Comparing two sampling methods to engage hard-to-reach communities in research priority setting

Using a co-design methodological approach to optimize perioperative nursing care for older adult patients from ethnically diverse backgrounds: a study protocol

This article outlines the use of a co-design methodological approach aimed at optimizing perioperative care experiences for ethnically diverse older adults and their family carers. The research involved three phases. In Phase 1, the foundation was established with the formation of a Core Advisory Group comprising key informants, including health consumers. This initial phase focused on forming relationships and conducting a literature review to inform subsequent stages of the research. Phase 2 progressed to data collection, where a qualitative survey on perioperative experiences was conducted. Semi-structured interviews were held with patients, their family carers, and perioperative staff. Phase 3 advanced the co-design process through a workshop involving patients, family carers, perioperative staff, and key stakeholders. Workshop participants collaborated on potential practice changes, proposing strategies for future clinical implementation. While data analysis and reporting for Phases 2 and 3 are forthcoming, the continued involvement of the Core Advisory Group ensures ongoing consensus-building on health consumer needs. This methodology article adopts a prospective stance, with findings to be presented in subsequent scholarly works. Use of this methodology will help to determine how the use of a co-design approach may impact the development of culturally responsive perioperative nursing care for those from ethnically diverse communities.

Perspectives and Experiences of Dance-Related Injuries: A Qualitative Survey of Adolescent Pre-Professional Ballet Dancers in Australia

Objective: To explore perspectives and experiences of adolescent ballet dancers in Australia in relation to dance-related injuries and their impact, injury risk factors, prevention, and treatment. Design: Adolescent ballet dancers aged from 12 to 19 years in Australia were invited to participate in an online qualitative survey. Methods: Responses to open-ended questions were analyzed thematically using grounded theory while quantitative information was summarized with descriptive statistics and triangulated with qualitative data. Results: Nineteen adolescent dancers reported experiencing pain and multiple injuries but hiding or ignoring injuries due to fear. Dancers recognized the significant physical and psycho-social impact of dance-related injuries on themselves and others. Several risks and injury prevention strategies were identified by dancers. Dancers perceived that treatments were not always informed or effective. Conclusion: Findings suggest that adolescent ballet dancers experience multiple dance-related injuries but require support to disclose injuries, participate in injury prevention, and access treatment. Health professionals may improve quality of care by increasing their understanding of ballet and providing specific management advice. Dance teachers may benefit from further education to support their students. Clinical trials are required to confirm or negate the validity of proposed injury risks and the effectiveness of injury prevention strategies and treatments.

Leaders' experiences of embedding a simulation-based education programme in a teaching hospital: an interview study informed by normalisation process theory

There is limited research on the experiences of people in working to embed, integrate and sustain simulation programmes. This interview-based study explored leaders' experiences of normalising a simulation-based education programme in a teaching hospital. Fourteen known simulation leaders across Australia and North America were interviewed. Semi-structured interviews were analysed using reflexive thematic analysis sensitised by normalisation process theory, an implementation science theory which defines 'normal' as something being embedded, integrated and sustained. We used a combined social and experiential constructivist approach. Four themes were generated from the data: (1) Leadership, (2) business startup mindset, (3) poor understanding of simulation undermines normalisation and (4) tension of competing objectives. These themes were interlinked and represented how leaders experienced the process of normalising simulation. There was a focus on the relationships that influence decision-making of simulation leaders and organisational buy-in, such that what started as a discrete programme becomes part of normal hospital operations. The discourse of 'survival' was strong, and this indicated that simulation being normal or embedded and sustained was still more a goal than a reality. The concept of being like a 'business startup' was regarded as significant as was the feature of leadership and how simulation leaders influenced organisational change. Participants spoke of trying to normalise simulation for patient safety, but there was also a strong sense that they needed to be agile and innovative and that this status is implied when simulation is not yet 'normal'. Leadership, change management and entrepreneurship in addition to implementation science may all contribute towards understanding how to embed, integrate and sustain simulation in teaching hospitals without losing responsiveness. Further research on how all stakeholders view simulation as a normal part of a teaching hospital is warranted, including simulation participants, quality and safety teams and hospital executives. This study has highlighted that a shared understanding of the purpose and breadth of simulation is a prerequisite for embedding and sustaining simulation. An approach of marketing simulation beyond simulation-based education as a patient safety and systems improvement mindset, not just a technique nor technology, may assist towards simulation being sustainably embedded within teaching hospitals.

Risk of low energy availability and nutrition knowledge among female team sport athletes

BACKGROUND

Nutrition knowledge influences adequate dietary intake in athletes. Inadequate dietary intakes can result in low energy availability (LEA) which can lead to relative energy deficiency in sport (RED-S). To date, there is little information on the relationship between nutrition knowledge and the risk of LEA in female team sport athletes. This study investigates if general and sports nutrition knowledge are associated with the risk of LEA in female team athletes.

METHODS

A cross-sectional design was used. Female athletes (>16 years) who participate in team sports in New Zealand were asked to complete an online questionnaire. The LEA in Females Questionnaire and the Abridged Sport Nutrition Knowledge Questionnaire were included. LEA risk and general/sports nutrition knowledge were assessed. The relationship between LEA risk and knowledge was analyzed using the Kruskal-Wallis Test of independent variables and χ2 tests.

RESULTS

Among 100 female athletes, 53% were at-risk for LEA, and 70% (N.=67) had poor nutrition knowledge. Athletes who were "at-risk" for LEA and those who were "not at-risk" for LEA did not differ statistically in terms of age (P=0.350) or BMI (P=0.576). Of those "not at risk" 54% had an A-NSK score between 50 and 60% (i.e., average knowledge), whereas 54% of the athletes who were "at risk" for LEA had poor nutrition knowledge. There was no statistical difference between the groups (P=0.273).

CONCLUSIONS

The poor nutrition knowledge and the high rates of those "at risk" of LEA among team sports athletes indicates the need for more nutrition education in this population.

Exploring the recovery journey of COVID-19 critical care survivors during the first year after hospital discharge

Objectives

To explore the longitudinal recovery of patients admitted to critical care following COVID-19 over the year following hospital discharge. To understand the important aspects of the patients' recovery process and key elements of their caregivers' experiences during this time.

Design

A longitudinal qualitative study using semi-structured interviews.

Setting

Two acute hospitals in South East England and follow-up in the community.

Participants

Six COVID-19 critical care survivors from the first wave of the pandemic (March-May 2020) and five relatives were interviewed 3 months after hospital discharge. The same six survivors and one relative were interviewed again at 1 year. Interviews were transcribed verbatim, anonymised and a reflexive thematic analysis was conducted.

Results

Three themes were developed: (1) 'The cycle of guilt, fear and stigma'; (2) 'Facing the uncertainties of recovery' and (3) 'Coping with lingering symptoms - the new norm'. The first theme highlights survivors' reluctance to share their experiences associated with contracting the disease. The second theme, explores challenges faced by the survivors and their relatives in navigating the recovery process, given the unknown nature of the illness. The final theme illustrates the mechanisms survivors develop to come to terms with the remnants of their illness and critical care stay.

Conclusions

The longitudinal nature of the study highlighted the persisting symptoms of long COVID-19, their impact on survivors and coping methods amidst the ongoing pandemic. Further research into the experiences of those affected in the first and subsequent waves of the COVID-19 pandemic, is desirable to help guide the formulation of the optimally supported recovery pathways.

Patient engagement in designing, conducting, and disseminating clinical pain research: IMMPACT recommended considerations

ABSTRACT

In the traditional clinical research model, patients are typically involved only as participants. However, there has been a shift in recent years highlighting the value and contributions that patients bring as members of the research team, across the clinical research lifecycle. It is becoming increasingly evident that to develop research that is both meaningful to people who have the targeted condition and is feasible, there are important benefits of involving patients in the planning, conduct, and dissemination of research from its earliest stages. In fact, research funders and regulatory agencies are now explicitly encouraging, and sometimes requiring, that patients are engaged as partners in research. Although this approach has become commonplace in some fields of clinical research, it remains the exception in clinical pain research. As such, the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials convened a meeting with patient partners and international representatives from academia, patient advocacy groups, government regulatory agencies, research funding organizations, academic journals, and the biopharmaceutical industry to develop consensus recommendations for advancing patient engagement in all stages of clinical pain research in an effective and purposeful manner. This article summarizes the results of this meeting and offers considerations for meaningful and authentic engagement of patient partners in clinical pain research, including recommendations for representation, timing, continuous engagement, measurement, reporting, and research dissemination.

