How adolescents lose control over social networks: A process-based approach to problematic social network use

Social networks (SNs) are immensely popular, especially among teenagers, yet our understanding of problematic SNs remains limited. Understanding motivations and patterns of use is crucial given the current prevalence of problematic SNs use. Perarles et al. (2020) distinguish two behavioral control modes: Model-Free Control, where actions are characterized by actions driven by immediate gratification without reflective consideration for long-term consequences, and Model-Based Control, enabling planned and goal-directed actions. Both control modes can lead to problematic social network use. This study aims to delve into problematic SNs use and the underlying motives behind adolescents' participation in SNs, drawing upon the theoretical proposal by Perales et al. (2020). We conducted four focus groups with adolescents aged 13-17 (50 % female; Mage = 14.5, SD = 1.75), comprising two public school and two Catholic private school groups. Thematic analysis using Atlas.ti software revealed three themes. The first uncovers characteristics of problematic SNs use, including withdrawal, increased usage time, impaired control, behavioral salience and attentional capture and cognitive hijacking. The second spotlights motives, emphasizing emotional regulation, finding out what is going on, and social interaction. The third theme explores consequences such as compromised academic performance and physical harm. In conclusion, addressing both motives and problematic behaviors present a more effective approach to confronting SNs use challenges and fostering healthier online experiences for adolescents.

Experiences of nursing students providing end of life care for children and young people: A focus group study

BACKGROUND

End of life care for Children and Young People (CYP) is known to be an emotive area of practice. Previous studies involving qualified nurses have demonstrated that nurses feel they need more end-of-life care education, as well as a platform for sharing experiences and discussing them with others. Evidence relating to nursing students remains limited despite being widely acknowledged as a difficult aspect of nursing education.

AIMS

This study aims to help improve understanding of the lived experiences of children's nursing students who have cared for a patient at, during, or immediately following end-of-life. The study describes the emotions experienced by children's nursing students and explores the student nurses' perceptions of education and support needs around caring for CYP during end-of-life care.

METHODOLOGY

A qualitative inquiry methodology allowed for a pragmatic approach to design this focus group study. Nine undergraduate student children's nurses participated in two focus groups. Ethical approval was granted by the host university. Thematic data analysis using Braun and Clarke's (2019) thematic analysis was conducted.

FINDINGS

Six themes emerged from the data; Emotional practice (1), the heart of the care (2), a lasting impact (3), hierarchy of grief (4), experience, knowledge and understanding (5), and the value of support (6). End of life care for children and young people is recognised by students as a sad but important part of the job role, which can have a lasting impact and which students required improved education and support for.

IMPLICATIONS FOR PRACTICE

Improved education on end-of-life care is required. This should be introduced early, encompassing practical approaches to the varied nature of end-of-life care, normalising a range of emotions and delayed responses. Furthermore, improved support is required for both student nurses and qualified staff, who are supporting students caring for CYP at the end of life.

Smart Speaker and ICT Use in Relationship With Social Connectedness During the Pandemic: Loneliness and Social Isolation Found in Older Adults in Low-Income Housing

BACKGROUND AND OBJECTIVES

Social well-being of older adults living in low-income housing was disproportionately affected by the coronavirus disease 2019 pandemic. We explored low-income residents' experiences of social isolation and loneliness and strategies to remain socially connected during the pandemic.

RESEARCH DESIGN AND METHODS

As part of a larger, 3-phase user-centered design study, we conducted a qualitative study using focus groups to gain insights into social isolation experiences and the role of information and communication technologies (ICTs), including smart speakers, in social connectedness (N = 25, 76% African American). We also collected survey data to describe social isolation, loneliness, and current ICT use in the sample. Participants included both smart speaker users and nonusers.

RESULTS

Experiences of social isolation and loneliness varied by participants' sociodemographic characteristics and previous experiences with smart speakers. Qualitative analysis showed participants demonstrated coping strategies developed during the pandemic to adapt to new norms of connecting with others, including technology-enabled social interactions. Participants expressed a strong desire to build community together in their facilities and highlighted the potential role of smart speakers in making meaningful social connections, encompassing safety checks to have a means for emergencies, and providing a virtual companion. Access, digital literacy, training, security, and privacy issues were discussed as factors affecting their adoption of new ICT for enhanced social connectedness.

DISCUSSION AND IMPLICATIONS

This study highlights the importance of understanding the unique social isolation experience, demographics, and social determinants of health of low-income residents to develop ICT-based interventions for social connectedness.

The influence of health service interactions and local policies on vaccination decision-making in immigrant women: A multi-site Canadian qualitative study

OBJECTIVES

Research on immigrant and refugee vaccination uptake in Canada shows that immunization decisions vary by vaccine type, location, age and migration status. Despite their diversity, these studies often treat immigrant and refugee populations as a single group relative to other Canadians. In this comparative study, we explored how previous risk communication and immunization experiences influence immunization decisions by immigrant and refugee women from three communities across Canada.

METHODS

Participants included women from the Punjabi immigrant community located in Surrey and Abbotsford, British Columbia (n = 36), the Nigerian immigrant community located in Winnipeg, Manitoba (n = 43), and the Congolese refugee community in Edmonton, Alberta (n = 18). Using focus groups guided by focused ethnography methodology, we sought to understand immunization experiences in Canada and before arrival, and what information sources influenced the immunization decision-making process by the women in the three communities.

RESULTS

Participants had differing past experiences in Canada and before their arrival that influenced how they used information in their vaccination decisions. Clear vaccination communications and dialogue with Canadian health care providers increased trust in Canadian health care and the likelihood of vaccine uptake. By contrast, weak vaccine recommendations and antivaccination information in the community prompted participants to decline future vaccines.

CONCLUSION

Given our participants' different communication preferences and needs, we argue that a one-size-fits-all communication approach is inappropriate for immigrant and refugee populations. Instead, multi-pronged communication strategies are required to reach participants and respond to previous experiences and information that may lead to vaccination hesitancy.

