hispanic caregivers from a safety-net hospital in Los Angeles County. To be eligible, participants had to be: the primary caregiver of a CCS who had completed active treatment, the primary caregiver or child self-identified as Hispanic, and proficient in English or Spanish. The interviews lasted approximately 60 min, were audio-recorded (in English and Spanish), and professionally transcribed. Data were analyzed following a thematic content analysis with deductive and inductive approaches on Dedoose. Participants described high levels of stress and fear when their child was diagnosed with cancer. They also shared experiencing symptoms of social anxiety, post-traumatic stress disorder, and depression. Participants' coping strategies were encompassed by three major themes: problem-focused, emotion-focused, and avoidant coping strategies. Problem-focused coping strategies included self-efficacy, behavioral change, and social support. Emotion-focused coping strategies included religious practices and positive reframing. Avoidant coping strategies included denial and self-distraction. Despite the evident disparities in psychological health for Hispanic parents of CCSs, gaps remain in designing a culturally tailored program to help alleviate the caregiver burden. This study provides insights regarding coping strategies that Hispanic caregivers use to deal with the psychological impact of their child's cancer diagnosis. Our findings also delve into the contextual and cultural factors that impact psychological adjustment.

Common Sense Models of Obesity: a Qualitative Investigation of Illness Representations

BACKGROUND

The Common Sense Model provides a framework to understand health beliefs and behaviors. It includes illness representations comprised of five domains (identity, cause, consequences, timeline, and control/cure). While widely used, it is rarely applied to obesity, yet could explain self-management decisions and inform treatments. This study answered the question, what are patients' illness representations of obesity?; and examined the Common Sense Model's utility in the context of obesity.

METHODS

Twenty-four participants with obesity completed semi-structured phone interviews (12 women, 12 men). Directed content analysis of transcripts/notes was used to understand obesity illness representations across the five illness domains. Potential differences by gender and race/ethnicity were assessed.

RESULTS

Participants did not use clinical terms to discuss weight. Participants' experiences across domains were interconnected. Most described interacting life systems as causing weight problems and used negative consequences of obesity to identify it as a health threat. The control/cure of obesity was discussed within every domain. Participants focused on health and appearance consequences (the former most salient to older, the latter most salient to younger adults). Weight-related timelines were generally chronic. Women more often described negative illness representations and episodic causes (e.g., pregnancy). No patterns were identified by race/ethnicity.

CONCLUSIONS

The Common Sense Model is useful in the context of obesity. Obesity illness representations highlighted complex causes and consequences of obesity and its management. To improve weight-related care, researchers and clinicians should focus on these beliefs in relation to preferred labels for obesity, obesity's most salient consequences, and ways of monitoring change.

Sexual and Reproductive Health Care Experiences and Perceptions of Women with Congenital Heart Disease

Due to medical advances, women with congenital heart disease (CHD) are living longer, healthier lives and many are considering pregnancy. The hemodynamic changes of pregnancy present high risks of morbidity and mortality for many women with CHD. As little is known about these women's reproductive health experiences, this study explores their perceptions of pregnancy and family planning care as related to CHD. Women ages 18-45 years with a diagnosis of CHD associated with a World Health Organization (WHO) classification II-IV for pregnancy morbidity and mortality participated in individual, semi-structured interviews exploring their experiences, attitudes, and preferences toward parenthood, pregnancy, contraception and family planning care provision. Interviews were audio-recorded, transcribed verbatim. Two independent coders performed analysis using deductive and inductive coding approaches. Twenty women with CHD participated in interviews (average age 30.1 years, SD 5.85). Nine women had a prior pregnancy and 14 considered becoming a parent in the future. We identified 5 key themes among the women: (1) CHD impacted their reproductive health goals and decisions; (2) Women with CHD perceived a lack of safe contraceptive methods for their condition; (3) Women desired tailored, disease-specific sexual and reproductive health (SRH) information; (4) Women viewed their cardiologist as the primary source for SRH information and prefer provider-initiated discussions starting in adolescence; and (5) Women desire coordinated pre-pregnancy and intrapartum care between their cardiologists and women's health providers. These results provide a foundation for interventions to improve patient-centered interdisciplinary reproductive healthcare for this population.