Knowledge, attitude, and practices of stakeholders involved in healthcare financing programs on economic evaluations in Cameroon

There are many healthcare financing programs (HFPs) in Cameroon; however, there is a lack of information on these programs' economic effectiveness and efficiency. Involvement of local stakeholders in the economic evaluations (EEs) of HFPs is critical for ensuring contextual factors are considered prior to program implementation. We conducted a cross-sectional study to assess the need for EEs of Cameroonian HFPs. Regular staff in supervisory roles aged 18 years and above were recruited in four Cameroonian cities. Data were collected via face-to-face surveys between June 15 and August 1, 2022. Descriptive analyses summarized participants' knowledge, attitudes, and practices in relation to performing EEs of HFPs. Principal component analyses identified organizational, individual, and contextual factors that could influence participants' involvement. The total sample included 106 participants. On average, 65% of participants reported being aware of the listed HFPs; however, of these, only 28% said that they had been involved in the HFPs. Of the 106 participants, 57.5% knew about EEs; yet, almost 90% reported that the HFP in question had never been subject to an EE, and 84% had never been involved in an EE. Most participants indicated that they had intended or would like to receive EE training. Using principal component analyses, the organizational factors were classified into two components ('policy and governance' and 'planning and implementation'), the individual factors were classified into two components ('training' and 'motivation'), and the contextual factors were classified into three components ('funding,' 'political economy,' and 'public expectations'). The findings of this study highlight the need to invest in EE training to improve participation rates of Cameroonian stakeholders in the EEs of HFPs. Improved knowledge, diversified skills, and increased participation of stakeholders from all levels of the Cameroonian healthcare system are critical to the effective and efficient development, implementation, and EE of the country's HFPs.

Priorities, needs and willingness of use of nerve stimulation devices for bladder and bowel function in people with spinal cord injury (SCI): an Australian survey

STUDY DESIGN

Anonymous online survey OBJECTIVES: To investigate the priorities, needs and willingness to adopt nerve stimulation devices for managing neurogenic bladder and bowel function in people with spinal cord injury (SCI) living in Australia.

SETTING

Online survey of people living with SCI in Australia.

METHODS

This anonymous online survey used Qualtrics and was advertised via standard communication channels, such as advocacy groups representing the SCI community in Australia, social media, attending SCI sporting events and by word-of-mouth.

RESULTS

Responses from 62 individuals (32% female, 68% male) were included. Bladder emptying through urethra without catheter was the highest priority for bladder function. Reducing time required for bowel routines and constipation were the top priorities regarding bowel function. The highest concern for internal/implanted devices was the 4% chance of device surgical removal, while wearing wires under the clothes was the main concern for external devices. 53% of respondents were willing to trial an implanted nerve stimulation device, while 70% would trial an external device to improve and gain independence in bladder and bowel function.

CONCLUSION

The findings of this study highlighted the potential role in which nerve stimulation can have in addressing bladder and bowel dysfunction in people with SCI, and have also identified that there was a need for Australian physiotherapists to evaluate their role in bladder and bowel dysfunction. Results from this study can help guide further research in nerve stimulation devices for bladder and bowel dysfunction in people with SCI.

SPONSORSHIP

n/a.

Penicillin allergy reassessment for treatment improvement: A dental office tool to support appropriate penicillin allergy labeling

BACKGROUND

Dental appointments offer an opportunity to evaluate a documented penicillin (PCN) allergy and determine whether the patient might be a candidate for medical reassessment of their allergy. The authors gathered feedback on the Penicillin Allergy Reassessment for Treatment Improvement (PARTI) tool, designed to enhance dentist-patient communications regarding PCN allergies.

METHODS

From January 2022 through May 2023, the authors conducted a mixed-methods study, collecting focus group data from patients with PCN allergies and surveying health care workers (HCWs) regarding the PARTI tool. Feedback focused on reassessment procedures, patient-centered allergy information, and medical records updates. Thematic analysis was used for focus group data.

RESULTS

The study included 15 patients in focus groups and 50 HCW survey respondents representing diverse US regions. Patient demographic characteristics included varied races, the mean age was 52 years, and most of the patients were female (53.3%). Most patients had health care interactions within the preceding year, at which 86.6% of patients were asked about drug allergies. HCW respondents primarily consisted of pharmacists (30%) and dentists, dental hygienists, and dental assistants (28%). Feedback on the PARTI tool was constructive, with both patients and HCWs recognizing its potential benefits and providing insights for improvement. Many HCWs (68%) highlighted the importance of step 3 of the PARTI tool, that is, the section on PCN allergy testing. Feedback from participants was incorporated into the final PARTI tool.

CONCLUSIONS

Patient and HCW feedback on the PARTI tool was used to finalize a tool for the dental office to provide to patients who are candidates for PCN allergy reassessment. The feedback will also be used to inform an upcoming pilot study in US dental offices, focused on the process for PCN allergy reassessment and health record documentation.

PRACTICAL IMPLICATIONS

Deploying the PARTI tool in dental offices is pivotal, as mislabeling patients with PCN allergies could have severe consequences, such as hindering the prescription of lifesaving antibiotics for conditions like endocarditis, in the future. This implementation not only enhances communication between dentists and patients, but it is also crucial for ensuring improved patient safety and maintaining accurate medical records among health care settings.

Reaching the unheard: overcoming challenges in health research with hard-to-reach populations

PURPOSE

Addressing obstacles such as logistical complexities, social stigma, and the impact of historical traumas is essential for the successful inclusion of underrepresented groups in health research.

METHODS

This article reviews engagement and interview techniques used to ethically engage recently settled Afghan refugees in Oklahoma and rural Mexican-born women in Illinois in research. The paper concludes with a reflective discussion on the challenges and lessons learned.

RESULTS

Creative strategies to engage hard-to-reach populations in research included considering the participants' socioeconomic and cultural contexts in their interactions and developing community partnerships to establish trust and obtain reliable data. Other engagement strategies were communicating in the participants' preferred language, providing assistance with reading and responding to study questions for those with low literacy, employing research staff from the population of interest, and recruiting in specific locations where the populations of interest live.

CONCLUSIONS

Community engagement is essential at all stages of research for building trust in hard-to-reach populations, achieving inclusivity in health research, and ensuring that interventions are culturally sensitive and effective.

Disrupted biographies and gendered identities: A qualitative study exploring sexuality and blood cancer

PURPOSE

This study examines how blood cancer impacts patients' sexuality and sense of gendered identity.

METHODS

An interpretive epistemological framework necessitated a qualitative study design. Participants (6 male and 6 female), recruited from a hospital Haematology department in a large Northern English City, took part in semi-structured in-depth interviews to gather rich data about their subjective experiences.

RESULTS

A key theme from the qualitative data was a sense of disruption in relation to several aspects of their gendered identities and sexual life. Participants explained disruption to their sexual function and sexual sense of self. They narrated concerns about future imagined relationships. The emotional burden of sexuality related concerns was strongly articulated. A gendered perspective enabled the similarities and differences between men and women to be explored.

CONCLUSION

This study, drawing on rich qualitative data, documents the sexuality concerns of blood cancer patients; for some such concerns arise many years post treatment. The findings highlight the need for gender appropriate care around sexuality which should continue to be accessible well after diagnosis and treatment phases have ceased.

Nutritional Considerations of Irish Performance Dietitians and Nutritionists in Concussion Injury Management

Sport-related concussion incidence has increased in many team-based sports, such as rugby, Gaelic (camogie, hurling, football), and hockey. Concussion disrupts athletes' brain function, causing an "energy crisis" that requires energy and nutrient support to restore function and heal. Performance dietitians and nutritionists play a role in supporting athletes' post-injury nutritional demands. This study aimed to investigate Irish performance dietitians' and nutritionists' knowledge and implementation of nutritional strategies to manage and support athletes' recovery following concussion. In-depth, semi-structured interviews were conducted with seventeen (n = 17) Irish performance dietitians and nutritionists recruited from the Sport and Exercise Nutrition register and other sporting body networks across Ireland. Participants practised or had practised with amateur and/or professional athletes within the last ten years. All interviews and their transcripts were thematically analysed to extract relevant insights. These data provided valuable insights revealing performance dietitians and nutritionists: (1) their awareness of concussion events and (2) their use of nutritional supports for concussion management. Furthermore, the research highlighted their implementation of 'novel nutritional protocols' specifically designed to support and manage athletes' concussion recovery. There was a clear contrast between participants who had an awareness and knowledge of the importance of nutrition for brain recovery after sport-related concussion(s) and those who did not. Participants presenting with a practical understanding mentioned re-emphasising certain foods and supplements they were already recommending to athletes in the event of a concussion. Performance dietitians and nutritionists were keeping up to date with nutrition research on concussions, but limited evidence has prevented them from implementing protocols in practice. Meanwhile, participants mentioned trialling/recommending nutritional protocols, such as carbohydrate reloading, reducing omega-6 intake, and acutely supplementing creatine, omega-3 fish oils high in Docosahexaenoic acid, and probiotics to support brain healing. Performance dietitians' and nutritionists' use of nutrition protocols with athletes following concussion was linked to their knowledge and the limited scientific evidence available. Nutrition implementation, therefore, may be overlooked or implemented with uncertainty, which could negatively affect athletes' recovery following sports-related concussions.

