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Kaufman J, Tuckerman J, Bonner C, Durrheim DN, Costa DSJ, Trevena L, Henseler J, Danchin M. Development and validation of the Vaccine Barriers Assessment Tool for identifying drivers of under-vaccination in children under five years in Australia. Hum Vaccin Immunother 2024; 20:2359623. [PMID: 38845399 PMCID: PMC11164230 DOI: 10.1080/21645515.2024.2359623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024] Open
Abstract
Data on routine childhood vaccination coverage can only tell us who is under-vaccinated; it cannot explain why vaccine coverage is low. Collecting data on the reasons behind under-vaccination is necessary to implement cost-effective strategies that address key barriers and target interventions appropriately. However, no instruments that measure both vaccine acceptance and access factors among parents of children <5 y have been validated in high-income countries. This study aims to develop and validate the Vaccine Barriers Assessment Tool (VBAT) for Australia. We applied three phases of mixed methods data collection and analysis. In Phase 1, we developed a comprehensive list of 80 items reflecting all potential parental barriers to childhood vaccination, derived from published literature and behavioral theory. Through cognitive interviews (n = 28), we refined this list to 45 items. In Phase 2, we conducted a two-wave online survey to test the reliability and validity of these items in an Australian sample of parents (n = 532) with structural equation modeling, further refining the list to 35 items. In Phase 3, we conducted a final parent survey (n = 156), administering these items along with the Parent Attitudes toward Childhood Vaccination (PACV) scale for comparison. We reviewed participants' immunization register data to assess the predictive validity of the proposed models. The final 6-item short form and 15-item long form Vaccine Barriers Assessment Tool assess access, communal benefit, personal risk, equity, commitment, social norms, and trust in health-care workers. It is being applied for national surveillance in Australia and will be adapted for additional populations and vaccines.
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Affiliation(s)
- Jessica Kaufman
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Royal Children’s Hospital, Parkville, Australia
| | - Jane Tuckerman
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Royal Children’s Hospital, Parkville, Australia
| | - Carissa Bonner
- School of Public Health, University of Sydney, Camperdown, Australia
| | - David N. Durrheim
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Australia
- Health Protection, Hunter New England Population Health, Wallsend, Australia
| | | | - Lyndal Trevena
- School of Public Health, University of Sydney, Camperdown, Australia
| | - Jörg Henseler
- Department of Design, Production & Management, University of Twente, Enschede, Netherlands
- Nova Information Management School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Margie Danchin
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Royal Children’s Hospital, Parkville, Australia
- Department of General Medicine, Royal Children’s Hospital, Parkville, Australia
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Gilanyi YL, Shah B, Cashin AG, Gibbs MT, Bellamy J, Day R, McAuley JH, Jones MD. Barriers and enablers to exercise adherence in people with nonspecific chronic low back pain: a systematic review of qualitative evidence. Pain 2024; 165:2200-2214. [PMID: 38635470 PMCID: PMC11404330 DOI: 10.1097/j.pain.0000000000003234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 02/25/2024] [Indexed: 04/20/2024]
Abstract
ABSTRACT Exercise is a first-line treatment for chronic low back pain (CLBP), reducing pain and disability in the short term. However, exercise benefits decrease over time, with a lack of long-term exercise adherence a potential reason for this. This study aimed to synthesize the perceptions and beliefs of individuals with CLBP and identify their barriers and enablers to exercise adherence. We searched CENTRAL, Embase, CINAHL, SPORTDiscus, PubMed, PsycINFO, and Scopus databases from inception to February 28, 2023, for qualitative studies that explored the factors influencing exercise adherence for people with CLBP. A hybrid approach combining thematic synthesis with the Theoretical Domains Framework was used to analyze data. We assessed methodological quality using the Critical Appraisal Skills Programme checklist and the level of confidence of the themes generated using the Confidence in the Evidence from Reviews of Qualitative Studies. Twenty-three papers (n = 21 studies) were included (n = 677 participants). Four main themes affected exercise adherence: (1) exercise, pain, and the body, (2) psychological factors, (3) social factors, and (4) external factors. These themes contained 16 subthemes that were predominantly both barriers and enablers to exercise adherence. The individual's experiences of barriers and enablers were most appropriately represented across a spectrum, where influencing factors could be a barrier or enabler to exercise adherence, and these could be specific to pre-exercise, during-exercise, and post-exercise situations. These findings may be used to improve exercise adherence and ultimately treatment outcomes in people with CLBP.
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Affiliation(s)
- Yannick L Gilanyi
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Brishna Shah
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Aidan G Cashin
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Mitchell T Gibbs
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Jessica Bellamy
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Richard Day
- St Vincent's Clinical Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - James H McAuley
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Matthew D Jones
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
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Calcedo-Barba A, Antón Basanta J, Paz Ruiz S, Muro Alvarez A, Elizagárate Zabala E, Estévez Closas V, López López A, Barrios Flores LF. Indifferent minds, broken system: a critical examination of mental health care provision for Spain's incarcerated population with serious mental illnesses. Front Psychiatry 2024; 15:1340155. [PMID: 39234620 PMCID: PMC11372278 DOI: 10.3389/fpsyt.2024.1340155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 07/25/2024] [Indexed: 09/06/2024] Open
Abstract
Background Spain healthcare system is decentralized, with seventeen autonomous regions overseeing healthcare. However, penitentiary healthcare is managed nationally, except in Catalonia, the Basque Country, and Navarra. These variations impact mental health care provision for inmates with serious mental illness (SMI). Objective To delineate differences between regions in terms of mental health care provision for individuals with SMI, available resources, and the perspectives of healthcare professionals operating in the Spanish prison environment. Methods Employing an explanatory sequential mixed-method approach, the study conducted an extensive literature review, quantitative data collection through structured questionnaires, and qualitative data collection via focus groups and four in-depth interviews. Analysis involved calculating percentages and ratios for quantitative data and thematic analysis for qualitative data interpretation to comprehensively understand mental healthcare provision. Results In December 2021, about 4% of inmates in Spain had SMI. There are three distinct models of mental healthcare within the Spanish prison system. The traditional penitentiary model, representing 83% of the incarcerated population, operates independently under the General Secretariat of Penitentiary Institutions at a national level. This model relies on an average of 5.2 penitentiary General Practitioners (pGP) per 1,000 inmates for psychiatric and general healthcare. External psychiatrists are engaged for part-time psychiatric assessment. Acute psychiatric hospitalization occurs in general nursing modules within penitentiary centers or in Restricted Access Units (RAUs) in reference hospitals. Two penitentiary psychiatric hospitals provide care to unimputable SMI inmates from all over Spain. Innovative penitentiary models, constituting 17% of the prison population, integrate penitentiary healthcare within regional public health systems. The Basque Country features a Mental Health Unit with full-time care teams within the penitentiary center. Catalonia emphasizes community care, providing full-time dedicated psychiatric services within and outside prisons, ensuring continued care in the community. Both models prioritize personnel with specialized mental health training and compensation akin to non-prison healthcare settings. Conclusions Regional disparities in penitentiary mental healthcare models in Spain result in resource inequalities, impacting specialized care for inmates with SMI and opportunities for healthcare professionals. The models in the Basque Country and Catalonia offer valuable experiences for penitentiary healthcare.