Acceptability and Feasibility of Initiating a Low Fat Eating Plan in Reproductive Aged Women with Obesity

Adverse effects of obesity on reproduction are believed in part due to diet related factors leading to hyperlipidemia and hyperinsulinemia. It is unknown whether administration of a low fat eating plan, regardless of weight loss, will improve reproductive axis function in women with obesity. To develop an acceptable and feasible low fat eating plan for a diverse group of reproductive aged women with obesity. Focus groups to determine preferences and barriers to a planned dietary intervention providing very low fat (22% daily calories from fat) eucaloric food to control fat exposure, but not cause weight loss. Logistics of the intervention and monitoring over three menstrual cycles were discussed. Eighteen women enrolled into 4 different focus groups both live and video, 2 at the University of Colorado and 2 at the Morehouse School of Medicine. All participants expressed interest in implementing a low fat dietary intervention and were further interested in instruction on how to maintain healthy eating habits for future fertility. Provision of ethnically appropriate foods, social support to avoid lapses, and tasty alternatives to high fat foods were considered ideal aspects of a feasible intervention. Incentives and graduated compensation for adherence were considered desirable features. Women with obesity are interested in implementing dietary interventions that may improve their health and fertility. Given the diversity of responses based upon the demographics of our sample, it is important to assess geographical and cultural preferences prior to implementing of a dietary strategy.

BREAST-Q REACT: Qualitative Assessment of the Design, Functionality, and Clinical Utility of a New Score Interpretation Tool

BACKGROUND

The BREAST-Q real-time engagement and communication tool (REACT) was developed to aid with BREAST-Q score interpretation and guide patient-centered care.

OBJECTIVE

The purpose of this qualitative study was to examine the perspectives of patients and providers on the design, functionality, and clinical utility of REACT and refine the REACT based on their recommendations.

METHODS

We conducted three patient focus groups with women who were at least 6 postoperative months from their postmastectomy breast reconstruction, and two provider focus groups with plastic surgeons, breast surgeons, and advanced practice providers. Focus groups were audio-taped, transcribed verbatim, and analyzed thematically.

RESULTS

A total of 18 breast reconstruction patients and 14 providers participated in the focus groups. Themes identified by thematic analysis were organized into two categories: (1) design and functionality, and (2) clinical utility. On the design and functionality of REACT, four major themes were identified: visual appeal and usefulness; contextualizing results; ability to normalize patients' experiences, noting participants' concerns; and suggested modifications. On the clinical utility of REACT, three major themes were identified: potential to empower patients to communicate with their providers; increase patient and provider motivation to engage with the BREAST-Q; and effective integration into clinical workflow.

CONCLUSION

Patients and providers in this qualitative study indicated that with some modifications, REACT has a great potential to elevate the clinical utility of the BREAST-Q by enhancing patient-provider communication that can lead to patient-centered, clinically relevant action recommendations based on longitudinal BREAST-Q scores.

Caregiving Among Older Black Same-Gender-Loving Women During the COVID-19 Pandemic: Findings From Qualitative Research

BACKGROUND AND OBJECTIVES

Few data on caregiving during the coronavirus disease 2019 pandemic use an intersectional lens to attend to how multiple social categories, such as gender, age, race, and sexual orientation, shape caregiving experiences. This analysis sought to explore caregiving experiences of aging Black same-gender-loving women.

RESEARCH DESIGN AND METHODS

Sixteen focus groups were conducted with 4-8 participants each (N = 102) from across the United States. Audio-recorded discussions lasted for approximately 90 min and were transcribed verbatim. Two analysts coded transcripts for discussions related to caregiving and used content analysis to identify themes.

RESULTS

Participants engaged in caregiving for children, parents, family, friends, and neighbors. They provided physical, economical, instrumental, and/or secondary caregiving; and sometimes received care themselves. The pandemic heavily affected their stress level and mental health as well as their intimate partner relationships. Discussions mostly offered descriptions of increased caregiving difficulty caused by the pandemic. However, a few participants identified ways the pandemic made caregiving easier; changed caregiving without making it easier or harder; or thwarted their ability to provide care.

DISCUSSION AND IMPLICATIONS

Older Black same-gender-loving women described some pandemic caregiving experiences that diverged from the existing literature, demonstrating the importance of considering how gender, race, age, and sexual orientation affect caregiving experiences during a pandemic fraught with health inequities. Ensuring the multiply marginalized caregivers have access to the practical and emotional support they need is critical for advancing health equity and preparing for future pandemics.

Perception of Barriers to and Factors Associated with HPV Vaccination Among Parents of American Indian Adolescents in the Cherokee Nation

The purpose of this study was to understand the perceptions of HPV vaccination barriers and factors among parents or guardians of American Indian adolescents in the Cherokee Nation. Fifty-four parents of American Indian adolescents in the Cherokee Nation participated in one of eleven focus group discussions from June to August 2019. Discussions were recorded, transcribed, coded, and analyzed for themes. Protection against cancer was the primary parent-reported reason for vaccinating their children against HPV. The lack of information and safety concerns about the HPV vaccine were the main reasons for non-vaccination. To increase HPV vaccine uptake, parents strongly supported offering vaccinations in school. Furthermore, increased healthcare provider-initiated discussion can ease parental concerns about HPV vaccine safety and improve coverage.

Development of a culturally targeted chatbot to inform living kidney donor candidates of African ancestry about APOL1 genetic testing: a mixed methods study

Clinical chatbots are increasingly used to help integrate genetic testing into clinical contexts, but no chatbot exists for Apolipoprotein L1 (APOL1) genetic testing of living kidney donor (LKD) candidates of African ancestry. Our study aimed to culturally adapt and assess perceptions of the Gia® chatbot to help integrate APOL1 testing into LKD evaluation. Ten focus groups and post-focus group surveys were conducted with 54 LKDs, community members, and kidney transplant recipients of African ancestry. Data were analyzed through thematic analysis and descriptive statistics. Key themes about making Gia culturally targeted included ensuring: (1) transparency by providing Black LKDs' testimonials, explaining patient privacy and confidentiality protections, and explaining how genetic testing can help LKD evaluation; (2) content is informative by educating Black LKDs about APOL1 testing instead of aiming to convince them to undergo testing, presenting statistics, and describing how genetic discrimination is legally prevented; and (3) content avoids stigma about living donation in the Black community. Most agreed Gia was neutral and unbiased (82%), trustworthy (82%), and words, phrases, and expressions were familiar to the intended audience (85%). Our culturally adapted APOL1 Gia chatbot was well regarded. Future research should assess how this chatbot could supplement provider discussion prior to genetic testing to scale APOL1 counseling and testing for LKD candidate clinical evaluation.