Written language achievement in children and adolescents with neurofibromatosis type 1 and Plexiform Neurofibromas

Neurofibromatosis type 1 (NF1) is associated with below average writing achievement. However, little is known about specific aspects of written language impacted by NF1, changes in writing over time, and associations between cognitive aspects of the NF1 phenotype and writing. At three timepoints over six years, children with NF1 and plexiform neurofibromas (PNs) completed Woodcock-Johnson tests of writing mechanics (Spelling, Punctuation & Capitalization, handwriting), written expression of ideas (Writing Samples), writing speed (Writing Fluency), and tests of general cognitive ability, executive function, memory, and attention. Children (N = 76, mean age = 12.8 ± 3.4 years) completed at least one baseline writing subtest. Overall writing scores were in the Average range (M = 93.4, SD = 17.4), but lower than population norms (p = 0.002). Scores were highest on Writing Samples (M = 95.2, SD = 17.3), and lowest for Punctuation & Capitalization (M = 87.9, SD = 18.8, p = 0.034). Writing scores were mostly stable over time. Nonverbal reasoning was related to some tests of writing mechanics and written expression of ideas. Short-term memory and inattention explained additional variance in Writing Samples and Spelling. Poor handwriting was associated with writing content beyond the impact of cognitive factors. Children with NF1 and PNs may benefit from early screening and writing support. Interventions should address the contribution of both cognitive and handwriting difficulties in written language.

Surgical leadership in a culture of safety: An inter-professional study of metrics and tools for improving clinical practice

BACKGROUND

Leadership in a safety culture environment is essential in avoiding patient harm. However, leadership in surgery is not routinely taught or assessed. This study aims to identify a framework, metrics and tools to improve surgical leadership and safety outcomes.

METHODS

Qualitative interviews were performed with leadership experts from safety-critical professions. Non-probability-based sampling was undertaken in major international airlines. Data underwent thematic analysis and clinical adaptation by multiple surgeon-analysts using the framework method.

RESULTS

583 codes were synthesised into 10 themes. Leaders were identified as 'threat and error managers' who placed safety first. Their core attribute was humble confidence. This allowed them to set the tone for high standards of practice, whilst empowering individuals to speak up about safety issues. Safety-oriented leaders assumed complete responsibility and applied their authority discerningly to obtain optimal outcomes. Finally, effective leaders rallied support for their mission by instilling confidence, building collaborations and managing conflict.

CONCLUSIONS

Surgical leadership requires the ability to manage risk, opportunity and people. The study provides an assessment matrix and deliverable tools for improving surgical safety.

[Satisfaction of wheelchair users in the Baixada Santista Metropolitan Region]

This article seeks to identify user satisfaction in relation to wheelchairs and the provision of public and private health services in the Baixada Santista Metropolitan Region. It involved a cross-sectional study with a quantitative approach. Participants answered a sociodemographic questionnaire and the Brazilian version of the Quebec Assistive Technology User Satisfaction Assessment. Data were analyzed using descriptive and comparative statistics by means of Student's t test. Cohen's d effect sizes were also calculated. Participants (n = 42) were "more or less satisfied" with the wheelchairs and "quite satisfied" with the services provided. Rigid frame wheelchair users were significantly more satisfied with their wheelchairs compared to users of wheelchairs weighing over 198 lbs. (p = 0.010, d = 1.04). Users of private services showed significantly greater satisfaction with the provision of the service compared to public services users (p = 0.021, d = 0.75). Wheelchair users in the Baixada Santista Metropolitan Region are more satisfied with the rigid frame wheelchair and less satisfied with public services.

Effects of armed conflict on maternal and infant health: a mixed-methods study of Armenia and the 2020 Nagorno-Karabakh war

INTRODUCTION

Armed conflict worldwide and across history has harmed the health of populations directly and indirectly, including generations beyond those immediately exposed to violence. The 2020 war between Armenia and Azerbaijan over Nagorno-Karabakh, inhabited by an ethnically Armenian population, provides an example of how conflict harmed health during COVID-19. We hypothesised that crises exposure would correspond to decreased healthcare utilisation rates and worse health outcomes for the maternal and infant population in Armenia, compounded during the pandemic.

METHODS

Following a mixed-methods approach, we used ecological data from 1980 to 2020 to evaluate health trends in conflict, measured as battle-related deaths (BRDs), COVID-19 cases, and maternal and infant health indicators during periods of conflict and peace in Armenia. We also interviewed 10 key informants about unmet needs, maternal health-seeking behaviours and priorities during the war, collecting recommendations to mitigate the effects of future crisis on maternal and infant health. We followed a deductive coding approach to analyse transcripts and harvest themes.

RESULTS

BRDs totalled more in the 2020 war compared with the previous Nagorno-Karabakh conflicts. Periods of active conflict between 1988-2020 were associated with increased rates of sick newborn mortality, neonatal mortality and pre-eclampsia or eclampsia. Weekly average COVID-19 cases increased sevenfold during the 2020 Nagorno-Karabakh war. Key informants expressed concerns about the effects of stress and grief on maternal health and pregnancy outcomes and recommended investing in healthcare system reform. Participants also stressed the synergistic effects of the war and COVID-19, noting healthcare capacity concerns and the importance of a strong primary care system.

CONCLUSIONS

Maternal and infant health measures showed adverse trends during the 2020 Nagorno-Karabakh war, potentially amplified by the concurrent COVID-19 pandemic. To mitigate effects of future crises on population health in Armenia, informants recommended investments in healthcare system reform focused on primary care and health promotion.

Meanings of nurses' role in Child and Adolescent Psychosocial Care Centers

OBJECTIVE

to analyze the meaning attributed to nurses' role in mental health care in Child and Adolescent Psychosocial Care Centers.

METHODS

qualitative research, anchored in the paradigm of complexity. Data collection was carried out through online semi-structured interviews with ten nurses from São Paulo, between March and September 2022, being analyzed thematically.

RESULTS

the diversity and specificity of a child and adolescent mental health clinic, with the need for expanded, territorial and intersectoral care, were unveiled in addition to a fragmented training in the area. There was a need for a deconstruction of being a nurse to make it possible to produce more inclusive and salutogenic practices.

FINAL CONSIDERATIONS

the need for training nurses with adequate knowledge and skills to care for the mental health of children, adolescents and their families is reinforced as well as permanent education of working teams.

Development, Reliability, and Structural Validity of the Scale for Knowledge, Attitude, and Practice in Ethics Implementation Among AI Researchers: Cross-Sectional Study

BACKGROUND

Medical artificial intelligence (AI) has significantly contributed to decision support for disease screening, diagnosis, and management. With the growing number of medical AI developments and applications, incorporating ethics is considered essential to avoiding harm and ensuring broad benefits in the lifecycle of medical AI. One of the premises for effectively implementing ethics in Medical AI research necessitates researchers' comprehensive knowledge, enthusiastic attitude, and practical experience. However, there is currently a lack of an available instrument to measure these aspects.

OBJECTIVE

The aim of this study was to develop a comprehensive scale for measuring the knowledge, attitude, and practice of ethics implementation among medical AI researchers, and to evaluate its measurement properties.

METHODS

The construct of the Knowledge-Attitude-Practice in Ethics Implementation (KAP-EI) scale was based on the Knowledge-Attitude-Practice (KAP) model, and the evaluation of its measurement properties was in compliance with the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) reporting guidelines for studies on measurement instruments. The study was conducted in 2 phases. The first phase involved scale development through a systematic literature review, qualitative interviews, and item analysis based on a cross-sectional survey. The second phase involved evaluation of structural validity and reliability through another cross-sectional study.

RESULTS

The KAP-EI scale had 3 dimensions including knowledge (10 items), attitude (6 items), and practice (7 items). The Cronbach α for the whole scale reached .934. Confirmatory factor analysis showed that the goodness-of-fit indices of the scale were satisfactory (χ2/df ratio:=2.338, comparative fit index=0.949, Tucker Lewis index=0.941, root-mean-square error of approximation=0.064, and standardized root-mean-square residual=0.052).

CONCLUSIONS

The results show that the scale has good reliability and structural validity; hence, it could be considered an effective instrument. This is the first instrument developed for this purpose.

Validation of the Patient Health Questionnaire-9 for Suicide Screening in Transgender Women

Purpose

High prevalence of depression in transgender women highlights the importance of validating the measure to assess depression. Moreover, depression is significantly associated with suicide across research studies. The aims of the current study were to validate a Chinese-language version of the Patient Health Questionnaire-9 (PHQ-9) and to assess operating characteristics of the PHQ-9 for suicide screening in transgender women.

Methods

With the approval of an Institutional Review Board (IRB), a total of 198 transgender women living in Shenyang, China, were recruited, and asked to complete the PHQ-9, including measures of their suicidal ideation, planning and attempt.

Results

A one-factor model of the PHQ-9 was supported in the current sample, showing good reliability and validity. The best cutoff point for the PHQ-9 in suicidal ideation was 17, with a sensitivity/specificity of 77.78%; the best cutoff point for PHQ-9 in suicidal planning was 17, with a sensitivity of 81.82% and a specificity of 73.26%; and the best cutoff point for PHQ-9 in suicidal attempt was 20, with a sensitivity of 75% and a specificity of 90.21%.

Conclusion

Findings supported the validity of the PHQ-9. With potential clinical or research application, the PHQ-9 can be an efficient instrument for suicide screening in transgender women.

