INTEGRAÇÃO ENTRE DADOS QUANTITATIVOS E QUALITATIVOS EM UMA PESQUISA DE MÉTODOS MISTOS

Effects of working in vulnerable contexts on the mental health of primary healthcare professionals during the COVID-19 pandemic: a mixed-methods study

OBJECTIVE

The objective of this study is to analyse the relationship and psychosocial issues between working during the COVID-19 pandemic in primary healthcare (PHC) facilities located in the most vulnerable health region (HR) of the Federal District of Brazil (FDB) compared with a lesser region.

DESIGN

Mixed-method study data. The questionnaire was based on the World Health Survey and the Convid Behavioural Survey. Quantitative data were described in absolute and relative frequency. Pearson's χ2 test verified differences according to the region (significance level <5%). A margin of error of 8% with 95% CI defined the sample. The content analysis (by Bardin) analysed the qualitative data.

SETTING

A representative sample of PHC professionals working at the Western HR and Central HR of the FDB.

PARTICIPANTS

111 women and 27 male PHC professionals, aged ≥ 18 years.

OUTCOME MEASURES

Psychosocial variables-personal emotions towards the clients, social relationships and use of psychoactive substances (PAS).

INTERVENTION

An online questionnaire (27 questions) and 1 open-ended question.

RESULTS

The sample comprised 138 PHC professionals; 80.40% were female aged between 40 and 49 years old (27.3%); declared themselves as black/pardo (58.7%); were married (53.60%), and worked in family healthcare teams (47.80%). No association between working in the most vulnerable HR compared with the least one and presenting psychosocial issues, except for anger towards clients (p=0.043). 55.10% worked much more than usual, 60.80% reported being depressed, 78.20% anxious, 76.80% stressed, 77.50% had no empathy and 78.30% felt isolated from family/friends. Towards the clients, 59.40% reported empathy and 72.5% no affection/care. The consume of psychotropic medications was reported by 34.80%, and 14.50% increased alcohol/PAS use. Qualitative data leverage quantitative findings: work overload, the indifference of the Federal Government and distance from family/friends.

CONCLUSION

Working in the most vulnerable region and in the least one affects the psychosocial aspects of the PHC professionals equally.

End-User Assessment of an Innovative Clothing-Based Sensor Developed for Pressure Injury Prevention: A Mixed-Method Study

This study aimed to evaluate a clothing prototype that incorporates sensors for the evaluation of pressure, temperature, and humidity for the prevention of pressure injuries, namely regarding physical and comfort requirements. A mixed-method approach was used with concurrent quantitative and qualitative data triangulation. A structured questionnaire was applied before a focus group of experts to evaluate the sensor prototypes. Data were analyzed using descriptive and inferential statistics and the discourse of the collective subject, followed by method integration and meta-inferences. Nine nurses, experts in this topic, aged 32.66 ± 6.28 years and with a time of profession of 10.88 ± 6.19 years, participated in the study. Prototype A presented low evaluation in stiffness (1.56 ± 1.01) and roughness (2.11 ± 1.17). Prototype B showed smaller values in dimension (2.77 ± 0.83) and stiffness (3.00 ± 1.22). Embroidery was assessed as inadequate in terms of stiffness (1.88 ± 1.05) and roughness (2.44 ± 1.01). The results from the questionnaires and focus groups' show low adequacy as to stiffness, roughness, and comfort. The participants highlighted the need for improvements regarding stiffness and comfort, suggesting new proposals for the development of sensors for clothing. The main conclusions are that Prototype A presented the lowest average scores relative to rigidity (1.56 ± 1.01), considered inadequate. This dimension of Prototype B was evaluated as slightly adequate (2.77 ± 0.83). The rigidity (1.88 ± 1.05) of Prototype A + B + embroidery was evaluated as inadequate. The prototype revealed clothing sensors with low adequacy regarding the physical requirements, such as stiffness or roughness. Improvements are needed regarding the stiffness and roughness for the safety and comfort characteristics of the device evaluated.