Developing messages to encourage healthy, sustainable dietary substitutions: A qualitative study with US emerging adults

Prior research shows that adopting simple dietary substitutions (e.g., replacing beef with poultry or plant-based entrees) can improve dietary quality and reduce the negative environmental consequences of food production, but little is known about how to encourage people to adopt these substitutions. This study aimed to examine reactions to messages encouraging healthy, sustainable dietary substitutions among emerging adults ages 18-25. We conducted four online focus groups with a diverse sample of US emerging adults (n = 28; 61% female). Focus groups explored emerging adults' reactions to messages encouraging them to adopt three target dietary substitutions: replacing beef and pork with poultry and plant-based entrees; replacing juice with whole fruit; and replacing dairy milk with non-dairy milk. We transcribed discussions verbatim and adopted a thematic approach to analyzing the transcripts. Results showed that participants perceived messages to be most effective at encouraging the target dietary substitutions when the messages: encouraged specific, achievable dietary changes; linked these dietary changes to clear consequences; included personally relevant content; included statistics; were succinct; and used a positive tone. Across the target dietary substitutions, two message topics (small changes, big benefits, which emphasized how small dietary changes can have large positive health and environmental impacts, and warning, which discussed the negative health and environmental impacts of dietary choices) were generally perceived to be most effective. A few participants expressed doubt that the target dietary substitutions would have meaningful environmental impacts. Results suggest that campaign messages to encourage healthy, sustainable dietary substitutions may be more effective if the messages make the target dietary substitutions seem achievable and use statistics to clearly describe the positive impacts of making these changes.

Choosing and evaluating randomisation methods in clinical trials: a qualitative study

BACKGROUND

There exist many different methods of allocating participants to treatment groups during a randomised controlled trial. Although there is research that explores trial characteristics that are associated with the choice of method, there is still a lot of variety in practice not explained. This study used qualitative methods to explore more deeply the motivations behind researchers' choice of randomisation, and which features of the method they use to evaluate the performance of these methods.

METHODS

Data was collected from online focus groups with various stakeholders involved in the randomisation process. Focus groups were recorded and then transcribed verbatim. A thematic analysis was used to analyse the transcripts.

RESULTS

Twenty-five participants from twenty clinical trials units across the UK were recruited to take part in one of four focus groups. Four main themes were identified: how randomisation methods are selected; researchers' opinions of the different methods; which features of the method are desirable and ways to measure method features. Most researchers agree that the randomisation method should be selected based on key trial characteristics; however, for many, a unit standard is in place. Opinions of methods were varied with some participants favouring stratified blocks and others favouring minimisation. This was generally due to researchers' perception of the effect these methods had on balance and predictability. Generally, predictability was considered more important than balance as adjustments cannot be made for it; however, most researchers felt that the importance of these two methods was dependent on the design of the study. Balance is usually evaluated by tabulating variables by treatment arm and looking for perceived imbalances, predictability was generally considered much harder to measure, partly due to differing definitions.

CONCLUSION

There is a wide variety in practice on how randomisation methods are selected and researcher's opinions on methods. The difference in practice observed when looking at randomisation method selection can be explained by a difference in unit practice, and also by a difference in researchers prioritisation of balance and predictability. The findings of this study show a need for more guidance on randomisation method selection.

Management of modifiable risk factors and comorbidities in atrial fibrillation: suggestions for improvement from a patient perspective

AIMS

In patients with atrial fibrillation (AF), improved management of modifiable risk factors and concomitant diseases is recommended by guidelines, yet many AF patients have sub-optimal risk factor management. Digital health solutions may offer support in this matter. This study aims to identify how patients with AF perceive they could be supported by a digital tool aimed to optimize management of comorbidities and modifiable risk factors associated with an unhealthy lifestyle.

METHODS AND RESULTS

This was a qualitative, descriptive study based on four semi-structured focus-group interviews analysed by manifest content analysis. Sixteen AF patients with recent in- or outpatient encounters were included [age 68 (52-78) years; 43% female; BMI 29.5 (20.4-35.8) kg/m2; paroxysmal/persistent AF (50%/50%); AF duration 7 (0-22) years]. Relevant comorbidities were hypertension (88%), heart failure (25%), diabetes mellitus type 2 (19%), and ischaemic heart disease (13%). The patients' suggestions were summarized into three main categories. First, person-centred information is essential, meaning that information should be customized and conveyed in an appropriate manner and include practical tips. Second, patients desire help with managing lifestyle habits in a way that is applicable in everyday life, and patients desire help with creating habits. Third, regular communication is necessary including inspirational reminders and motivational feedback.

CONCLUSION

Patients with AF request person-centred information, support in managing healthy lifestyle habits, and more regular communication with caregivers. This study provides a first foundation on how to better support AF patients, and using a digital tool in standard care may improve outcomes and reduce cost of care.

Primary-school-aged children inspire their peers and families to eat more vegetables in the KiiDSAY project: a qualitative descriptive study

BACKGROUND

While vegetable intakes in Australia remain sub-optimal across all age groups, children are rarely consulted about their ideas on how to increase consumption. Qualitative research involving children provides an opportunity to consider their views. The aim of the Kids initiative inspires Dietary Success in Adults and Youth (KiiDSAY) project was to explore the views of school-aged children, who had participated in a school-based nutrition education program, about inspiring their peers and families to eat more vegetables.