An Exploratory Study of Physical Therapists From High-Income Countries Practising Outside of Their Scope in Low and Middle-Income Countries

PURPOSE

To quantify how often physical therapists from high-income countries (HIC) travelling to low- and middle-income countries (LMIC) practise outside their scope of practice, in what circumstances, and their likelihood of doing the same in the future.

METHODS

An exploratory descriptive study using a survey.

RESULTS

One hundred and twenty-six licensed physical therapists from around the world participated. Physical therapists typically spent less than a month (73.8 per cent) in LMIC; 67.5 per cent believed that physical therapists practise outside of their scope, and 31.7 per cent reported doing so. Reasons were believing that something is better than nothing (47.5 per cent ), a mismatch between the physical therapist's and host's expectations (40.0 per cent ), and preserving their relationship with the host (25.0 per cent ). It was deemed appropriate by 64.5 per cent to practise outside of their scope in some situations and 53.8% considered repeating the activity in the future. Half of the respondent's first experience in LMIC occurred as a student or in their first decade of practice.

CONCLUSIONS

Working in LMIC requires a keen understanding of the risks and challenges associated with such experiences. To ensure best practice, a skill set that consists of critical self-reflection, systems thinking, and structural competency combined with clinical competency and accountability is imperative.

Evaluating the role of social media in providing support for family caregivers of individuals with spinal cord injury

STUDY DESIGN

Quantitative study.

OBJECTIVES

The study aimed to explore Family Caregivers of Individuals with Spinal Cord Injury (FC-SCI) social media use patterns, most frequently used platforms, importance of social media for receiving and providing support, and type of social support (i.e., social companionship, emotional support, informational support) that FC-SCI receive or provide online.

SETTING

FC-SCI participants from Canada and USA.

METHODS

FC-SCI responded to measures regarding the social media platforms they use to access support, the importance of each platform, and the types of online social support they access through social media.

RESULTS

Sample consisted of 115 FC-SCI. Most caregivers were a partner or spouse of the individual with SCI (n = 110) and female (n = 111). Majority of FC-SCI spent 1-3 h daily on social media (n = 74), and Facebook was used predominantly (n = 108), followed by Instagram (n = 92), and YouTube (n = 66). For receiving or providing support, Facebook was ranked most important (60%), followed by Instagram (26%) and YouTube (17%). The mean differences and standard deviation were found for the types of social support: emotional support (25.93 ± 7.60), social companionship (23.85 ± 7.46), and informational support (27.24 ± 7.50).

CONCLUSIONS

Using social media for informational support is desired by FC-SCI as it is easily accessible, and time-efficient. The prevalent use of social media for support by FC-SCI demonstrates that social media is a valued platform for support. The support benefits for the mental and physical health of caregivers should be further evaluated.

Towards a plastic-less planet. Gender and individual responsibility predict the effect of imagery nudges about marine (micro)plastic pollution on R-behavior intentions

Emerging microplastics (MP) pollution is one of the biggest threats for the oceans today. Consumers could reduce MP pollution adopting R-behaviors such as reducing consumption of plastic, refusing products with MP, replacing them for green products, and recycling. Here we tested the efficiency of online nudges (images and short messages) for promoting MP-conscious behavior in Spain (n = 671). The perceived level of environmental responsibility and the willingness to adopt R-behaviors were measured. Messages about seafood with MP and plastic-polluted marine environment were more efficient than images of animals killed by plastics. Feeling responsible for MP pollution predicted R-behavior intention. Women would adopt more R-behaviors than men, while men were more sensitive than females to the proposed nudges. Raising the sense of environmental responsibility would be priority in education campaigns. For different cultural sensitivities to animal suffering, evoking environmental health instead of threats to wildlife would be generally recommended.

Development of the WHO eye care competency framework

BACKGROUND

The eye care workforce, particularly in lower resource settings, face challenges of limited integration into the health system, limited workforce capacity, mismatch of workforce to population need and poor quality of care. In recognition of these challenges, coupled with a gap in existing tools, provides a strong rationale for the development of the Eye care competency framework (ECCF).

METHODS

A mixed methods approach was utilised to develop and validate the ECCF. Content was developed by extracting relevant components of existing frameworks used both within and outside of eye care. A diverse technical working group provided feedback and guidance on the structure, design, and content to create a preliminary draft. Competencies and activities were validated using a modified-Delphi study, and the framework was then piloted at four sites to understand how the tool can be implemented in different settings.

RESULTS

The final version of the ECCF included eight outcomes, nine guiding principles, and content of each of the key elements, including the six domains, 22 competencies, 21 activities, 193 behaviours and 234 tasks, and the knowledge and skills that underpin them. 95/112 participants from the six WHO regions completed the modified-Delphi study, yielding an average of 96% agreement across the competencies and activities in the ECCF. The pilot showcased the versatility and flexibility of the ECCF, where each of the four sites had a different experience in implementing the ECCF. All sites found that the ECCF enabled them to identify gaps within their current workforce documentation.

CONCLUSIONS

The ECCF was developed using a collaborative approach, reflecting the opinions of participants and stakeholders from all around the world. The comprehensive competencies and activities developed in the ECCF encompass the diverse roles of eye care workers, and thus encourage multi-disciplinary care and better integration into the health system. It is recommended that eye care workforce planners and developers use the ECCF, and adapt it to their context, to support workforce development and focus on the quality and scope of eye care service provision.

Supporting ethical end-of-life care during pandemic: Palliative care team perspectives

BACKGROUND

Italy was the first European country to be involved with the COVID-19 pandemic. As a result, many healthcare professionals were deployed and suddenly faced end-of-life care management and its challenges.

AIMS

To understand the experiences of palliative care professionals deployed in supporting emergency and critical care staff during the COVID-19 first and second pandemic waves.

RESEARCH DESIGN

A qualitative descriptive design was adopted, and in-depth interviews were used to investigate and analyse participants' perceptions and points of view.

PARTICIPANTS AND RESEARCH CONTEXT

Twenty-four healthcare professionals (physicians, nurses, psychologists, physiotherapists, and spiritual support) from the most affected areas of Italy were recruited via the Italian society of palliative care and researchers' network.

ETHICAL CONSIDERATIONS

The University Institutional Board granted ethical approval. Participants gave written informed consent and agreed to be video-recorded.

FINDINGS

The overarching theme highlighted participants' experience supporting health professionals to negotiate ethical complexity in end-of-life care. Crucial topics that emerged within themes were: training emergency department professionals on ethical dimensions of palliative and end-of-life care, preserving dying patients' dignity and developing ethical competence in managing end-of-life care.

CONCLUSIONS

Our study showed palliative care teams' challenges in supporting health professionals' ethical awareness in emergencies. However, while they highlighted their concerns in dealing with the emergency staff's lack of ethical perspectives, they also reported the positive impact of an ethically-informed palliative care approach. Lastly, this study illuminates how palliative care professionals' clinical and ethical competence might have assisted a cultural change in caring for dying patients during COVID-19 and future emergencies.

Perceived public stigma and perceived public exposure by persons living with bipolar disorder: A qualitative study

BACKGROUND

Stigma impact the lives of persons living with bipolar disorder.

AIM

The aim of this study was to explore how perceived public stigma is described by people living with bipolar disorder and examine the links between perceived public stigma and perceived public exposure.

METHOD

Face-to-face in-depth interviews were conducted in a purposive sample of euthymic people living with bipolar disorder recruited in a mood disorder ambulatory unit.

RESULTS

Thematic analysis of the transcript yielded five independent themes that were related to perceived public stigma. Perceived public stigma of bipolar disorder was modeled as comprising the three elements of public stigmas (stereotype, prejudice, and discrimination), with the addition of public exposure as a core component.

CONCLUSION

The representation of bipolar disorder in society via newspapers, films/TV series, conferences, and celebrity self-disclosures is considered to have multiple impacts. People living with bipolar disorder have also reported a perceived public stigma of bipolar disorder that has both specific features and characteristics of general mental illness.

The challenges of pig farming in Hong Kong: a study of farmers' perceptions and attitudes towards a pig health and production management service

BACKGROUND

Pig farming in Hong Kong differs markedly from other places in the world, with a highly urbanised population, the majority of pigs being imported for slaughter, and limited on-farm veterinary support. Little is known about the barriers and attitudes of pig farmers in Hong Kong and their expectations of a new pig health and production management service provided by veterinarians. We collected qualitative and quantitative data to 1) describe pig farms, 2) identify barriers to pig farming in Hong Kong and 3) describe the perceptions of the new service. Thematic analysis was conducted to identify barriers and attitudes.

RESULTS

Eight and nine out of 38 pig farmers agreed to participate in the qualitative and quantitative components, respectively. All farms were farrow-to-finish farms with a median of 2800 (range 950 to 7000) pigs per farm. Three themes were identified during the interview analysis and could be ranked based on their importance to the farmers: the regulatory environment (Theme 1), veterinary support structures (Theme 2), and the sustainability of the pig industry (Theme 3). Farmers expressed dissatisfaction with the regulation of the industry and veterinary services on offer within Hong Kong. However, farmers did note that the provision of a new pig health and production management service was as a positive development. The public perception of pig farming, market forces, and competition from mainland pig farmers have resulted in sustainability challenges for the industry.