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Affiliation(s)
- Alfredo Calcedo-Barba
- Institute of Psychiatry and Mental Health, Gregorio Marañón General University Hospital, Medical School, Complutense University of Madrid, Madrid, Spain
- Spanish Society of Legal Psychiatry, Madrid, Spain
| | - Joaquín Antón Basanta
- General Practice Penitentiary Health Care, Albolote Penitentiary Centre, Granada, Spain
- Spanish Society of Penitentiary Health, Barcelona, Spain
| | | | | | - Edorta Elizagárate Zabala
- Psychiatry Service of the Mental Health Network of Araba, Mental Health Centre, Zaballa Penitentiary Center, Spanish Society of Clinical Psychiatry, Deusto University Medical School, Bilbao, Spain
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Leek AE, Keren N, Shelley MC, Franke W, Mosher GA, Simpson SA, Rice T, Hayden HE. Assessing the Mental Model State of Emergency Responders in the Context of Radiological Dispersal Device (RDD) Incidents: A Multi-state Study. HEALTH PHYSICS 2024:00004032-990000000-00176. [PMID: 39052001 DOI: 10.1097/hp.0000000000001856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
ABSTRACT Hazardous Materials (HAZMAT) Technicians' notions of mental model, or cognitive representations of their understanding and beliefs regarding Radiological Dispersal Devices (RDDs) incidents, have not been previously explored. A prior study developed an Expected Mental Model State (EMMS) framework specific to RDD incident response for HAZMAT technicians. The work herein presents the development of a derivative of this framework, the EMMS Diagnostic Matrix, to evaluate the actual Mental Model State (MMS) of HAZMAT technicians in the context of RDD incidents. The EMMS Diagnostic Matrix was administered via a survey and simulation activity in four U.S. states representing the Northeast, West, South, and Midwest regions. Data were collected and coded using grounded theory methodology. Reflexive thematic analysis was employed to identify themes across related areas where the notions of mental model for the HAZMAT technician responders' actual MMS differed from the EMMS. The analysis of the collected data revealed four significant themes representing incomplete notions of the mental model spanning various EMMS conceptual domains: Overestimation of Radiation Dose and Health Effects, indicating misunderstandings about the health impacts of radiation exposure, Acute Radiation Syndrome (ARS), particularly in the lower range of radiation doses; Overreliance on Responder Protection [personal protective equipment (PPE)/self-contained breathing apparatus (SCBA)], highlighting gaps in understanding radiation principles and radioactive material dispersal properties from a radiological dispersal device; Misunderstanding Radiation Detection and Units, signifying confusion about radiation units and differentiation between dose rate and accumulated dose; and Incomplete Understanding of Radiation Characteristics and Dispersal Properties, outlining a limited grasp of inhalation risks from radiation and the dispersal traits of a radiological dispersal device. The interconnectedness of these technical misunderstandings can guide the development of a strategic plan to evaluate and modify existing training, aiming at these specific themes to improve the efficiency of HAZMAT technicians in emergency situations and to identify areas for further research.
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Affiliation(s)
| | | | | | | | - Gretchen A Mosher
- Department of Agricultural and Biosystems Engineering, Iowa State University, Ames, IA
| | - Stephen A Simpson
- Department of Agricultural and Biosystems Engineering, Iowa State University, Ames, IA
| | | | - H Emily Hayden
- Strategic Education Research Partnership, Washington, DC
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5
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Payne VL, Sattar U, Wright M, Hill E, Butler JM, Macpherson B, Jeppesen A, Del Fiol G, Madaras-Kelly K. Clinician perspectives on how situational context and augmented intelligence design features impact perceived usefulness of sepsis prediction scores embedded within a simulated electronic health record. J Am Med Inform Assoc 2024; 31:1331-1340. [PMID: 38661564 PMCID: PMC11105126 DOI: 10.1093/jamia/ocae089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/04/2024] [Accepted: 04/05/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE Obtain clinicians' perspectives on early warning scores (EWS) use within context of clinical cases. MATERIAL AND METHODS We developed cases mimicking sepsis situations. De-identified data, synthesized physician notes, and EWS representing deterioration risk were displayed in a simulated EHR for analysis. Twelve clinicians participated in semi-structured interviews to ascertain perspectives across four domains: (1) Familiarity with and understanding of artificial intelligence (AI), prediction models and risk scores; (2) Clinical reasoning processes; (3) Impression and response to EWS; and (4) Interface design. Transcripts were coded and analyzed using content and thematic analysis. RESULTS Analysis revealed clinicians have experience but limited AI and prediction/risk modeling understanding. Case assessments were primarily based on clinical data. EWS went unmentioned during initial case analysis; although when prompted to comment on it, they discussed it in subsequent cases. Clinicians were unsure how to interpret or apply the EWS, and desired evidence on its derivation and validation. Design recommendations centered around EWS display in multi-patient lists for triage, and EWS trends within the patient record. Themes included a "Trust but Verify" approach to AI and early warning information, dichotomy that EWS is helpful for triage yet has disproportional signal-to-high noise ratio, and action driven by clinical judgment, not the EWS. CONCLUSIONS Clinicians were unsure of how to apply EWS, acted on clinical data, desired score composition and validation information, and felt EWS was most useful when embedded in multi-patient views. Systems providing interactive visualization may facilitate EWS transparency and increase confidence in AI-generated information.