METHODS

A total of 26 children (15 boys) aged 10-12 years from four primary schools in New South Wales, Australia, participated in seven focus group interviews. Purposeful sampling was used to recruit participants. The study involved open-ended semi-structured questions conducted via Zoom that were audio-recorded, transcribed verbatim and analysed using thematic analysis with deductive and inductive coding in NVivo.

RESULTS

Four major themes emerged: (i) taste; (ii) family environment; (iii) healthy eating; and (iv) change makers; with subthemes that were embedded within Social Cognitive Theory and Ecological Model of Health Behaviour theoretical frameworks.

CONCLUSIONS

Children's inputs hold great potential for informing future interventions, particularly when designing or refining school-based nutrition programs. Children offered suggestions on how to inspire increased vegetable consumption among their peers and families that could be taken into consideration for future research and practice. These included: cooking activities in the home and school settings using recipes that creatively hide/mask/enhance the flavour of vegetables, involving positive role models and supportive school environments. Additionally, children recommended a sequential approach to the delivery of recipes starting from fruit-based and transitioning to vegetable-based recipes. Given the challenges faced in increasing children's vegetable consumption, particular focus on future research in this area is warranted.

TRIAL REGISTRATION

FEAST Trial registered 14th December 2020 with the Australian and New Zealand Clinical Trials Registry (ACTRN12620001347954).

Recording harms in randomised controlled trials of behaviour change interventions: a qualitative study of UK clinical trials units and NIHR trial investigators

BACKGROUND

Harms, also known as adverse events (AEs), are recorded and monitored in randomised controlled trials (RCTs) to ensure participants' safety. Harms are recorded poorly or inconsistently in RCTs of Behaviour Change Interventions (BCI); however, limited guidance exists on how to record harms in BCI trials. This qualitative study explored experiences and perspectives from multi-disciplinary trial experts on recording harms in BCI trials.

METHODS

Data were collected through fifteen in-depth semi-structured qualitative interviews and three focus groups with thirty-two participants who work in the delivery and oversight of clinical trials. Participants included multi-disciplinary staff from eight CTUs, Chief investigators, and patient and public representatives. Interviews and focus group recordings were transcribed verbatim and thematic analysis was used to analyse the transcripts.

RESULTS

Five themes were identified, namely perception and understanding of harm, proportionate reporting and plausibility, the need for a multi-disciplinary approach, language of BCI harms and complex harms for complex interventions. Participants strongly believed harms should be recorded in BCI trials; however, making decisions on "how and what to record as harms" was difficult. Recording irrelevant harms placed a high burden on trial staff and participants, drained trial resources and was perceived as for little purpose. Participants believed proportionate recording was required that focused on events with a strong plausible link to the intervention. Multi-disciplinary trial team input was essential for identifying and collecting harms; however, this was difficult in practice due to lack of knowledge on harms from BCIs, lack of input or difference in opinion. The medical language of harms was recognised as a poor fit for BCI trial harms but was familiar and established within internal processes. Future guidance on this topic would be welcomed and could include summarised literature.

CONCLUSIONS

Recording harms or adverse events in behaviour change intervention trials is complex and challenging; multi-disciplinary experts in trial design and implementation welcome forthcoming guidance on this topic. Issues include the high burden of recording irrelevant harms and use of definitions originally designed for drug trials. Proportionate recording of harms focused on events with a strong plausible link to the intervention and multi-disciplinary team input into decision making are essential.

A nursing perspective on inpatient sleep and circadian disruptions for pediatric stem cell transplant patients

BACKGROUND

Children treated with stem cell transplant (SCT) are routinely hospitalized for long periods where they are exposed to significant sleep and circadian disruptions. As nurses play a primary role in symptom management during SCT, we sought to understand their perspective on patient sleep and circadian disruptions, perceived barriers to a good sleep and circadian environment, and suggestions for improvement.

PROCEDURE

Four focus groups were conducted with pediatric SCT nurses (N = 25 participants). A semistructured focus group guide was administered, with the discussions recorded and transcribed. A multistage thematic analysis combining prefigured and emergent dimensions was conducted. Our analysis focused on drawing comparisons within and across focus groups to understand the unique work experiences that participants had related to the patient's sleep and circadian environment.

RESULTS

Three key themes emerged. First, nurses expressed a high awareness of how disruptive the hospital environment is for patients. Second, nurses described their extensive efforts to try to minimize the impact of these disruptions. Finally, they provided clear recommendations for how to improve upon these concerns, along with barriers that they perceive could impede implementation.

CONCLUSIONS

Front-line caregivers on a pediatric SCT unit describe key contributors to sleep/circadian disturbances for patients. Within the constraints of the considerable medical needs of this patient population and the physical room/hospital environment, nurses strive to minimize these disruptions to the best of their ability. It is crucial that hospitals assess and remediate these disturbances for these children that have important implications for overall health.

The influence of intensive clinical skills 'bootcamps' on nursing students' perceptions of ability to provide acute care: A mixed methods study

OBJECTIVES

To examine the influence of an intensive clinical skill bootcamp on students' perceptions to provide care in acute situations.

SETTING

Evidence indicates that the recognition and response to patient change can be a challenge in nursing practice and especially so for undergraduate students (Goldsworthy et al., 2022). Additionally, the impact of the pandemic interrupted the preparation of undergraduate nursing students across the world. It is suggested that intensive clinical skills practice can enhance clinical skills, confidence and time management (Hinton and Chirgwin, 2010). However, little is known about the value of these intensive programs on the perceived ability of nursing students to provide care in acute situations.

METHODS

An embedded mixed methods design was employed with a quasi-experimental repeated pre-post design using the Perception to Care in Acute Situations scale (Sterner et al., 2020) and qualitative focus groups. The intervention comprised 4 h of technical skills simulation and 2 h of immersive simulation. Data were analysed using descriptive and inferential statistics and inductive thematic analysis.