CONCLUSIONS

Farmers identified very specific local systems and challenges unique to pig farming in Hong Kong. The lack of veterinary support was one of these challenges and although a certain level of scepticism towards the new pig health and production service was expressed, farmers indicated their interest and listed areas where they would benefit from improved veterinary support. Prior experiences of veterinary services clouded farmers perceptions of the usefulness of a new service. To be successful in this environment, clear communication about the goals, role and limitations of the new on farm service is crucial, as is the alignment with the needs of farmers. Despite the small sample size, the qualitative methodology used allows us to assume that these themes give a general idea of what Hong Kong farmers' concerns and attitudes are.

Systems and processes for regulation of investigational medical devices in Uganda

Background

In many parts of the world, medical devices and the processes of their development are tightly regulated. However, the current regulatory landscape in Uganda like other developing countries is weak and poorly defined, which creates significant barriers to innovation, clinical evaluation, and translation of medical devices.

Aim

To evaluate current knowledge, systems and infrastructure for medical devices regulation and innovation in Uganda.

Methods

A mixed methods study design using the methods triangulation strategy was employed in this study. Data of equal weight were collected sequentially. First, a digital structured questionnaire was sent out to innovators to establish individual knowledge and experience with medical device innovation and regulation. Then, a single focus group discussion involving both medical device innovators and regulators to collect data about the current regulatory practices for medical devices in Uganda. Univariate and bivariate analysis was done for the quantitative data to summarize results in graphs and tables. Qualitative data was analyzed using thematic analysis. Ethical review and approval were obtained from the Makerere University School of Biomedical Sciences, Research and Ethics Committee, and the Uganda National Council for Science and Technology.

Results

A total of 47 innovators responded to the questionnaire. 14 respondents were excluded since they were not medical device innovators. Majority (76%) of individuals had been innovators for more than a year, held a bachelor's degree with a background in Engineering and applied sciences, and worked in an academic research institute. 22 of the 33 medical device innovators had stopped working on their innovations and had stalled at the proof-of-concept stage. Insufficient funding, inadequate technical expertise and confusing regulatory landscape were major challenges to innovation. The two themes that emerged from the discussion were "developing standards for medical devices regulation" and "implementation of regulations in practical processes". Legal limitations, lengthy processes, and low demand were identified as challenges to developing medical device regulations.

Conclusions

Efforts have been taken by government to create a pathway for medical device innovations to be translated to the market. More work needs to be done to coordinate efforts among stakeholders to build effective medical device regulations in Uganda.

Mental health and well-being of unpaid caregivers: a cross-sectional survey protocol

INTRODUCTION

Unpaid caregiving, care provided by family/friends, is a public health issue of increasing importance. COVID-19 worsened the mental health conditions of unpaid caregivers, increasing substance/drug use and early development of chronic disease. The impact of the intersections of race and ethnicity, sex, age and gender along with unpaid care work and caregivers' health and well-being is unknown. The aim of this study is to describe the inequities of caregiver well-being across the intersections of race and ethnicity, sex, age and gender using a cross-sectional survey design.

METHODS AND ANALYSIS

We are collaborating with unpaid caregivers and community organisations to recruit a non-probability sample of unpaid caregivers over 18 years of age (n=525). Recruitment will focus on a target sample of 305 South Asian, Chinese and Black people living in Canada, who represent 60% of the Canadian racial and ethnic populations. The following surveys will be combined into one survey: Participant Demographic Form, Caregiver Well-Being Index, interRAI Self-report of Carer Needs and the GENESIS (GENdEr and Sex DetermInantS of Cardiovascular Disease: From Bench to Beyond-Premature Acute Coronary Syndrome) PRAXY Questionnaire. Sample characteristics will be summarised using descriptive statistics. The scores from the Caregiver Well-Being Index will be dichotomised into fair/poor and good/excellent. A two-stage analytical strategy will be undertaken using logistic regression to model fair/poor well-being and good/excellent well-being according to the following axes of difference set a priori: sex, race and ethnicity, gender identity, age, gender relations, gender roles and institutionalised gender. The first stage of analysis will model the main effects of each factor and in the second stage of analysis, interaction terms will be added to each model.

ETHICS AND DISSEMINATION

The University of Toronto's Health Sciences Research Ethics Board granted approval on 9 August 2022 (protocol number: 42609). Knowledge will be disseminated in pamphlets/infographics/email listservs/newsletters and journal articles, conference presentation and public forums, social media and through the study website.

TRIAL REGISTRATION NUMBER

This is registered in the Open Sciences Framework with a Registration DOI as follows: https://doi.org/10.17605/OSF.IO/PB9TD.

Sampling Sexual and Gender Minority Youth With UnACoRN (Understanding Affirming Communities, Relationships, and Networks): Lessons From a Web-Based Survey

BACKGROUND

Periodic surveys of sexual and gender minority (SGM) populations are essential for monitoring and investigating health inequities. Recent legislative efforts to ban so-called conversion therapy make it necessary to adapt youth surveys to reach a wider range of SGM populations, including those <18 years of age and those who may not adopt an explicit two-spirit, lesbian, gay, bisexual, transgender, and queer (2S/LGBTQ) identity.

OBJECTIVE

We aimed to share our experiences in recruiting SGM youth through multiple in-person and online channels and to share lessons learned for future researchers.

METHODS

The Understanding Affirming Communities, Relationships, and Networks (UnACoRN) web-based survey collected anonymous data in English and French from 9679 mostly SGM respondents in the United States and Canada. Respondents were recruited from March 2022 to August 2022 using word-of-mouth referrals, leaflet distribution, bus advertisements, and paid and unpaid campaigns on social media and a pornography website. We analyzed the metadata provided by these and other online resources we used for recruitment (eg, Bitly and Qualtrics) and describe the campaign's effectiveness by recruitment venue based on calculating the cost per completed survey and other secondary metrics.

RESULTS

Most participants were recruited through Meta (13,741/16,533, 83.1%), mainly through Instagram; 88.96% (visitors: 14,888/18,179) of our sample reached the survey through paid advertisements. Overall, the cost per survey was lower for Meta than Pornhub or the bus advertisements. Similarly, the proportion of visitors who started the survey was higher for Meta (8492/18,179, 46.7%) than Pornhub (58/18,179, 1.02%). Our subsample of 7037 residents of Canada had a similar geographic distribution to the general population, with an average absolute difference in proportion by province or territory of 1.4% compared to the Canadian census. Our US subsample included 2521 participants from all US states and the District of Columbia. A total of CAD $8571.58 (the currency exchange rate was US $1=CAD $1.25) was spent across 4 paid recruitment channels (Facebook, Instagram, PornHub, and bus advertisements). The most cost-effective tool of recruitment was Instagram, with an average cost per completed survey of CAD $1.48.

CONCLUSIONS

UnACoRN recruited nearly 10,000 SGM youth in the United States and Canada, and the cost per survey was CAD $1.48. Researchers using online recruitment strategies should be aware of the differences in campaign management each website or social media platform offers and be prepared to engage with their framing (content selection and delivery) to correct any imbalances derived from it. Those who focus on SGM populations should consider how 2S/LGBTQ-oriented campaigns might deter participation from cisgender or heterosexual people or SGM people not identifying as 2S/LGBTQ, if relevant to their research design. Finally, those with limited resources may select fewer venues with lower cost per completed survey or that appeal more to their specific audience, if needed.

Greater willingness to reduce microplastics consumption in Mexico than in Spain supports the importance of legislation on the use of plastics

Introduction

Microplastics (MP) threaten all organisms worldwide. MP are produced directly as microbeads in cosmetics and hygiene products, or indirectly from breakage of larger plastics. The control of MP requires consumers' engagement to refuse products containing microbeads.

Methods

We conducted a survey on 572 university students from Mexico and Spain, two countries where microbeads are not banned yet. More strict laws for plastic control areenforced in Mexico than in Spain.

Results

Controlling for age and education, despite knowing less about MP, Mexicans checked for microbeads on product labels more frequently than Spaniards, and desired to reduce MP consumption more. A stronger correlation between individual awareness and willingness of MP control was found for Mexican than for Spanish students.

Discussion

Perhaps more strict legislation against plastics creates an environment favorable to MP control. Unclear statement of microbeads on labels was the main reason for not checking microbead contents; environmental education and a stricter control of plastics and MP were identified as necessary policy changes in the two countries. Corporation engagement on clearer product labeling is also suggested.

Food price volatility and socio-economic inequalities in poor food consumption status during coronavirus disease-2019 lockdown among slum and non-slum households in urban Nansana municipality, Uganda

BACKGROUND

This study assessed staple food price volatility, household food consumption scores (FCS), poor household food consumption status and its association with socio-economic inequalities during enforcing and partial lifting of coronavirus disease-2019 (COVID-19) lockdown restrictions in slum and non-slum households (HHs) of Nansana municipality, Uganda.