Perfil e avaliação de competências comportamentais empreendedoras em médicos de família e comunidade brasileiros donos de clínicas e consultório

Introdução: Os médicos de família e comunidade, até pouco tempo atrás restritos ao Sistema Único de Saúde, têm sido cada vez mais requisitados no sistema suplementar. As experiências como profissionais ligados à assistência e como gestores das operadoras de saúde têm levado alguns a buscar empreender por meio de negócios próprios, na forma de clínicas e consultórios. Há um conjunto de competências que caracteriza o comportamento empreendedor, chamadas na literatura de competências comportamentais empreendedoras. Objetivo: Entender como essas competências comportamentais empreendedoras estão presentes nos médicos de família e comunidade pioneiros, seu perfil demográfico e socioeconômico, e quais influências pregressas encorajaram o aceitamento do risco para investir. Metodologia: Estudo misto, com desenho qualiquantitativo e exploratório-descritivo, com médicos de família e comunidade que já possuem consultório próprio. Foi aplicado o instrumento criado por Lenzi para a quantificação das competências comportamentais empreendedoras individuais e outro com questões para a caracterização sociodemográfica e contextual da amostra. Resultados: Foram convidados 16 médicos de família e comunidade empreendedores e atuantes no território brasileiro, encontrados por meio de contato em grupos da especialidade ativos em redes sociais. Apenas 11 responderam a ambos os questionários: seis homens e cinco mulheres de oito cidades diferentes, a maior parte capitais com mais de 1 milhão de habitantes, 90,9% formados em universidades públicas, 63,6% entre 30 e 40 anos, todos com experiência pregressa no Sistema Único de Saúde. A maior parte dos negócios tem menos de um ano (45,5%), rende menos de R$ 5.000,00 ao mês (45,5%), e a maior parte dos entrevistados trabalha ainda em outros serviços, como o próprio Sistema Único de Saúde ou para operadoras de saúde (90,9%). As competências comportamentais empreendedoras mais presentes foram “comprometimento” (90,9%), “busca de informações” (81,8%), “persistência” (72,7%) e “correr riscos calculados” (72,7%). As menos presentes foram “independência e autoconfiança” (27,3%) e “estabelecimento de metas” (45,4%). Conclusões: Apesar de ser por conveniência, é possível que a amostra represente significativa parcela dos poucos médicos de família que se têm arriscado no competitivo mercado do setor privado em saúde. Suas características: jovens, com gênero equilibrado, longa experiência no Sistema Único de Saúde e início recente no mercado privado, ainda com muito receio de investir e pouca formação formal no ramo do empreendedorismo. Este provavelmente é um retrato fidedigno do momento atual. O perfil das competências comportamentais empreendedoras desenvolvidas corroborou a literatura e serviu para alertar sobre a falta de foco no planejamento, mostrando que, embora trazer a médicos de família e comunidade para o mercado privado seja uma ideia inovadora, só boas ideias não são suficientes para produzir a estabilidade e sustentabilidade dos negócios.

The impact of COVID-19 on autologous stem cell transplantation in multiple myeloma: A single-centre, qualitative evaluation study

Autologous stem cell transplantation (ASCT) is standard of care in biologically fit, newly diagnosed multiple myeloma (MM) patients, offering better therapeutic outcomes and improved quality of life (QoL). However, with the UK's 1st national lockdown on 23/03/2020, several guidelines recommended deferring ASCT due to risks of infection, with resource limitations forcing some units to suspend ASCT entirely. Such changes to patients' treatment plans inevitably altered their lived experience during these uncertain times with expected impact on QoL. We conducted a qualitative study using semi-structured interviews to gain insight into MM patients' understanding of their disease, initial therapy and ASCT, and their response to therapy changes. A clinical snapshot of how COVID-19 affected the MM ASCT service in a single UK institution is also provided, including changes to chemotherapy treatment plans, timing, and prioritisation of ASCT. Framework analysis identified 6 overarching themes: (1) beliefs about ASCT, (2) perceptions of information provided about MM and ASCT, (3) high levels of fear and anxiety due to COVID-19, (4) feelings about ASCT disruption or delay due to COVID-19, (5) perceptions of care, and (6) importance of social support. Example subthemes were beliefs that ASCT would provide a long-remission/best chance of normality including freedom from chemotherapy and associated side-effects, disappointment, and devastation at COVID-related treatment delays (despite high anxiety about infection) and exceptionally high levels of trust in the transplant team. Such insights will help us adjust our service and counselling approaches to be more in tune with patients' priorities and expectations.