RESULTS

From 130 final year nursing student who participated in the bootcamp, 73 responses to the survey were obtained. Fifty-four responses from students before the simulation activities and 19 responses after. Significant changes in student perceptions of their abilities to provide care in acute situations were noted. Three focus groups were conducted with four themes recognised in the qualitative data including interrupted preparation; factors that influence learning; role modelling; and making connections.

CONCLUSION

The pandemic interrupted student preparation for clinical placement. Intensive clinical skills bootcamps develop student perceived confidence by providing feedback and opportunities for reflection to make connections. Opportunities for student reflection on their current competence supports developing realistic insights into perceived capabilities.

The role of the radiographer in promoting health: A qualitative examination of diagnostic radiographer perspectives at a Scottish Major Trauma hospital

INTRODUCTION

Publication of Government directives and initiatives have signalled a shift in healthcare priorities, with growing emphasis on prevention and early intervention. In comparison to other allied health professions, perceptions of Diagnostic Radiographers of their contribution to addressing these initiatives and role in promoting health, has not been explored. There is limited evidence on current practices, knowledge and confidence in providing health promotion advice to patients within this professional group. This study aimed to investigate the perceptions of Diagnostic Radiographers of their role in promoting health.

METHODS

Semi-structured focus groups were conducted with 20 Diagnostic Radiographers recruited via convenience sampling from a Scottish Major Trauma Hospital. Focus groups were transcribed and analysed using thematic analysis.

RESULTS

Findings demonstrated a lack of awareness and understanding of government initiatives and professional body recommendations surrounding health promotion. Diagnostic radiographers felt ill-equipped to provide appropriate and impactful health promotion advice and reported lack of time as a barrier to contributing to such activities.

CONCLUSION

Diagnostic Radiographers noted a willingness to undertake additional training to enable them to participate and were able to identify areas where they could adopt health promotion activities in their clinical practice. Addressing the barriers to participation is essential to empower Diagnostic Radiographers to contribute to the health promotion agenda.

IMPLICATIONS FOR PRACTICE

There is a need to address profession specific education at pre-registration and post-qualification levels, to ensure Diagnostic Radiographers are equipped with the knowledge, skills and confidence to promote health to their patients. Strong leadership is essential for creating a positive environment to facilitate education, training and the acceptance of health promotion as a key part of a diagnostic radiographer's role.

Fluctuating cohesion: A grounded theory study of nursing students engaged in a combined debriefing format

AIM

This study explored the social processes enacted by nursing students when they engage in a combined format of structured peer debriefing followed by instructor-led debriefing after in-person simulation. The aim was to gain insight into nursing students' perceptions and how peer processes influenced reflection and learning.

BACKGROUND

Debriefing, a key component of clinical simulation, promotes development of nursing students' reflective processes and enhances learning. In-person group-debriefing led by faculty/instructors is the most used debriefing format in healthcare simulation education. Yet, recent studies indicate instructor-led formats may increase students' anxiety and limit their capacity for reflection, a crucial step in clinical reasoning and decision making. Investigations into learner-centered formats support peer debriefing as a reasonable alternative to traditional instructor-led debriefing. However, current peer debriefing studies provide little insight into the social interactions and processes supporting reflection and learning; and little theoretical basis exists for the integration of alternatives to instructor-led debriefing formats (such as peer debriefing) into simulation-based education.

DESIGN

This qualitative study used a Straussian grounded theory design.

METHODS

Senior-level baccalaureate and associate degree nursing students from an U.S. public university with first-hand experience using the combined format of peer debriefing followed by instructor-led debriefing were recruited to participate in focus-group interviews. Data gathered from semi structured interviews were analysed using the iterative process of constant comparison. Theory building was aided using memoing, theoretical sampling and conceptual diagramming.

RESULTS

The sample consisted of 34 students. Study findings revealed the core category of the constructed theory, 'Fluctuating cohesion', involved students' pervasive sense of going back and forth between a sense of unity (we-ness) and separatism (me-ness) while engaged in the combined debriefing format. The theory integrated five related categories: discovering the process, normalizing experiences, developing mutuality, dynamic balancing and engaging informal social connections. Findings illustrated the processes students enacted to take ownership for learning and proactively discuss their clinical decision-making with the instructor. In turn, reflection was enhanced by increased receptiveness to subsequent expert feedback.

CONCLUSIONS

The study findings demonstrated that augmenting instructor-led debriefing with peer debriefing leveraged the beneficial nature of peer interactions, promoted psychological safety, facilitated nascent team behaviors and enhanced reflective thinking. The resultant theory that was generated from the findings and grounded in participants' experience, provides a meaningful framework that may inform future learner-centered debriefing formats aimed at optimizing debriefing effectiveness.

A qualitative exploration of multi-stakeholder perspectives of before-school physical activity

BACKGROUND

Engagement in before-school physical activity can potentially enhance health and learning-related outcomes for children and adolescents. However, influencing factors and stakeholder perceptions of before-school physical activity remain under-researched. This qualitative study aimed to examine stakeholder perceptions of: a) the suitability of the before-school segment for physical activity, b) barriers and facilitators associated with before-school physical activity, and c) strategies for schools to support before-school physical activity.

METHODS

Twelve focus groups and one interview were conducted with 38 participants from a range of school stakeholder groups-students, parents, teachers, school leaders, external physical activity providers, and school health and physical activity experts. Focus groups were analysed using template analysis, guided by a social-ecological model.

RESULTS

Stakeholders perceived before-school physical activity as valuable, for reasons including perceptions of meaningful contributions to students' cognitive functioning, classroom behaviours, and wellbeing. Factors influencing before-school physical activity were identified across multiple social-ecological levels, including the critical role of school leadership support, availability of facilities, and provision of qualified supervision. Proposed strategies highlighted the need for sustainable design, contextual relevance, and community engagement in before-school initiatives. Additionally, communication of the manifold benefits identified by stakeholders was suggested as a means to drive support and engagement in before-school physical activity.