METHODS

Repeated cross-sectional surveys were conducted during enforcing and partial lifting of COVID-19 lockdown restrictions. A total of 205 slum and 200 non-slum HHs were selected for the study. Telephone based interviews with HH heads were used to collect data on socio-economic factors. Data for FCS was collected using the World Food Programme FCS method. Prices for staple foods were collected by face-to-face interviews with food vendors from the local market. Mean staple food price differences before COVID-19 lockdown, during enforcing, and partial lifting of lockdown was tested by Analysis of variance with repeated measures. Multivariate logistic regression analysis was used to assess the association between socio-economic variables and poor food consumption status. A statistical test was considered significant at p < 0.05.

RESULTS

Mean staple food prices were significantly higher during enforcing COVID-19 total lockdown restrictions compared to either 1 week before lockdown or partial lifting of lockdown (p < 0.05). Mean FCS for staple cereals and legumes were significantly higher in slum HHs during COVID-19 lockdown compared to when the lockdown was partially lifted (p < 0.05). In slum HHs, the prevalence of poor food consumption status was significantly higher during partial lifting (55.1%) compared to total lockdown of COVID-19 (15.1%), p < 0.05. Among slum HHs during lockdown restrictions, food aid distribution was negatively associated with poor food consumption status (AOR: 0.4, 95% CI: 0.1-0.6), whilst being a daily wage earner was positively associated with poor food consumption status (AOR: 0.5, 95% CI: 0.1-0.6). During partial lifting of COVID-19 lockdown in slum HHs, poor food consumption status was positively associated with female headed HHs (AOR: 1.2, 95%CI: 1.1-1.6), daily wage earners (AOR: 3.2, 95% CI: 2.6-3.8), unemployment (AOR: 1.9, 95% CI: 1.5-2.1) and tenants (AOR: 2.4, 95% CI: 1.8-3.5). Female headed HHs, daily wage earners and tenants were positively associated with poor food consumption status either during enforcing or partial lifting of COVID-19 lockdown restrictions in non-slum HHs.

CONCLUSION

Staple food prices increased during enforcing either the COVID-19 lockdown or partial lifting of the lockdown compared to before the lockdown. During the lockdown, food consumption improved in slum HHs that received food aid compared to those slum HHs that did not receive it. Household heads who were females, daily wage earners, unemployed, and tenants were at risk of poor food consumption status either in slum or non-slum, and therefore needed some form of food assistance either during enforcing or partial lifting of the lockdown.

Factors Influencing the Adoption of Magnetic Resonance-Guided High-Intensity Focused Ultrasound for Painful Bone Metastases in Europe, A Group Concept Mapping Study

Magnetic resonance imaging-guided high-intensity focused ultrasound (MR-HIFU) is an innovative treatment for patients with painful bone metastases. The adoption of MR-HIFU will be influenced by several factors beyond its effectiveness. To identify contextual factors affecting the adoption of MR-HIFU, we conducted a group concept mapping (GCM) study in four European countries. The GCM was conducted in two phases. First, the participants brainstormed statements guided by the focus prompt "One factor that may influence the uptake of MR-HIFU in clinical practice is...". Second, the participants sorted statements into categories and rated the statements according to their importance and changeability. To generate a concept map, multidimensional scaling and cluster analysis were conducted, and average ratings for each (cluster of) factors were calculated. Forty-five participants contributed to phase I and/or II (56% overall participation rate). The resulting concept map comprises 49 factors, organized in 12 clusters: "competitive treatments", "physicians' attitudes", "alignment of resources", "logistics and workflow", "technical disadvantages", "radiotherapy as first-line therapy", "aggregating knowledge and improving awareness", "clinical effectiveness", "patients' preferences", "reimbursement", "cost-effectiveness" and "hospital costs". The factors identified echo those from the literature, but their relevance and interrelationship are case-specific. Besides evidence on clinical effectiveness, contextual factors from 10 other clusters should be addressed to support adoption of MR-HIFU.

Meaningful Community-Engaged Partnerships: Lessons Learned from Implementing a Community Health Needs Survey among Asian American and Pacific Islander Subgroups

BACKGROUND

Community-based needs assessments are instrumental to address gaps in data collection and reporting, as well as to guide research, policy, and practice decisions to address health disparities in under-resourced communities.

OBJECTIVES

The New York University Center for the Study of Asian American Health collaboratively developed and administered a large-scale health needs assessment in diverse, low-income Asian American and Pacific Islander communities in New York City and three U.S. regional areas using an in-person or web-based, community-engaged approach.

METHODS

Community-engaged processes were modified over the course of three survey rounds, and findings were shared back to communities of interest using community preferred channels and modalities.

LESSONS LEARNED

Sustaining multiyear, on-the-ground engagement to drive community research efforts requires active bidirectional communication and delivery of tangible support to maintain trust between partners.

CONCLUSIONS

Findings to facilitate community health programming and initiatives were built from lessons learned and informed by new and existing community-based partners.

Understanding the Impact and Tackling the Burden of Osteoarthritis for Aboriginal and Torres Strait Islander People

OBJECTIVE

The aim of this study was to understand and describe the lived experience of Aboriginal and Torres Strait Islander people with osteoarthritis.

METHODS

Qualitative study guided by cultural security, which ensures that research is conducted in a way that will not compromise the cultural values, beliefs, and expectations of Aboriginal and Torres Strait Islander people. Participants were purposively sampled through the networks of project staff. Research yarns (a cultural form of conversation used as a data gathering tool) were conducted with 25 Aboriginal and Torres Strait Islander adults with self-reported osteoarthritis in Western Australia and Victoria, Australia. Data were analyzed using a framework approach and presented through composite storytelling (hypothetical stories representing an amalgam of participants' experiences).

RESULTS

Two composite stories were constructed to reflect themes relating to beliefs and knowledge, impact, coping, and health care experiences. Common beliefs held by participants were that osteoarthritis is caused by previous physically active lifestyles. Many participants feared for their future, increasing disability and needing a wheelchair. Pain associated with osteoarthritis impacted daily activities, sleep, work, family, and social life and cultural activities. Multidimensional impacts were often experienced within complex health or life circumstances and associated with increased anxiety and depression. Most participants reported negative health care experiences, characterized by poor patient-provider communication.

CONCLUSION

Our findings highlight that osteoarthritis is a multidimensional issue for Aboriginal and Torres Strait Islander people that permeates all aspects of life and highlights the need for integrated, multidisciplinary care that is culturally informed and individualized to patient need.

Analysis of Factors Affecting Psychological Resilience of Emergency Room Nurses Under Public Health Emergencies

Resilience is essential for frontline health workers to cope with the unfavorable situations, especially under public health emergencies. Emergency room (ER) nurses are a special cohort of health professionals that may present moderate level of resilience. This study aimed to identify factors that are correlated with resilience in this special cohort to provide directions for intervention and management. ER nurses that have encountered a public health emergency within 3 months were recruited using purposive sampling and snowball technique for the study. Questionnaires, including Connor-Davidson Resilience Scale (CD-RISC), Zung Self-Rating Depression Scale (SDS), and Maslach Burnout Inventory-Human Services Survey (MBI-HSS) were established, followed by an in-depth interview to identify different clusters of themes. Thirteen ER nurses were recruited, and the average CD-RISC score was 66 ± 21. Resilience was negatively correlated with SDS index, and positively correlated with personal accomplishment. Five clusters of themes were identified from in-depth interviews, including physical tolerability, psychological tolerability, tenacity of internal drive, institutional implementation, and external adjustment. This study identified factors associated with resilience in ER nurses under public health emergencies, providing useful information for future directions for intervention.

Advancing Access to Healthcare through Telehealth: A Brownsville Community Assessment

(1) Background: This paper focuses on the development of a community assessment for telehealth using an interprofessional lens, which sits at the intersection of public health and urban planning using multistakeholder input. The paper analyzes the process of designing and implementing a telemedicine plan for the City of Brownsville and its surrounding metros. (2) Methods: We employed an interprofessional approach to CBPR which assumed all stakeholders as equal partners alongside the researchers to uncover the most relevant and useful knowledge to inform the development of telehealth community assessment. (3) Results: Key findings include that: physicians do not have the technology, financial means, or staff to provide a comprehensive system for telemedicine; and due to language and literacy barriers, many patients are not able to use a web-based system of telemedicine. We also found that all stakeholders believe that telehealth is a convenient tool that has the capacity to increase patient access and care. (4) Conclusions: Ultimately, the use of an interprofessional community-based participatory research (CBPR) design allowed our team to bring together local knowledge with that of trained experts to advance the research efforts.

Who do Australian women seek social support from during the reproductive decision-making process?

Limited evidence exists about women's experiences of social support for reproductive decision-making, particularly who women seek social support from during decision-making. Using a concurrent mixed methods approach, this research explored who women aged 25-35 years living in Victoria, Australia, seek social support from during reproductive decision-making. Women seek social support for reproductive decision-making from multiple sources. However, through exploring women's support seeking for reproductive decision-making, rather than once a reproductive decision had been made, the study highlights the nuanced and contextual nature of support seeking for reproductive decision-making demonstrating support seeking is influenced by: type of reproductive decision; women's relationships with members of their social network; previous experiences of support seeking for reproductive decisions; expectations of the support they would receive; homophily; and temporality. This research provides important insight into who women seek support from for reproductive decision-making. Understanding this will help inform future social and public health interventions.