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Affiliation(s)
- Velma L Payne
- Kasiska Division of Health Sciences, College of Health, Idaho State University, Pocatello, ID 83209, United States
| | - Usman Sattar
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT 84108, United States
| | - Melanie Wright
- Tunnell Government Services, Inc., Bethesda, MD 20817, United States
| | - Elijah Hill
- Kasiska Division of Health Sciences, College of Pharmacy, Idaho State University, Pocatello, ID 83209, United States
| | - Jorie M Butler
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT 84108, United States
| | - Brekk Macpherson
- Virginia Commonwealth University Health System, Richmond, VA 83298, United States
| | - Amanda Jeppesen
- Kasiska Division of Health Sciences, College of Pharmacy, Idaho State University, Pocatello, ID 83209, United States
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT 84108, United States
| | - Karl Madaras-Kelly
- Kasiska Division of Health Sciences, College of Pharmacy, Idaho State University, Pocatello, ID 83209, United States
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Kurlander JE, Helminski D, Yuan L, Krein SL, Lanham MS, Henstock JL, Kidwell KM, De Vries R, Resnicow K, Sholl H, Kim JJ, Perry LK, Parsons J, Ha N, Froehlich JB, Aikens JE, Richardson CR, Saini SD, Barnes GD. Feasibility and acceptability of patient- and clinician-level antithrombotic stewardship interventions to reduce gastrointestinal bleeding risk in patients using warfarin (Anticoagulation with Enhanced Gastrointestinal Safety): a factorial randomized controlled pilot trial. Res Pract Thromb Haemost 2024; 8:102421. [PMID: 38827255 PMCID: PMC11143904 DOI: 10.1016/j.rpth.2024.102421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 04/04/2024] [Indexed: 06/04/2024] Open
Abstract
Background Overuse of antiplatelet therapy and underuse of gastroprotection contribute to preventable bleeding in patients taking anticoagulants. Objectives (1) Determine the feasibility of a factorial trial testing patient activation and clinician outreach to reduce gastrointestinal (GI) bleeding risk in patients prescribed warfarin-antiplatelet therapy without proton pump inhibitor gastroprotection and (2) assess intervention acceptability. Methods Pragmatic 2 × 2 factorial cluster-randomized controlled pilot comparing (1) a patient activation booklet vs usual care and (2) clinician notification vs clinician notification plus nurse facilitation was performed. The primary feasibility outcome was percentage of patients completing a structured telephone assessment after 5 weeks. Exploratory outcomes, including effectiveness, were evaluated using chart review, surveys, and semistructured interviews. Results Among 47 eligible patients, 35/47 (74.5%; 95% CI, 58.6%-85.7%) met the feasibility outcome. In the subset confirmed to be high risk for upper GI bleeding, 11/29 (37.9%; 95% CI, 16.9%-64.7%) made a medication change, without differences between intervention arms. In interviews, few patients reported reviewing the activation booklet; barriers included underestimating GI bleeding risk, misunderstanding the booklet's purpose, and receiving excessive health communication materials. Clinicians responded to notification messages for 24/47 patients (51.1%; 95% CI, 26.4%-75.4%), which was lower for surgeons than nonsurgeons (22.7% vs 76.0%). Medical specialists but not surgeons viewed clinician notification as acceptable. Conclusion The proposed trial design and outcome ascertainment strategy were feasible, but the patient activation intervention is unlikely to be effective as designed. While clinician notification appears promising, it may not be acceptable to surgeons, findings which support further refinement and testing of a clinician notification intervention.
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Affiliation(s)
- Jacob E. Kurlander
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, USA
| | - Danielle Helminski
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Liyang Yuan
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Sarah L. Krein
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, USA
| | - Michael S.M. Lanham
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Office of Clinical Informatics, Ann Arbor, Michigan, USA
| | - Jennifer L. Henstock
- Health Information Technology and Services, University of Michigan, Ann Arbor, Michigan, USA
| | - Kelley M. Kidwell
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Raymond De Vries
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kenneth Resnicow
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA
| | - Haden Sholl
- Department of Medicine, Division of General Internal Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Joyce J. Kim
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Linda K. Perry
- Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Jacqueline Parsons
- Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Nghi Ha
- Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, USA
| | - James B. Froehlich
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, USA
| | - James E. Aikens
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Sameer D. Saini
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, USA
| | - Geoffrey D. Barnes
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, USA
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Ardissone A, Leonowicz-Bukała I, Struck-Peregończyk M. "Can Anyone Tell Me…". Online Health Communities in Diabetes Self-Management in Poland and Italy. HEALTH COMMUNICATION 2024:1-8. [PMID: 38687112 DOI: 10.1080/10410236.2024.2348842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
This paper contributes to the debate about the role of Online Health Communities (OHCs) in the healthcare system by concentrating on the kind of information sought and shared by their members. The paper focuses on OHCs for diabetes and discusses the main findings of a qualitative study conducted in Italy and Poland. The Uses and Gratifications approach informed the study, while content analysis was used to perform the analysis. The findings show that OHCs' role goes beyond information and emotional support, which relies on expertise by experience. Indeed, the lack of basic knowledge constituting the essential diabetes literacy for self-management was partially compensated by peer exchange in the OHCs. This raises at least two problems: quality and reliability of the information shared online, and consequences in terms of the equity that a healthcare system provides.
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Affiliation(s)
| | - Iwona Leonowicz-Bukała
- Faculty of Media and Social Communication, University of Information Technology and Management in Rzeszow
| | - Monika Struck-Peregończyk
- Faculty of Media and Social Communication, University of Information Technology and Management in Rzeszow
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Edmonds DM, Zayts-Spence O, Fortune Z, Chan A, Chou JSG. A scoping review to map the research on the mental health of students and graduates during their university-to-work transitions. BMJ Open 2024; 14:e076729. [PMID: 38443080 PMCID: PMC11146370 DOI: 10.1136/bmjopen-2023-076729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 01/02/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVES This scoping review maps the extant literature on students' and graduates' mental health experiences throughout their university-to-work transitions. The current review investigates the methodological features of the studies, the main findings, and the theories that the studies draw on to conceptualise mental health and transitions. DESIGN This project used a scoping review methodology created and developed by Peters and colleagues and the Joanna Briggs Institute. The review searched academic databases and screened existing studies that met predetermined inclusion criteria. DATA SOURCES Seven academic databases and Google Scholar were searched with sets of search terms. ELIGIBILITY The included studies examined participants who were final-year university students or those who had graduated from university within a 3-year period. Studies published in English since 2000 and from any country were included. The review included studies examining the negative dimensions of mental health. The review excluded studies focusing on medical students and graduates. DATA EXTRACTION Basic information about the studies and their findings on mental health and university-to-work transitions was retrieved. The findings are presented in tables and in a qualitative thematic summary. RESULTS The scoping review included 12 studies. Mental health was often not explicitly defined and it's theoretical foundations were not clearly articulated. The review identified factors, including a lack of social support and economic precarity, as sources of adverse mental health. Other protective factors in these studies-variables that guard against mental health problems-were identified, such as career preparedness and having a good job. CONCLUSIONS Despite the methodological focus on the negative aspects of mental health, people's mental health experiences during university-to-work transitions are not uniformly negative. Clear conceptualisations of mental health in future studies will aid in developing resources to improve well-being. TRIAL REGISTRATION NUMBER This scoping review adhered to a protocol previously published in this journal and that is registered on the Open Science Framework website (https://osf.io/gw86x).