Psychosocial Stressors and Coping Strategies Among African Americans During Early Stages of the COVID-19 Pandemic: a Qualitative Study

OBJECTIVES

The disproportionate impact of coronavirus (COVID-19) on African Americans along with associated inequities in social determinants of health (SDOH) and racism increase their vulnerability to the psychosocial impact of COVID-19. This qualitative study applied the socio-ecological model (SEM) to explore psychosocial stressors, coping styles, and needs to improve psychosocial health among unique subgroups of African Americans in early pandemic stages.

METHODS

Sixty-two African Americans (16 parents, 15 young adults, 16 essential workers, and 15 individuals with underlying medical conditions) participated in qualitative, semi-structured interviews between May and September 2020. Interview data were analyzed based on the SEM using thematic analysis.

RESULTS

The majority (84%) reported being stressed with parents having the highest level. Four themes emerged : (1) our COVID-19 pandemic state of mind, (2) top stressors in the early stages of the COVID-19 pandemic, (3) coping strategies during COVID-19, and (4) needs during the COVID-19 pandemic to reduce stress. While there were similarities, different stressors were experienced among subgroups, which yielded different coping styles and needs from stakeholders across multi-levels to improve their psychosocial health.

CONCLUSIONS

Findings suggest current and future pandemic response plans need targeted strategies across multiple levels of influence to address the psychosocial impact of the COVID-19 pandemic on African Americans.

The experiences of UK-Chinese individuals during the COVID-19 pandemic: A qualitative interview study

Infectious disease outbreaks have historically been associated with stigmatisation towards minority groups, specifically those associated with the geographical region that the disease was first identified. We aimed to investigate how the emerging COVID-19 pandemic was experienced by UK-resident individuals of Chinese ethnicity: how their perceived cultural and ethnic identity influenced their experiences, and how early insights into the pandemic in China influenced attitudes and behaviours. We undertook in-depth semi-structured interviews with individuals who self-identified as UK-Chinese. Participants were recruited from three cities in the UK. Interviews were undertaken over the telephone between 9th April 2020 and 16th July 2020. Interviews were digitally recorded and transcribed verbatim. Transcripts were coded using NVivo software and analysed using inductive thematic analysis. Sixteen individuals were interviewed. Three main themes were identified: (1) Attribution of stigma, (2) Pandemic legacies, and (3) Individual versus societal responses. These reflected six sub-themes: (1) Stigmatisation through (mis)identity, (2) Markers of pandemic awareness, (3) Legacies of previous pandemics, (4) Ascription of blame, (5) Extent of freedom, and (6) Implicit faith in government. Experiences of xenophobia included accounts of physical violence. UK-Chinese individuals experienced and perceived widespread xenophobia, in the context of media representations that ascribed blame and exacerbated stigmatisation. Prior experience of respiratory epidemics, and insight into the governmental and societal response in China, contributed to the early adoption of face masks. This in turn marked UK-Chinese individuals as targets for abuse. Awareness is needed to safeguard stigmatized groups from social and economic harm in future infectious disease pandemics.

Data Collection in Times of Pandemic: A Self-Study and Revisit of Research Practices During a Crisis

COVID-19 as a global pandemic has greatly disrupted research, not only in terms of the practicality of research activities such as data collection, but also in data quality. Using self-study in form of duoethnography method for reflecting on research practice, this article reviews and reflects on the practices of remote data collection during the pandemic and further revisits additional issues brought about by these practices and concerns. One key observation from this self-study is the prevalence of practical challenges, particularly those related to participant access, that overshadows the potential advantages of remote data collection as well as other challenges. This challenge results in researchers' reduced control of the research process and also a requirement for more flexibility, greater sensitivity toward the participants and research skills for the researchers. We also observe greater conflation of quantitative and qualitative data collection and the emergence of triangulation as the main strategy to offset potential threats to data quality. This article concludes by calling for more discussions on several areas that feature scarce discussion in literature, including potential rhetoric importance assigned to data collection, adequacy of triangulation to safeguard data quality, and the potential difference between COVID-19's impact on quantitative and qualitative research.