Factors influencing variation in implementation outcomes of the redesigned community health fund in the Dodoma region of Tanzania: a mixed-methods study

Introduction

Micro-health insurance (MHI) has been identified as a possible interim solution to foster progress towards Universal Health Coverage (UHC) in low- and middle- income countries (LMICs). Still, MHI schemes suffer from chronically low penetration rates, especially in sub-Saharan Africa. Initiatives to promote and sustain enrolment have yielded limited effect, yet little effort has been channelled towards understanding how such initiatives are implemented. We aimed to fill this gap in knowledge by examining heterogeneity in implementation outcomes and their moderating factors within the context of the Redesigned Community Health Fund in the Dodoma region in Tanzania.

Methods

We adopted a mixed-methods design to examine implementation outcomes, defined as adoption and fidelity of implementation (FOI) as well as their moderating factors. A survey questionnaire collected individual level data and a document review checklist and in-depth interview guide collected district level data. We relied on descriptive statistics, a chi square test and thematic analysis to analyse our data.

Results

A review of district level data revealed high adoption (78%) and FOI (77%) supported also by qualitative interviews. In contrast, survey participants reported relatively low adoption (55%) and FOI (58%). Heterogeneity in adoption and FOI was observed across the districts and was attributed to organisational weakness or strengths, communication and facilitation strategies, resource availability (fiscal capacity, human resources and materials), reward systems, the number of stakeholders, leadership engagement, and implementer’s skills.

At an individual level, heterogeneity in adoption and FOI of scheme components was explained by the survey participant’s level of education, occupation, years of stay in the district and duration of working in the scheme. For example, the adoption of job description was statistically associated with occupation (p = 0.001) and wworking in the scheme for more than 20 months had marginal significant association with FOI (p = 0.04).

Conclusion

The study demonstrates that assessing the implementation processes helps to detect implementation weaknesses and therefore address such weaknesses as the interventions are implemented or rolled out to other settings. Attention to contextual and individual implementer elements should be paid in advance to adjust implementation strategies and ensure greater adoption and fidelity of implementation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-10013-y.

Infection and Risk Perception of SARS-CoV-2 among Airport Workers: A Mixed Methods Study

This is a mixed-methods research study carried out on a cohort of airport workers during the SARS-CoV-2 pandemic. We used quantitative and qualitative methods to describe the infection and risk perception of SARS-CoV-2 in a cohort of workers at the International Airport El Dorado/Luis Carlos Galán Sarmiento in Bogotá, Colombia. An incidence of SARS-CoV-2 infection of 7.9% was found in the workers. A high perception of risk was associated with activities such as using public transport. Risk perception is strongly influenced by practices related to work conditions and environments. These findings could help us understand the pandemic's dynamics and the conceptions of the risk of transmission to promote policies on health and safety in this group of workers.

Patient Organizations' Barriers in Pharmacovigilance and Strategies to Stimulate Their Participation

INTRODUCTION

European drug regulations aim for a patient-centered approach, including involving patients in the pharmacovigilance (PV) systems. However many patient organizations have little experience on how they can participate in PV activities.

AIM

The aim of this study was to understand patient organizations' perceptions of PV, the barriers they face when implementing PV activities, and their interaction with other stakeholders and suggest methods for the stimulation of patient organizations as promoters of PV.

METHODS

A sequential qualitative method study was conducted and integrated with the quantitative study performed by Matos, Weits, and van Hunsel to complete a mixed method study.

RESULTS

The qualitative phase expands the understanding of the quantitative results from a previous study by broadening the knowledge on external barriers and internal barriers that patient organizations face when implementing PV activities. The strategies to stimulate patient-organization participation are the creation of more awareness campaigns, more research that creates awareness, education for patient organizations, communication of real PV examples, creation of a targeted PV system, creation of a PV communication network that provides feedback to patients, improvement of understanding of all stakeholders, and a more proactive approach from national competent authorities.

CONCLUSION

Both study phases show congruent results regarding patients' involvement and the activities patient organizations perform to promote drug safety. Patient organizations progressively position themselves as stakeholders in PV, carrying out many activities that stimulate awareness and participation of their members in drug safety, but still face internal and external barriers that can hamper their involvement.