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Affiliation(s)
| | | | - Zoë Fortune
- School of English, The University of Hong Kong, Hong Kong, China
- School of Social Sciences, Heriot-Watt University Dubai, Dubai, UAE
| | - Angus Chan
- School of English, The University of Hong Kong, Hong Kong, China
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9
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Maraveas C, Kyrtopoulos IV, Arvanitis KG, Bartzanas T. The Aging of Polymers under Electromagnetic Radiation. Polymers (Basel) 2024; 16:689. [PMID: 38475374 DOI: 10.3390/polym16050689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024] Open
Abstract
Polymeric materials degrade as they react with environmental conditions such as temperature, light, and humidity. Electromagnetic radiation from the Sun's ultraviolet rays weakens the mechanical properties of polymers, causing them to degrade. This study examined the phenomenon of polymer aging due to exposure to ultraviolet radiation. The study examined three specific objectives, including the key theories explaining ultraviolet (UV) radiation's impact on polymer decomposition, the underlying testing procedures for determining the aging properties of polymeric materials, and appraising the current technical methods for enhancing the UV resistance of polymers. The study utilized a literature review methodology to understand the aging effect of electromagnetic radiation on polymers. Thus, the study concluded that using additives and UV absorbers on polymers and polymer composites can elongate the lifespan of polymers by shielding them from the aging effects of UV radiation. The findings from the study suggest that thermal conditions contribute to polymer degradation by breaking down their physical and chemical bonds. Thermal oxidative environments accelerate aging due to the presence of UV radiation and temperatures that foster a quicker degradation of plastics.
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Affiliation(s)
- Chrysanthos Maraveas
- Department of Natural Resources Development and Agricultural Engineering, Agricultural University of Athens, 75 Iera Odos Street, 11855 Athens, Greece
| | - Ioannis Vasileios Kyrtopoulos
- Department of Natural Resources Development and Agricultural Engineering, Agricultural University of Athens, 75 Iera Odos Street, 11855 Athens, Greece
| | - Konstantinos G Arvanitis
- Department of Natural Resources Development and Agricultural Engineering, Agricultural University of Athens, 75 Iera Odos Street, 11855 Athens, Greece
| | - Thomas Bartzanas
- Department of Natural Resources Development and Agricultural Engineering, Agricultural University of Athens, 75 Iera Odos Street, 11855 Athens, Greece
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10
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Kerstiens S, Gleason LJ, Huisingh-Scheetz M, Landi AJ, Rubin D, Ferguson MK, Quinn MT, Holl JL, Madariaga MLL. Barriers and facilitators to smartwatch-based prehabilitation participation among frail surgery patients: a qualitative study. BMC Geriatr 2024; 24:129. [PMID: 38308234 PMCID: PMC10835899 DOI: 10.1186/s12877-024-04743-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/24/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND For older, frail adults, exercise before surgery through prehabilitation (prehab) may hasten return recovery and reduce postoperative complications. We developed a smartwatch-based prehab program (BeFitMe) for older adults that encourages and tracks at-home exercise. The objective of this study was to assess patient perceptions about facilitators and barriers to prehab generally and to using a smartwatch prehab program among older adult thoracic surgery patients to optimize future program implementation. METHODS We recruited patients, aged ≥50 years who had or were having surgery and were screened for frailty (Fried's Frailty Phenotype) at a thoracic surgery clinic at a single academic institution. Semi-structured interviews were conducted by telephone after obtaining informed consent. Participants were given a description of the BeFitMe program. The interview questions were informed by The Five "Rights" of Clinical Decision-Making framework (Information, Person, Time, Channel, and Format) and sought to identify the factors perceived to influence smartwatch prehab program participation. Interview transcripts were transcribed and independently coded to identify themes in for each of the Five "Rights" domains. RESULTS A total of 29 interviews were conducted. Participants were 52% men (n = 15), 48% Black (n = 14), and 59% pre-frail (n = 11) or frail (n = 6) with a mean age of 68 ± 9 years. Eleven total themes emerged. Facilitator themes included the importance of providers (right person) clearly explaining the significance of prehab (right information) during the preoperative visit (right time); providing written instructions and exercise prescriptions; and providing a preprogrammed and set-up (right format) Apple Watch (right channel). Barrier themes included pre-existing conditions and disinterest in exercise and/or technology. Participants provided suggestions to overcome the technology barrier, which included individualized training and support on usage and responsibilities. CONCLUSIONS This study reports the perceived facilitators and barriers to a smartwatch-based prehab program for pre-frail and frail thoracic surgery patients. The future BeFitMe implementation protocol must ensure surgical providers emphasize the beneficial impact of participating in prehab before surgery and provide a written prehab prescription; must include a thorough guide on smartwatch use along with the preprogrammed device to be successful. The findings are relevant to other smartwatch-based interventions for older adults.