A qualitative study investigating Stakeholders' perspectives on a professional body of pharmacy

Background

With the advent of “shared regulation” over a decade ago in healthcare to allow for greater public input, the Pharmaceutical Society of Ireland (PSI) shed its professional leadership role. Since then there has been no unified voice for the profession of pharmacy in Ireland, which is in stark contrast to other jurisdictions and allied healthcare professions, where both public and practitioner are catered for in separate entities. This is an issue which has received little academic scrutiny thus far, and therefore this study provides a unique opportunity for stakeholders to submit their views.

Methods

Semi-structured interviews with key stakeholders working in representative bodies in Ireland using purposive and snowball sampling. Each interview was audio-video recorded and transcribed accordingly for six phase thematic analysis.

Results

Interviews were conducted with thirteen participants working in diverse sectors relevant to professional representation. There was a consensus regarding the existing void in the pharmacy profession, and how this has had a detrimental impact on the development of the profession and pharmacists' position in the Irish healthcare system. Different structural models were proposed by participants and potential financial and logistical hurdles for the profession to overcome were considered.

Conclusion

The study provides a unique review of stakeholders' perspectives who had clear desires for change. The manner in which such change will occur is a consideration for the profession and policy makers going forward.

Analysis of cyber security knowledge gaps based on cyber security body of knowledge

Due to the increasing number of cyber incidents and overwhelming skills shortage, it is required to evaluate the knowledge gap between cyber security education and industrial needs. As such, the objective of this study is to identify the knowledge gaps in cyber security graduates who join the cyber security workforce. We designed and performed an opinion survey by using the Cyber Security Knowledge Areas (KAs) specified in the Cyber Security Body of Knowledge (CyBOK) that comprises 19 KAs. Our data was gathered from practitioners who work in cyber security organizations. The knowledge gap was measured and evaluated by acknowledging the assumption for employing sequent data as nominal data and improved it by deploying chi-squared test. Analyses demonstrate that there is a gap that can be utilized to enhance the quality of education. According to acquired final results, three key KAs with the highest knowledge gap are Web and Mobile Security, Security Operations and Incident Management. Also, Cyber-Physical Systems (CPS), Software Lifecycles, and Vulnerabilities are the knowledge areas with largest difference in perception of importance between less and more experienced personnel. We discuss several suggestions to improve the cyber security curriculum in order to minimize the knowledge gaps. There is an expanding demand for executive cyber security personnel in industry. High-quality university education is required to improve the qualification of upcoming workforce. The capability and capacity of the national cyber security workforce is crucial for nations and security organizations. A wide range of skills, namely technical skills, implementation skills, management skills, and soft skills are required in new cyber security graduates. The use of each CyBOK KA in the industry was measured in response to the extent of learning in university environments. This is the first study conducted in this field, it is considered that this research can inspire the way for further researches.

Laying the foundations of community engagement in Aboriginal health research: establishing a community reference group and terms of reference in a novel research field

BACKGROUND

Community engagement or community involvement in Aboriginal health research is a process that involves partnering, collaborating and involving Aboriginal and Torres Strait Islander people or potential research participants to empower them to have a say in how research with Aboriginal communities is conducted. In the context of Aboriginal health, this is particularly important so that researchers can respond to the priorities of the community under study and conduct research in a way that is respectful of Aboriginal cultural values and beliefs. One approach to incorporating the principals of community engagement and to ensure cultural oversight and guidance to projects is to engage a community reference group. The aim of this study was to describe the process of establishing an Aboriginal community reference group and terms of reference. The community reference group was established to guide the research activities of a newly formed research collaboration aiming to to develop osteoarthritis care that meets the needs of Aboriginal and Torres Strait Islander people in Australia.

METHODS

Adopting a Participatory Action Research approach, this two-phase study was conducted in Victoria, Australia. In phase one, semi-structured research yarns (a cultural form of conversation used as a data gathering tool) were conducted collaboratively by Aboriginal and non-Aboriginal co-investigators to explore Aboriginal health stakeholder perspectives on establishing a community reference group and terms of reference. In phase two, recommendations in phase one were identified to invite members to participate in the community reference group and to ratify the terms of reference through a focus group. Data were analyzed using a framework analysis approach.

RESULTS

Thirteen people (eight female, four male) participated in phase one. Participants represented diverse professional backgrounds including physiotherapy, nursing, general practice, health services management, hospital liaison, cultural safety education, health research and the arts. Three themes were identified in phase one; Recruitment and Representation (trust and relationships, in-house call-outs, broad-spectrum expertise and Aboriginal majority); Purpose (community engagement, research steering, knowledge dissemination and advocacy) and; Function and Logistics (frequency and format of meetings, size of group, roles and responsibilities, authority, communication and dissemination). In phase two, six Aboriginal people were invited to become members of the community reference group who recommended changes which were incorporated into the seven domains of the terms of reference.

CONCLUSION

The findings of this study are captured in a 10-step framework which describes practical strategies for establishing a community reference group and terms of reference in Aboriginal health research.

Sexual Concurrency Among Adolescent Women With Multiple Partners: A Daily Diary Study

PURPOSE

Sexual partnerships that overlap in some period of time (i.e., concurrent) are a key factor in sexually transmitted infection (STI) transmission. Research examining concurrency among adolescents typically uses person-level, cross-sectional, and/or retrospective data, obscuring factors that manifest on any given occasion of concurrency. We used sexual diaries to examine: (1) daily prevalence of vaginal sex concurrency when two partners are reported by adolescent women; and (2) individual, relational, and behavioral attributes that impact the likelihood of sex with neither partner, with one partner or the other, or with both partners on any given day.

METHODS

Daily diaries were drawn from a large longitudinal cohort study examining sexual relationships, behaviors, and STIs among adolescent women. Participants contributed 280,844 partner-associated diary entries, of which (27.9%; n = 78,356) indicated multiple partners. All two-partner diary entries were retained for analysis (N = 323; Mage = 17.55; 90% African American). Random intercept mixed-effects multinomial logistic regression was used to evaluate the impact of predictor variables on odds of having sex with one or the other, both, or neither partner.

RESULTS

Most two-partner days (93.5%) involved no sex with either partner. Few reports (.2%) indicated same-day sexual concurrency. Older age, greater partner support, and higher sexual interest increased the likelihood of sex with both partners on the same day.

CONCLUSIONS

Individual, relational, and behavioral factors predict concurrency in ways that challenge assumptions that secondary partnerships constitute negligible relationships. Programs targeting partner concurrency in adolescents may find success tailoring messaging around these findings.

Strengthening supervisor support for employees with common mental health problems: developing a workplace intervention using intervention mapping

Background

This study presents the development of a workplace intervention to strengthen supervisor’s support for employees with common mental health problems (CMHP). CMHP have been increasing over the last years, resulting into negative work outcomes, such as absenteeism or reduced work performance. To date, organisational interventions have been promising in preventing these negative work outcomes, however it is yet unknown in what way the role of workplace stakeholders, in particular supervisors, can be strengthened. This study contributes to the literature of interventions on an organizational level which uses a preventative approach by promoting stay at work among employees with CMHP through supervisor support.

Methods

we applied the intervention mapping (IM) approach, by actively involving workplace stakeholders (employees with CMHP, supervisors and occupational health professionals) through the development process and the use of Integrated model of behaviour prediction for employers. All six steps of IM are followed and thematic analysis was used to analyse interviews and focus groups.

Results

Based on a comprehensive needs assessment, the intervention resulted in an online guideline, with five step-wise themes on how to support employees with CMHP to stay at work (SAW). The guideline addressed the most important and changeable actions using the Integrated model of behaviour prediction. The guideline presents how to signal and address problems in the workplace and find solutions by stimulating autonomy of employees, explore job accommodations and ask for occupational support. In addition, basic conditions on how to create mentally healthy workplaces were presented. Coaching sessions by occupational health professionals, that include practical strategies using the best available evidence, were identified by the stakeholders.

Conclusions

This SAW-Supervisor Guideline-intervention responds to the need of supervisors to be supported in their role, responsibility and ways to support employees with mental health issues, through a behaviour-oriented, preventative approach. Intervention mapping provided a systematic process to identify, structure and prioritize factors of supervisor support, resulting in a novel workplace intervention. The active involvement of workplace stakeholders throughout the process resulted into a well-received intervention. The theoretical framework provided practical ways to induce supportive behaviour of supervisors, bridging theory with practice.

Towards a Sustainable Metamorphosis of a Small Island Tourism: Dynamizing Capacity Building, Alternating Governance Arrangements, and Emerging Political Bargaining Power

This study examines how local agents (non-profit-seeking actors and residents of Pahawang Island) developed empowering methods to address ecological problems during the island’s transformation from a small, secluded island to a tourist destination. Building capacity through grassroots initiatives, bottom-linked collaboration, and improved political bargaining power were critical components, constituting the conceptual framework to analyse the data. The socio-spatial shift in Pahawang Island reflects the nature, degree of involvement, and participation of multiple stakeholders. Slowly and gradually, bottom-up and later bottom-linked institutional efforts were implemented to lay the groundwork for a more sustainable ecology, social economy, and political transformation. Capacity building was dynamized by including it in a social innovation process, bottom-linked governance, and stimulated empowerment, which altered the governance, political bargaining power and policymaking power balance. Under these conditions, collaborative grassroots learning and action efforts can be a virtuous panacea for improving the sustainable governance of small islands, which is frequently disregarded in a neoliberal society.