CONCLUSIONS

This study provides insight for schools seeking to enhance opportunities for physical activity in the before-school hours and may inform future intervention research on the subject, taking into account its multi-faceted influences and the need for context-specific strategies.

The impact of prior care experience on nursing students' compassionate values and behaviours: A mixed methods study

BACKGROUND

Compassion is critical to the provision of high-quality healthcare and is foregrounded internationally as an issue of contemporary concern. Paid care experience prior to nurse training has been suggested as a potential means of improving compassion, which has been characterised by the values and behaviours of care, compassion, competence, communication, courage, and commitment. There is however a dearth of evidence to support the effectiveness of prior care experience as a means of improving compassion in nursing.

OBJECTIVE

To explore the impact of paid prior care experience on the values and behaviours of pre-registration nursing students indicated as characterising compassionate care.

DESIGN

Longitudinal mixed methods design employing a modified concurrent triangulation strategy, comprising two work packages. Work package 1 was qualitative, and work package 2 adopted a concurrent embedded strategy with a dominant quantitative component. Research is reported in accordance with the Good Reporting of a Mixed Methods Study framework.

SETTING(S)

Three United Kingdom universities.

PARTICIPANTS

Pre-registration nursing students attending one of three universities, and individuals who had previously participated in a Health Education England paid prior care experience pilot. Participant numbers at time point 1 were questionnaires n = 220, telephone interviews n = 10, and focus groups n = 8.

METHODS

Work package 1 consisted of longitudinal semi-structured telephone interviews. Work package 2 comprised validated online questionnaires measuring emotional intelligence, compassion satisfaction and fatigue, resilience, psychological empowerment, and career commitment (as proxies of compassionate values and behaviours), and focus groups. Qualitative data were thematically analysed. Quantitative data were analysed via Analysis of Variance in SPSS v 26.

RESULTS

Qualitative findings suggest that prior care experience has both positive and negative effects on students' compassionate values and behaviours, however positive effects do not extend to qualification. No statistically significant differences were found in any of the quantitative outcome measures between participants with and without paid prior care experience. A statistically significant increase in compassion fatigue was identified in both groups of participants post-qualification. Paid prior care experience did not prevent participants from experiencing reality shock on becoming a student or on qualification.

CONCLUSIONS

There is insufficient evidence of longitudinal beneficial impact to recommend paid prior care experience as an effective intervention to foster nursing students' compassionate values and behaviours. These findings do not support mandating a period of paid care experience as a prerequisite for entry into nurse education.

REGISTRATION

N/A. Tweetable abstract Insufficient evidence of longitudinal beneficial impact to recommend prior care experience as an effective intervention to foster nursing student compassion @PriorCareExp @Sarah_F_R.

Educating the nurses of tomorrow: exploring first-year nursing students' reflections on a one-week senior peer-mentor supervised inspiration practice in nursing homes

BACKGROUND

Worldwide, the healthcare system stresses a severe deficit of nurses because of elevated levels of work-induced stress, burnout and turnover rates, as well as the ageing of the nursing workforce. The diminishing number of nursing students opting for a career in nursing older people has exacerbated this shortage. A determining factor in the choice of a career within the field of residential care for nursing students is educational institutions offering students learning opportunities with positive learning experiences. Therefore, educational institutions must develop programmes that employ student active learning methods during clinical periods. Although much focus has been given to the development of new educational programs, insufficient consideration has been given to the value of peer mentoring and students' interactions during the clinical placement at nursing homes. The aim of the present study is to explore first-year nursing students' perceptions and experiences with peer mentoring as an educational model during their inspiration practice week at nursing home.

METHODS

The study employed a qualitative exploratory and descriptive research design. Data collection took place in October 2022 using focus group interviews. A total of 53 students in their first year of the bachelor's programme at the Oslo Metropolitan University participated in eight focus group interviews. The data were analysed following the principles of inductive content analysis.

RESULTS

The analysis resulted in one main category, 'Being inspired-keep learning and moving forward', representing first-year nursing students' common perceptions of being mentored by third-year students. The main category is supported by two categories: 'Closeness to the mentor' and 'Confidence in mentors' professional knowledge and teaching and supervision methods', which are interpreted as the drivers that enabled first-year students to learn more about nurses' roles and responsibilities in the nursing home.

CONCLUSION

Mentorship enhances the learning transfer from third-year nursing students over to first-year nursing students by providing them with real-world exposure and guidance from their more experienced peers. This hands-on approach allows them to bridge the gap between theory and practice more effectively, boosting first-year nursing students' confidence and competence in nursing and caring for older people living in nursing homes.

Barriers to the spiritual care of parents taking care of their child with a life-limiting condition at home

The changes that parents face when caring for a child with a life-limiting condition at home can affect them on a spiritual level. Yet, indications remain that parents do not feel supported when dealing with spiritual issues related to caring for a severely ill child. This paper explores, from the perspectives of bereaved parents, chaplains, grief counselors, and primary health care providers, the barriers to supporting the spiritual needs of parents. We conducted a qualitative focus group study from a constructivist point with chaplains/grief counselors, primary care professionals, and bereaved parents. All groups participated in two consecutive focus group sessions. Data were thematically analyzed. Six chaplains/grief counselors, 6 care professionals, and 5 parents participated. We identified six barriers: (1) There were difficulties in identifying and communicating spiritual care needs. (2) The action-oriented approach to health care hinders the identification of spiritual care needs. (3) There is an existing prejudice that spiritual care needs are by nature confrontational or difficult to address. (4) Spiritual support is not structurally embedded in palliative care. (5) There is a lack of knowledge and misconceptions about existing support. (6) Seeking out spiritual support is seen as too demanding.

CONCLUSION

 Parents of children with life-limiting conditions face existential challenges. However, care needs are often not identified, and existing support is not recognized as such. The main challenge is to provide care professionals and parents with the tools and terminology that suit existing care needs.

WHAT IS KNOWN

• Spiritual care needs are an important aspect of pediatric palliative care. • Parents of children with life-limiting conditions feel unsupported when dealing with spiritual questions.