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Affiliation(s)
- Savanna Kerstiens
- Department of Surgery, Biological Sciences Division, University of Chicago, Chicago, IL, USA.
| | - Lauren J Gleason
- Department of Medicine, Section of Geriatrics & Palliative Medicine, Biological Sciences Division, University of Chicago Medicine, Chicago, IL, USA
| | - Megan Huisingh-Scheetz
- Department of Medicine, Section of Geriatrics & Palliative Medicine, Biological Sciences Division, University of Chicago Medicine, Chicago, IL, USA
| | - A Justine Landi
- Department of Medicine, Section of Geriatrics & Palliative Medicine, Biological Sciences Division, University of Chicago Medicine, Chicago, IL, USA
| | - Daniel Rubin
- Department of Anesthesia and Critical Care, Biological Sciences Division, University of Chicago Medicine, Chicago, IL, USA
| | - Mark K Ferguson
- Department of Surgery, Biological Sciences Division, University of Chicago, Chicago, IL, USA
| | - Michael T Quinn
- Department of Medicine, Section of General Internal Medicine, University of Chicago, Chicago, IL, USA
| | - Jane L Holl
- Department of Neurology, Biological Sciences Division, University of Chicago, Chicago, IL, USA
| | - Maria Lucia L Madariaga
- Department of Surgery, Biological Sciences Division, University of Chicago, Chicago, IL, USA
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Hwang JHA, Downing MG, Specht RAG, Ponsford JL. Co-designing for behavioural change: understanding barriers and enablers to addressing sexuality after traumatic brain injury and mapping intervention strategies in a multi-disciplinary rehabilitation unit. BRAIN IMPAIR 2024; 25:IB23068. [PMID: 38566291 DOI: 10.1071/ib23068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/24/2023] [Indexed: 04/04/2024]
Abstract
Background Persistent changes in sexuality often follow traumatic brain injury (TBI). However, health professionals remain reticent about discussing sexuality and have reported barriers including uncertainties around whose role it is and limited educational and institutional support. This study employed a co-design and implementation process, aiming to promote team-wide behavioural change, whereby health professionals at a TBI rehabilitation unit would attempt to address sexuality with patients routinely. Methods Focus group sessions with multidisciplinary health professionals were conducted to identify barriers and enablers to behavioural change, identify areas for development, and co-design intervention options. Implementation deliverables were then finalised and provided to the team. The Theoretical Domains Framework was used to map factors influencing behaviours and the Behaviour Change Wheel was used to map interventions. Thematic analysis was used to further analyse barrier themes. Results Thirty-five barriers and eight enablers falling within 12 theoretical domains to behavioural change were identified. Thematic analysis revealed highly correlated barriers in initiating and sustaining change. Nine co-designed intervention options aligned with five intervention functions of the Behaviour Change Wheel, resulting in six final implementation deliverables. Conclusions Barriers were highly interrelated, influencing the approach to implementation deliverables. Simultaneously addressing multiple barriers could potentially alleviate discomfort associated with discussing sexuality. Concerns around initiating change were related to confidence in achieving sustainable changes. Achieving change requires organisational and team-level environmental restructuring and enablement. The next step involves evaluating the effectiveness of the co-design and implementation process in driving behavioural change and potential impacts on patient satisfaction and sexuality outcomes.
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Affiliation(s)
- Jill H A Hwang
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Vic. 3121, Australia; and Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Richmond, Vic. 3121 Australia
| | - Marina G Downing
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Vic. 3121, Australia; and Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Richmond, Vic. 3121 Australia
| | - Riccarda A G Specht
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Jennie L Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Vic. 3121, Australia; and Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Richmond, Vic. 3121 Australia
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Hart A, Schaffhausen CR, McKinney WT, Gonzales K, Perugini J, Snyder JJ, Ladin K. "You don't know what you don't know": A qualitative study of informational needs of patients, family members, and living donors to inform transplant system metrics. Clin Transplant 2024; 38:e15240. [PMID: 38289894 DOI: 10.1111/ctr.15240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 12/28/2023] [Accepted: 01/03/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Informational needs and potential use of transplant metrics, especially among patients, remain understudied and a critical component of the transplant community's commitment to patient-centered care. We sought to understand the perspectives and needs of patients, family members/caregivers, living donors, and deceased donor family members. METHODS We examined decision-making experiences and perspectives on the needs of these stakeholder groups for data about the national transplant system among 58 participants of 14 focus groups and 6 interviews. RESULTS Three major themes emerged: 1) informational priorities and unmet needs (transplantation system processes, long-term outcomes data, prelisting data, patient-centered outcomes, and ability to compare centers and regions); 2) challenges obtaining relevant and trustworthy information (patient burden and effort, challenges with medical jargon, and difficulty finding trustworthy information); and 3) burden of facing the unknown (stress and anxiety leading to difficulty processing information, challenges facing the transplant journey when you "don't know what you don't know"). CONCLUSION Patient, family member, and living donor participation in shared decision-making has been limited by inadequate access to patient-centered information. New metrics and patient-facing data presentations should address these content gaps using best practices to improve understanding and support shared decision-making.
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Affiliation(s)
- Allyson Hart
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Division of Nephrology, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Cory R Schaffhausen
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Warren T McKinney
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Division of Nephrology, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Kristina Gonzales
- Departments of Occupational Therapy and Community Health, Tufts University, Medford, Massachusetts, USA
| | - Julia Perugini
- Departments of Occupational Therapy and Community Health, Tufts University, Medford, Massachusetts, USA
| | - Jon J Snyder
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Keren Ladin
- Departments of Occupational Therapy and Community Health, Tufts University, Medford, Massachusetts, USA
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Svedin F, Blomberg O, Brantnell A, Farrand P, Åberg AC, Woodford J. Healthcare and community stakeholders' perceptions of barriers and facilitators to implementing a behavioral activation intervention for people with dementia and depression: a qualitative study using Normalization Process Theory. BMC Geriatr 2023; 23:814. [PMID: 38062362 PMCID: PMC10702110 DOI: 10.1186/s12877-023-04522-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Depression is commonly experienced by people with dementia, and associated with lower quality of life and functional decline. However, access to evidence-based psychological interventions for people with dementia and depression is limited. One potential solution is guided low-intensity behavioral activation. Following the new Medical Research Council Framework, considering factors such as potential barriers and facilitators to implementation is recommended during the development of new interventions. Aims of this study were to: (1) develop an understanding of existing healthcare and community support in the Swedish context for people with dementia and their informal caregivers; and (2) identify barriers and facilitators to intervention uptake informed by Normalization Process Theory. METHODS Semi-structured interviews and focus groups were held with healthcare (n = 18) and community (n = 7) stakeholders working with people with dementia and/or informal caregivers. Interview questions were informed by Normalization Process Theory. Data was analysed utilizing a two-step deductive analysis approach using the Normalization Process Theory coding manual, with inductive categories applied to data related to the main mechanisms of the theory, but not captured by its sub-constructs. RESULTS Twelve deductive and three inductive categories related to three Normalization Process Theory primary mechanisms (Coherence, Cognitive Participation, and Collective Action) were identified. Identified barriers to intervention uptake included: (1) additional burden for informal caregivers; (2) lack of appropriate workforce to provide guidance; (3) lack of time and financial resources; (4) people with dementia not recognising their diagnosis of dementia and/or a need for support; and (5) stigma. Identified facilitators to intervention uptake included: (1) intervention has potential to fill a large psychological treatment gap in Sweden; (2) objectives and potential benefits understood and agreed by most stakeholders; and (3) some healthcare professionals recognized their potential role in providing intervention guidance. CONCLUSIONS Several barriers and facilitators for future implementation, specific to the intervention, individuals and families, as well as professionals, were identified during intervention development. Barriers were mapped into evidence-based implementation strategies, which will be adopted to overcome identified barriers. A feasibility study further examining implementation potential, acceptability and feasibility, alongside clinical, methodological, and procedural uncertainties associated with the intervention will be conducted. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Frida Svedin
- Healthcare Sciences and E-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, 751 85, Sweden
| | - Oscar Blomberg
- Healthcare Sciences and E-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, 751 85, Sweden
| | - Anders Brantnell
- Healthcare Sciences and E-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, 751 85, Sweden
- Industrial Engineering and Management, Department of Civil and Industrial Engineering, Uppsala University, 751 21, Uppsala, Sweden
| | - Paul Farrand
- Clinical Education, Development and Research (CEDAR); Psychology, University of Exeter, Perry Road, Devon, EX4 4QG, UK
| | - Anna Cristina Åberg
- Clinical Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, 751 85, Uppsala, Sweden
- Medical Sciences, School of Health and Welfare, Dalarna University, 791 88, Falun, Sweden
| | - Joanne Woodford
- Healthcare Sciences and E-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, 751 85, Sweden.