HIV Testing Autonomy: The Importance of Relationship Factors in HIV Testing to People in Lusaka and Chongwe, Zambia

In recent times, informed consent has been adopted worldwide as a cornerstone to ensure autonomy during HIV testing. However, there are still ongoing debates on whether the edifice on which informed consent requirements are grounded, that is, personal autonomy, is philosophically, morally, and practically sound, especially in countries where HIV is an epidemic and/or may have a different ontological perspective or lived reality. This study explores the views of participants from Zambia. In-depth and focus group discussions were conducted at various locations in Lusaka and Chongwe, Zambia. Participants came from various demographics, including people living with HIV (PLHIV), healthcare professionals and workers, policymakers, pregnant women, churchgoers, teachers, rural-based persons, and police officers. Data were manually analysed by conducting inductive and deductive thematic analyses. Results show that participants were not in favour of HIV policies that promote personal autonomy at the expense of pursuit of the common good. Participants viewed interdependence, not autonomy, as an essential characteristic of being human. The participants' views have a realistic potential to provide a contextual and appropriate ethical, respectful, and realistic foundation for HIV testing policies.

Surviving severe COVID-19: Interviews with patients, informal carers and health professionals

BACKGROUND

The COVID-19 pandemic has been associated with an unprecedented number of critical care survivors. Their experiences through illness and recovery are likely to be complex, but little is known about how best to support them.

AIM

This study aimed to explore experiences of illness and recovery from the perspective of survivors, their relatives and professionals involved in their care.

STUDY DESIGN

In-depth qualitative interviews were conducted with three stakeholder groups during the first wave of the pandemic. A total of 23 participants (12 professionals, 6 survivors and 5 relatives) were recruited from 5 acute hospitals in England and interviewed by telephone or video call. Data analysis followed the principles of Reflexive Thematic Analysis.

FINDINGS

Three themes were generated from their interview data: (1) Deteriorating fast-a downhill journey from symptom onset to critical care; (2) Facing a new virus in a hospital-a remote place; and (3) Returning home as a survivor, maintaining normality and recovering slowly.

CONCLUSIONS

Our findings highlight challenges in accessing care and communication between patients, hospital staff and relatives. Following hospital discharge, patients adopted a reframed 'survivor identity' to cope with their experience of illness and slow recovery process. The concept of survivorship in this patient group may be beneficial to promote and explore further.

RELEVANCE TO CLINICAL PRACTICE

All efforts should be made to continue to improve communication between patients, relatives and health professionals during critical care admissions, particularly while hospital visits are restricted. Adapting to life after critical illness may be more challenging while health services are restricted by the impacts of the pandemic. It may be beneficial to promote the concept of survivorship, following admission to critical care due to severe COVID-19.

Nutrition knowledge of elite and non-elite Gaelic footballers

Dietary intake plays a significant role in athletic performance and is influenced by several factors, including nutrition knowledge. Gaelic footballers are amateur athletes who conduct high-intensity, intermittent activity during training and competition, and have previously demonstrated insufficient dietary intake. This study aimed to examine nutrition knowledge in elite and non-elite Gaelic footballers. An online survey was distributed to competitive Gaelic footballers, examining nutrition knowledge using the Abridged Nutrition for Sport Knowledge Questionnaire. Total, general, and sport nutrition knowledge were compared between elite and non-elite athletes, and those who had and had not previously received nutrition education, using Mann-Whitney U-tests. A total of 190 participants (15.3% women) completed the survey. No differences between elite and non-elite athletes in nutrition knowledge were identified (p > 0.05). Athletes with previous nutrition education scored higher than those without previous nutrition education in total (54.0 ± 4.9% vs 46.8 ± 9.6%; p = 0.002) and sport (51.9 ± 12.5% vs 43.4 ± 11.8%; p = 0.005) nutrition knowledge. Findings suggest an importance of nutrition education at all levels of athletic competition to improve nutrition knowledge, which may empower athletes to make appropriate dietary decisions to support training and competition demands.

Cochlear implant aesthetics and its impact on stigma, social interaction and quality of life: a mixed-methods study protocol

INTRODUCTION

Awareness of the benefits of cochlear implants is low, and barriers such as fear of surgery and ongoing rehabilitation have been noted. Perceived stigma associated with hearing loss also plays a key role, with many adults not wanting to appear old or be identified as a person with a disability. In effect, a cochlear implant makes deafness visible. New technologies have led to a smaller external profile for some types of cochlear implants, but qualitative assessments of benefit have not been explored. This study will examine cochlear implant aesthetics and cosmetics, and its impact on perceived stigma, social interactions, communication and quality of life. A particular focus will be the examination of totally implantable device concepts. A secondary aim is to understand what research techniques are best suited and most appealing for cochlear implant recipients, to assist in future study design and data collection methods.

METHODS AND ANALYSIS

This study utilises a mixed-methods design. Three datasets will be collected from each participant with an expected sample size of 10-15 participants to allow for data saturation of themes elicited. Each participant will complete a demographic questionnaire, a quickfire survey (a short concise questionnaire on a topic of research familiarity and preference) and a semi-structured interview. Questionnaire and quickfire survey data will be analysed using descriptive statistics. Interviews will be transcribed and analysed thematically. All participants will be adults with more than 1 year of experience using cochlear implants.

ETHICS AND DISSEMINATION

This study has been granted ethical approval from Macquarie University (HREC: 520211056232432) and meets the requirements set out in the National Statement on Ethical Conduct in Human Research. Study findings will be disseminated widely through international peer-reviewed journal articles, public and academic presentations, plain language summaries for participants and an executive summary for the project funder. This work was supported by Cochlear Limited (Cochlear Ltd). The funder will have no role in conducting or reporting on the study.

A Qualitative Study of Health Care Professionals' Views on Bowel Care in Multiple Sclerosis: Whose Job Is It Anyway?

BACKGROUND

Bowel dysfunction, including constipation and fecal incontinence, is prevalent in individuals with multiple sclerosis (MS), adversely affecting quality of life and increasing caregiver burden. How health care professionals (HCPs) identify, assess, and manage people with MS with bowel dysfunction is understudied. This study explored how HCPs think about, assess, and manage bowel dysfunction in individuals with MS.

METHODS

Semistructured interviews were conducted with 18 HCPs from different professional disciplines and clinical specialties recruited from UK National Health Service primary, secondary, and tertiary care services using purposive and chain referral sampling through professional networks. One participant worked for a bladder and bowel charity. Data were analyzed using thematic analysis.

RESULTS

Views differed regarding responsibilities for providing bowel care. Participants thought individuals with MS should notify HCPs of bowel symptoms and take responsibility for self-management where possible, with family caregivers required to help with bowel care. Although people with MS were often referred to bladder and bowel specialists when a crisis point was reached, earlier referral was called for by these HCPs. There were variations in assessment processes, treatment options offered, and service provision. Participants thought HCPs needed more education on bowel dysfunction, bowel care should take a high priority, and evidence-based clinical guidelines and referral pathways would improve service delivery.

CONCLUSIONS

The HCPs caring for individuals with MS see many with bowel dysfunction, and there is variation in care and service provision; HCPs require more education, evidence-based clinical guidelines, and referral pathways to improve case finding, assessment, and management of these symptoms for individuals with MS.

The Mediating Effect of Depression on the Relation Between Interpersonal Needs and Suicidal Ideation Among Chinese Transgender Women

BACKGROUND

Transgender women are at high risk of depression and suicidal ideation. The interpersonal theory of suicide proposes that suicidal ideation could be a consequence of high interpersonal needs (thwarted belongingness and perceived burdensomeness). The current study tests this theory and investigates whether depression could mediate the relationship between interpersonal needs and suicidal ideation among transgender women in Shenyang, China.

METHODS

A total of 198 transgender women were recruited by snowball sampling. A cross-sectional study was conducted through a structured questionnaire. Suicidal ideation, depression, and interpersonal needs were assessed. Path analysis was used to carry out the research goals and the mediating effect of depression was tested.

RESULTS

There were nearly 37% of the participants reported lifetime suicidal ideation. Suicidal ideation was positively correlated with thwarted belongingness (t = -5.53, p < 0.01) and perceived burdensomeness (t = -5.02, p < 0.01). The direct effect from thwarted belongingness to suicidal ideation via depression was statistically significant (Std. β = 0.232, p < 0.01). Depression could also mediate the indirect path from perceived burdensomeness to suicidal ideation through depression (Std. β = 0.222, p < 0.01) although the direct path between them was not significant (Std. β = 0.046, p = 0.693).

CONCLUSIONS

Depression fully mediated the relationship between perceived burdensomeness and suicidal ideation, and partially mediate the relationship between thwarted belongingness and suicidal ideation. To reduce the risk of suicidal ideation among transgender women, interventions targeting thwarted belongingness, perceived burdensomeness, and depression are needed.