WHAT IS NEW

• Parents and professionals mention barriers that hinder spiritual support for parents. • There is a disconnect between existing support and the care needs that parents have.

Perspectives of key informants before and after implementing UPSIDES peer support in mental health services: qualitative findings from an international multi-site study

BACKGROUND

Peer support is an essential part of recovery-oriented care worldwide. Contextual factors have an impact on the implementation of peer support work. However, research has paid little attention to similarities and differences of implementation factors in settings varying by income-level and cultural values. The aim of this study is to assess the factors influencing the implementation of a peer support intervention across study sites in low-, middle- and high-income countries in line with the Consolidation Framework for Implementation Research (CFIR).

METHOD

6 focus groups with a total of 54 key informants with relevant contextual (organisational) knowledge regarding implementation facilitators and barriers were conducted at six study sites Ulm and Hamburg (Germany), Butabika (Uganda), Dar es Salaam (Tanzania), Be'er Sheva (Israel), and Pune (India) before and 1.5 years after the start of UPSIDES peer support. Transcripts were analysed using qualitative content analysis.

RESULTS

Across study sites key informants reported benefits of peer support for service users and peer support workers as implementation facilitators. At study sites with lower resources, reduced workload for mental health workers and improved access to mental health services through peer support were perceived as implementation facilitators (CFIR Domain 1: Intervention characteristics). The degree of engagement of mental health workers (CFIR Domain 3: Inner Setting/Domain 4: Individuals involved) varied across study sites and was seen either as a barrier (low engagement) or a facilitator (high engagement). Across study sites, adequate training of peer support workers (CFIR Domain 5: Implementation process) was seen as animplementation facilitator, while COVID-19 as well as low resource availability were reported as implementation barriers (CFIR Domain 2: Outer setting).

CONCLUSIONS

This study highlights the importance of considering contextual factors when implementing peer support, including previous experience and perceived benefits. Particular attention should be given to organisational benefits such as workload reduction and the allocation of sufficient resources as key drivers in LMICs. In HICs, the potential of organisational benefits for successful implementation should be further investigated and promoted.

Clinician and patient views on janus kinase inhibitors in the treatment of inflammatory arthritis: a mixed methods study

BACKGROUND

Janus kinase inhibitors (JAKi) are new targeted synthetic disease-modifying antirheumatic drugs (DMARDs) licenced in the UK to treat rheumatoid and psoriatic arthritides. Unlike currently often prescribed biological DMARDs, they target a different part of the inflammatory pathway and are taken orally. The aim of this study was to explore what UK-based rheumatology clinicians and inflammatory arthritis (IA) patients think about the awareness, prescription and use of JAKi; how they compare with biologics; and how the COVID-19 pandemic has affected how JAKi are viewed and prescribed.

METHODS

Rheumatology clinicians and IA patients completed online surveys and participated in interviews/focus groups between September 2021 and January 2022. Survey data were analysed descriptively, and interview/focus group data underwent an inductive thematic analysis.

RESULTS

66.6% of patients had at least some awareness of JAKi, 73.0% from their rheumatology team. Problems getting earlier access to these drugs were raised by some patients, with many being prescribed JAKi after multiple other therapies had failed. 91.5% of clinicians prescribed JAKi in keeping with their local guidelines, with 72.3% prescribing them frequently as a monotherapy. Some clinicians had lingering safety concerns over JAKi use. Despite experiencing side effects and knowing of possible long-term risks, patients felt overall the benefits of JAKi outweighed the risks. 39.3% of patients were 'very satisfied' on JAKi, compared with 25.0% on biologics. Patients on JAKi appreciated their short half-life when it comes to infections, and their convenience as an oral therapy. When JAKi were discontinued in patients, it was predominantly due to inefficacy and non-cardiovascular adverse events. The COVID-19 pandemic resulted in increased prescription of JAKi as an alternative to injections and infusions, primarily to avoid potentially exposing patients to the coronavirus. Some patients believed their JAKi may confer some protection against developing severe COVID-19.

CONCLUSION

JAKi are an effective treatment option for IA and are liked by patients. The COVID-19 pandemic appears to have impacted their prescription favourably. However, clinicians have safety concerns over JAKi use. Any decision to go on a JAKi should be informed and take into account individual patient risk factors, circumstances and preferences.

[Cooperation of geriatrics and trauma surgery in certified geriatric trauma centers : Insights into different care models and the implementation of requirements resulting from certification]

BACKGROUND

In Germany, different models of orthogeriatric co-management have been implemented in certified geriatric trauma centers. So far, it is not clear how the different models are implemented and what influence the certification has on the structures and processes within the centers. The present study examined the extent of cooperation between surgery and geriatrics and if the quality of care had changed since the certification of the centers.

METHODS

In this study 4 guided focus group interviews (FGI) were conducted in different teams of certified geriatric trauma centers in 3 federal states with 16 participants. To specify the content of the FGI, two additional interviews were conducted with system auditors. Both types of interview were analyzed by content analysis.

RESULTS

The certification supported the implementation of structures and processes in the different orthogeriatric models; however, the quality of care and cooperation between surgery and geriatrics depends on the spatial proximity and the orthogeriatric care model in the geriatric trauma centers. Simultaneously, challenges in the area of geriatric syndromes and the recruitment of skilled staff became relevant.

DISCUSSION

The results can help to reflect processes in the certified geriatric trauma centers and to treat geriatric syndromes more effectively. In the future, the challenge will be to establish geriatric care under the existing shortage of skilled staff.

Heteronormative biases and distinctive experiences with prostate cancer among men who have sex with men: a qualitative focus group study

BACKGROUND

Men who have sex with men (MSM) face many challenges and biases in healthcare. Within urology there is a need to better understand how prostate cancer impacts MSM given the unique ways in which side effects that accompany treatment may affect this population. The goal of this study is to explore the experience of MSM with prostate cancer to advance the existing literature in this area and inform implementation and delivery of clinical practice and policy guidelines.