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Tata V, Al Saadi R, Cho SK, Varisco TJ, Wanat M, Thornton JD. Physician perspective on the implementation of risk mitigation strategies when prescribing opioid medications: a qualitative analysis. BMC Health Serv Res 2023; 23:1185. [PMID: 37907915 PMCID: PMC10617230 DOI: 10.1186/s12913-023-10136-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 10/12/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE To understand the physician perspective on the barriers and facilitators of implementing nine different opioid risk mitigation strategies (RMS) when prescribing opioid medications. METHODS We created and dispersed a cross-sectional online survey through the Qualtrics© data collection platform among a nationwide sample of physicians licensed to practice medicine in the United States who have prescribed an opioid medication within the past year. The responses were analyzed using a deductive thematic analysis approach based on the Consolidated Framework for Implementation Research (CFIR) to ensure a holistic approach to identifying the barriers and facilitators for each RMS assessed. In concordance with this method, the themes and codes for the thematic analysis were defined prior to the analysis. The five domains within the CFIR were used as themes and the 39 nested constructs were treated as the codes. Two members of the research team independently coded the transcripts and discussed points of disagreement until consensus was reached. All analyses were conducted in ATLAS.ti© V7. RESULTS The completion rate for this survey was 85.1% with 273 participant responses eligible for analysis. Intercoder reliability was calculated to be 82%. Deductive thematic analysis yielded 2,077 descriptions of factors affecting implementation of the nine RMS. The most salient code across all RMS was Knowledge and Beliefs about the Intervention, which refers to individuals' attitudes towards and value placed on the intervention. Patient Needs and Resources, a code referring to the extent to which patient needs are known and prioritized by the organization, also emerged as a salient code. The physicians agreed that the patient perspective on the issue is vital to the uptake of each of the RMS. CONCLUSIONS This deductive thematic analysis identified key points for actionable intervention across the nine RMS assessed and established the importance of patient concordance with physicians when deciding on a course of treatment.
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Affiliation(s)
- Vaishnavi Tata
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, 4349 Martin Luther King Jr. Blvd, Houston, TX, 77204, USA.
- Prescription Drug Misuse and Education Research (PREMIER) Center, University of Houston College of Pharmacy, Houston, TX, 77204, USA.
| | - Randa Al Saadi
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, 4349 Martin Luther King Jr. Blvd, Houston, TX, 77204, USA.
- Prescription Drug Misuse and Education Research (PREMIER) Center, University of Houston College of Pharmacy, Houston, TX, 77204, USA.
| | - Sang Kyu Cho
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, 4349 Martin Luther King Jr. Blvd, Houston, TX, 77204, USA
- Prescription Drug Misuse and Education Research (PREMIER) Center, University of Houston College of Pharmacy, Houston, TX, 77204, USA
| | - Tyler J Varisco
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, 4349 Martin Luther King Jr. Blvd, Houston, TX, 77204, USA
- Prescription Drug Misuse and Education Research (PREMIER) Center, University of Houston College of Pharmacy, Houston, TX, 77204, USA
| | - Matthew Wanat
- Prescription Drug Misuse and Education Research (PREMIER) Center, University of Houston College of Pharmacy, Houston, TX, 77204, USA
- College of Pharmacy, Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, 77204, USA
| | - J Douglas Thornton
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, 4349 Martin Luther King Jr. Blvd, Houston, TX, 77204, USA
- Prescription Drug Misuse and Education Research (PREMIER) Center, University of Houston College of Pharmacy, Houston, TX, 77204, USA
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Benzo MV, Barwise A, Clark MM, Dupuy-McCauley K, Roy M, Benzo RP. Improving Dyspnea by Targeting Weight Loss in Patients With Chronic Obstructive Lung Disease and Severe Obesity Through Health Coaching and Remote Monitoring. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2023; 10:444-449. [PMID: 37606647 DOI: 10.15326/jcopdf.2023.0404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Affiliation(s)
- Maria V Benzo
- Mindful Breathing Laboratory, Division of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Amelia Barwise
- Mindful Breathing Laboratory, Division of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Matthew M Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, United States
| | - Kara Dupuy-McCauley
- Mindful Breathing Laboratory, Division of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Madison Roy
- Mindful Breathing Laboratory, Division of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Roberto P Benzo
- Mindful Breathing Laboratory, Division of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, Minnesota, United States
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O'Donovan B, Kirke C, Pate M, McHugh S, Bennett K, Cahir C. Mapping the Theoretical Domain Framework to the Consolidated Framework for Implementation Research: do multiple frameworks add value? Implement Sci Commun 2023; 4:100. [PMID: 37620981 PMCID: PMC10464139 DOI: 10.1186/s43058-023-00466-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 07/03/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Implementation researchers often combine the Theoretical Domain Framework (TDF) and Consolidated Framework for Implementation Research (CFIR) in their studies. However there is some debate on the merits of using multiple frameworks-whether they contribute to results or provide superfluous analysis. Our recent research combined the TDF and CFIR to identify determinants to widespread incorporation of patient held medication lists (PHML) in healthcare practice. The aim of this report is to provide guidance on the use of the TDF and CFIR; by assessing the degree of overlap between the two frameworks in their application to interviews about PHML. METHODS Semi-structured telephone interviews were conducted with healthcare professionals (HCPs) and non HCPs (people taking multiple medicines and caregivers).Interview data were transcribed and analysed using the TDF and CFIR. Within paired domains substantial intersection/overlap across constructs and domains within the two frameworks was classified as > 75% of coding references, consistent intersection/overlap was defined as > 50% and ≤ 75%, average intersection/overlap was defined as ≤ 50% and > 25% and non-substantial intersection/overlap was classified as ≤ 25% of coding references. RESULTS Interview data were collected from 39 participants - 21 HCPs and 18 non HCPs. Mapping of TDF domains to CFIR domains/constructs identified key determinants in six TDF domains: Environmental context & resources, Beliefs about capabilities, Beliefs about consequences, Social influences, Behavioural regulation and Social/professional role & identity; and five CFIR domains: Intervention Characteristics, Outer Setting, Inner Setting, Characteristics of Individual and Process. A pattern of substantial intersection/overlap in coding emerged with broad TDF domains such as Environmental context & resources often linked to well-defined CFIR domains and constructs (e.g. design quality & packaging within Intervention Characteristics). Broad CFIR constructs such as knowledge & beliefs about intervention within Characteristics of Individuals also linked to more descriptive TDF domains like Beliefs about capabilities. In addition there was some unexpected non-substantial intersection/overlap in coding with the TDF domain Social influences less frequently linked to the CFIR Inner Setting domain and constructs such as networks and communications. CONCLUSIONS Identifying intersections/overlaps in coding between CFIR and TDF can assist interpretation of findings in implementation research. The strengths of each framework were exploited in a reciprocal process which provided more information to broad/poorly defined domains and enabled identification of implementation determinants and innovation determinants.
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Affiliation(s)
- B O'Donovan
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - C Kirke
- Quality Improvement Division, Health Service Executive (HSE), Medication Safety, Dublin, Ireland
| | - M Pate
- Quality Improvement Division, Health Service Executive (HSE), Medication Safety, Dublin, Ireland
| | - S McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - K Bennett
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - C Cahir
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Ng W, Beales D, Gucciardi DF, Slater H. Applying the behavioural change wheel to guide the implementation of a biopsychosocial approach to musculoskeletal pain care. FRONTIERS IN PAIN RESEARCH 2023; 4:1169178. [PMID: 37228807 PMCID: PMC10204590 DOI: 10.3389/fpain.2023.1169178] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
Achieving high value, biopsychosocial pain care can be complex, involving multiple stakeholders working synergistically to support the implementation of quality care. In order to empower healthcare professionals to assess, identify and analyse biopsychosocial factors contributing to musculoskeletal pain, and describe what changes are needed in the whole-of-system to navigate this complexity, we aimed to: (1) map established barriers and enablers influencing healthcare professionals' adoption of a biopsychosocial approach to musculoskeletal pain against behaviour change frameworks; and (2) identify behaviour change techniques to facilitate and support the adoption and improve pain education. A five-step process informed by the Behaviour Change Wheel (BCW) was undertaken: (i) from a recently published qualitative evidence synthesis, barriers and enablers were mapped onto the Capability Opportunity Motivation-Behaviour (COM-B) model and Theoretical Domains Framework (TDF) using "best fit" framework synthesis; (ii) relevant stakeholder groups involved in the whole-of-health were identified as audiences for potential interventions; (iii) possible intervention functions were considered based on the Affordability, Practicability, Effectiveness and Cost-effectiveness, Acceptability, Side-effects/safety, Equity criteria; (iv) a conceptual model was synthesised to understand the behavioural determinants underpinning biopsychosocial pain care; (v) behaviour change techniques (BCTs) to improve adoption were identified. Barriers and enablers mapped onto 5/6 components of the COM-B model and 12/15 domains on the TDF. Multi-stakeholder groups including healthcare professionals, educators, workplace managers, guideline developers and policymakers were identified as target audiences for behavioural interventions, specifically education, training, environmental restructuring, modelling and enablement. A framework was derived with six BCTs identified from the Behaviour Change Technique Taxonomy (version 1). Adoption of a biopsychosocial approach to musculoskeletal pain involves a complex set of behavioural determinants, relevant across multiple audiences, reflecting the importance of a whole-of-system approach to musculoskeletal health. We proposed a worked example on how to operationalise the framework and apply the BCTs. Evidence-informed strategies are recommended to empower healthcare professionals to assess, identify and analyse biopsychosocial factors, as well as targeted interventions relevant to various stakeholders. These strategies can help to strengthen a whole-of-system adoption of a biopsychosocial approach to pain care.
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Affiliation(s)
- Wendy Ng
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Darren Beales
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
- Curtin enAble Institute, Curtin University, Perth, WA, Australia
| | - Daniel F. Gucciardi
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
- Curtin enAble Institute, Curtin University, Perth, WA, Australia
| | - Helen Slater
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
- Curtin enAble Institute, Curtin University, Perth, WA, Australia
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Zayts O, Edmonds DM, Kong BCK, Fortune Z. Mental health of new and recent graduates during the university-to-work transition: a scoping review protocol. BMJ Open 2023; 13:e071357. [PMID: 37105690 PMCID: PMC10151949 DOI: 10.1136/bmjopen-2022-071357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION University students face challenges when starting their careers and entering the workforce after tertiary education is associated with negative psychological outcomes. The planned scoping review will synthesise the literature on the impact of university-to-work transitions on the mental health of new and recent graduates. We will describe the characteristics and main findings of the studies, and will examine the variables associated with, and the theories used to explain, the relationship between transitions to work and graduates' mental health. METHODS We will search the following databases: Scopus, Web of Science, ERIC, PSYCINFO, Social Sciences Citation Index, CINAHL Plus, Ovid MEDLINE and Google Scholar, to locate published and unpublished literature. The included studies will focus on undergraduate and postgraduate university students during planned or current university-to-work transitions, as well as early-career workers. We will include studies involving people who have left or are in their final year of study, are undergoing career transition preparation or have worked for no longer than 3 years since graduation. Studies from all countries, those published in English and since 2000, will be included. We will use a set of predefined search terms and we will extract studies using the EndNote V.20 reference management software. Two reviewers will screen and assess the identified studies using the Covidence software. Finally, we will present the data in a summary table and will qualitatively analyse the studies using thematic analysis. ETHICS AND DISSEMINATION Our scoping review does not require ethical approval. The scoping review's findings will be disseminated in peer-reviewed journal articles and conference presentations, and will inform the development of training resources for different stakeholders as part of a wider research project. TRIAL REGISTRATION NUMBER The study has been registered with the Open Science Framework (https://osf.io/gw86x).
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Affiliation(s)
- Olga Zayts
- School of English, The University of Hong Kong, Hong Kong, Hong Kong
| | | | | | - Zoë Fortune
- School of English, The University of Hong Kong, Hong Kong, Hong Kong
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Mynttinen MA, Mishina KE, Kangasniemi MK. How Adolescents and Parents See Their Moral Responsibilities With Regard to Adolescents Using Alcohol-A Deductive Secondary Analysis. THE JOURNAL OF SCHOOL HEALTH 2023; 93:62-72. [PMID: 36251496 PMCID: PMC10091950 DOI: 10.1111/josh.13248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 08/13/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND This study described how adolescents and the parents saw their moral responsibilities with regard to adolescents using alcohol. METHODS This was a deductive secondary analysis, based on Hart's taxonomy of moral responsibility. The primary studies were based on 19 group interviews with 87 adolescents aged 14-16 and 17 interviews with 20 parents. Voluntary participants were recruited by purposive sampling from two public schools in Finland. RESULTS Role responsibilities comprised of adolescents taking care of themselves and parents providing authority figures and helping adolescents to make rational decisions about alcohol. Capacity responsibilities referred to adolescents' abilities to make independent decisions on using alcohol and their developing abilities to control their actions. Parents required abilities to get involved in and show an interest in their children's everyday lives. Causal responsibilities focused on ensuring that adolescents did not cause harm when they used alcohol, and parents had to acknowledge and react to the consequences. Liability responsibilities were about the law on alcohol use and responsibilities for any legal consequences. The role schools could play was important. CONCLUSIONS Adolescents and parents had wide-ranging responsibilities related to the adolescents' using alcohol and school nurses could play an important role in healthy decisions.
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Affiliation(s)
- Mari A. Mynttinen
- Department of Nursing Science, Faculty of Medicine, University of Turku, 20014 Turku, Finland; Nursing Degree ProgramKarelia University of Applied Sciences80200JoensuuFinland
| | - Kaisa E. Mishina
- Departments of Nursing Science and Child Psychiatry, Faculty of Medicine, University of Turku, 20014 Turku, FinlandINVEST Research Flagship CenterTurkuFinland
| | - Mari K. Kangasniemi
- Department of Nursing Science, Faculty of MedicineUniversity of Turku20014TurkuFinland
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Pearce R, Topping A, Willis C. Enhancing healthcare students' clinical placement experiences. Nurs Stand 2022; 37:e11887. [PMID: 35285216 DOI: 10.7748/ns.2022.e11887] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 11/09/2022]
Abstract
Over the past few years, efforts to address a shortage of nurses in the UK has led to an increase in nursing student numbers. However, in one large UK healthcare trust, this increase in student numbers led to a need to improve the quality of the trust's clinical placements. To address this issue, the authors undertook a quality improvement project, in which focus groups were used to enable 53 nursing, allied health professional, midwifery and nursing associate students to have in-depth discussions about their clinical placement experiences in the trust. Three main themes emerged from the data: being part of a team; support; and being unprepared. Following the project, the trust introduced student-led clinical learning environments to provide an innovative practice-based experience for students.
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Affiliation(s)
- Ruth Pearce
- School of Nursing, Allied Health Professionals and Midwifery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, England
| | | | - Carol Willis
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, England
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Kaufman J, Tuckerman J, Bonner C, Durrheim DN, Costa D, Trevena L, Thomas S, Danchin M. Parent-level barriers to uptake of childhood vaccination: a global overview of systematic reviews. BMJ Glob Health 2021; 6:e006860. [PMID: 34580071 PMCID: PMC8477248 DOI: 10.1136/bmjgh-2021-006860] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/09/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Understanding barriers to childhood vaccination is crucial to inform effective interventions for maximising uptake. Published systematic reviews include different primary studies, producing varying lists of barriers. To make sense of this diverse body of literature, a comprehensive level of summary and synthesis is necessary. This overview of systematic reviews maps all potential parent-level barriers to childhood vaccination identified in systematic reviews. It synthesises these into a conceptual framework to inform development of a vaccine barriers assessment tool. METHODS We applied Joanna Briggs methodology, searching the Epistemonikos review database and reference lists of included reviews to June 2020. Systematic reviews of qualitative or quantitative data on parent-level barriers to routine vaccination in preschool-aged children were included. Reviews addressing influenza, reporting non-modifiable determinants or reporting barriers not relevant to parents were excluded. Where possible, we extracted review details, barrier descriptions and the number, setting and design of primary studies. Two authors independently screened search results and inductively coded barrier descriptions. RESULTS We screened 464 papers, identifying 30 relevant reviews with minimal overlap. Fourteen reviews included qualitative and quantitative primary studies, seven included quantitative and seven included qualitative studies only. Two did not report included study designs. Two-thirds of reviews (n=20; 67%) only included primary studies from high-income countries. We extracted 573 barrier descriptions and inductively coded these into 64 unique barriers in six overarching categories: (1) Access, (2) Clinic or Health System Barriers, (3) Concerns and Beliefs, (4) Health Perceptions and Experiences, (5) Knowledge and Information and (6) Social or Family Influence. CONCLUSIONS A global overview of systematic reviews of parent-level barriers to childhood vaccine uptake identified 64 barriers to inform development of a new comprehensive survey instrument. This instrument will assess both access and acceptance barriers to more accurately diagnose the reasons for under-vaccination in children in different settings.
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Affiliation(s)
- Jessica Kaufman
- Vaccine Uptake Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Tuckerman
- Vaccine Uptake Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Carissa Bonner
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - David N Durrheim
- Health Protection, Hunter New England Health, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Daniel Costa
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - Lyndal Trevena
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - Susan Thomas
- Health Protection, Hunter New England Health, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Margie Danchin
- Vaccine Uptake Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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