METHODS

Four focus groups were conducted with a semi-structured interview guide. Using a phenomenological qualitative approach consistent with grounded theory [1] and naturalistic inquiry principles we sought to better understand the direct experiences of MSM with prostate cancer. Audio transcriptions were thematically analyzed to identify themes that impact MSM throughout their prostate cancer journey. An iterative, team-wide classification process was used to identify, organize, and group common codes into higher-order categories and themes.

RESULTS

Patient's choice of provider and their interactions with the healthcare system were strongly impacted by their sexual identities. Participants commented on navigating the heteronormative healthcare environment and the impact of assumptions they encountered. MSM experienced the sexual side effects of prostate cancer treatment in unique ways. Issues with erectile dysfunction and ejaculatory dysfunction had significant impacts on patient's sexual experience, with some describing being forced to explore new modes of sexual expression. Anejaculation was a theme that was distressing for many participants. The emotional impact of a prostate cancer diagnosis was significant in the men interviewed. Common themes included loss of identity and fear for future relationships.

CONCLUSIONS

MSM have unique concerns after prostate cancer treatment that differ from men who don't identify as MSM. It is critical that providers familiarize themselves with the concerns of this patient population regarding prostate cancer treatment. An important step toward reducing heteronormative bias in prostate cancer care is to better understand the goals, identity, and sexual practices of MSM and to provide informed anticipatory guidance.

Integrated virtual simulation and face-to-face simulation for clinical judgment training among undergraduate nursing students: a mixed-methods study

BACKGROUND

Virtual simulation and face-to-face simulation are effective for clinical judgment training. Rare studies have tried to improve clinical judgment ability by applying virtual simulation and face-to-face simulation together. This study aimed to evaluate the effect of an integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program on enhancing nursing students' clinical judgment ability and understanding of nursing students' experiences of the combined simulation.

METHODS

A sequential exploratory mixed-methods study was conducted in a nursing simulation center of a university in Central China. Third-year nursing students (n = 122) taking clinical training in ICUs were subsequentially assigned to the integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program arm (n = 61) or the face-to-face simulation-only arm (n = 61) according to the order in which they entered in ICU training. Clinical judgment ability was measured by the Lasater Clinical Judgment Rubric (LCJR). Focus group interviews were conducted to gather qualitative data.

RESULTS

Students in both arms demonstrated significant improvement in clinical judgment ability scores after simulation, and students in the integrated arm reported more improvement than students in the face-to-face simulation-only arm. The qualitative quotes provided a context for the quantitative improvement measured by the LJCR in the integrated arm. Most of the quantitative findings were confirmed by qualitative findings, including the domains and items in the LJCR. The findings verified and favored the effect of the combination of non-immersive virtual simulation and high-fidelity face-to-face simulation integrated program on enhancing nursing students' clinical judgment ability.

CONCLUSIONS

The integrated virtual simulation and face-to-face simulation program was feasible and enhanced nursing students' self-reported clinical judgment ability. This integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program may benefit nursing students and newly graduated nurses in the ICU more than face-to-face simulation only.

Perspectives of adult patients with mental health disorders on the relationship with nurses: a focus group study

BACKGROUND

The relationship between the nurse and the patient with mental health disorder is crucial to the recovery process. Thus, patients with mental health disorders should be active subjects in this relationship by having autonomy and self-determination.

METHODS

This study aimed to explore the perspectives of adult patients with mental health disorders on the relationship with nurses. A qualitative, descriptive, and exploratory study was conducted in March 2023, using focus group meetings in an association to support patients with severe mental health disorders in the Northern region of Portugal. The study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ). A total of 8 patients participated in the study. Two focus group meetings were conducted. The inductive method was used, and content analysis of the transcripts was performed. The QDA Miner Lite 4.0 and Microsoft Excel were used for content analysis.

RESULTS

Participants considered the relationship with nurses important for their recovery and expected nurses to provide support and help, being able to identify their needs, thus personalising their care. Attitudinal and communication aspects were also considered crucial for establishing a solid, trusting, and meaningful relationship.

CONCLUSION

According to the findings nursing care is expected to focus on the patient, his/her preferences, expectations, and the uniqueness of each individual. The results of this study may be useful for the reflection and improvement of nurses in their relational and communication skills and the driving force for nursing students' awareness of the perspective of the relationship with patients with mental health disorder and its relevance.

Understanding anxiety experienced by young males with Duchenne muscular dystrophy: a qualitative focus group study

In this multi-methods study we explored the characteristics, causes and impact of anxiety in Duchenne muscular dystrophy (DMD) from the perspective of young males with DMD and their parents. Eight young males with DMD (7-18 years) and 14 parents participated in separate focus groups. Perspectives on anxiety were explored using semi-structured interview schedules. Themes were identified using Framework Analysis. Neurodevelopmental, emotional and behavioural symptom scores were obtained using standard instruments including the Strengths and Difficulties Questionnaire and Revised Children's Anxiety and Depression Scale. We identified six common anxiety characteristics: Catastrophic conclusions; Rigidly-held anxieties; Extreme distress; Social anxieties; Physical changes/needs; Unexpected/unfamiliar. Four further themes described influential systemic factors: Individual, Family, and Social responses and Physical environment and service contexts. All DMD participants had significantly higher total difficulties, emotional problems and impact scores than population norms. The Revised Children's Anxiety and Depression Scale showed low sensitivity in identifying anxiety symptoms. Fifty-seven percent (8/14) of parents who had wanted help for their son's anxiety were dissatisfied with the available support. In conclusion, anxiety can severely impact wellbeing and functioning of individuals with DMD. There are important nuances to consider when managing DMD-associated anxiety. We highlight the importance of multimodal assessment considering the multiple contexts within which anxiety arises.

Exploring the COVID-19 Landscape and Our Path Forward Using a Formalized SWOT Analysis

OBJECTIVE

This study aimed to share the results of a formalized SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis focusing on perceptions and the long-term impact of the COVID-19 pandemic.

METHODS

The study used a parallel mixed-methods approach. This included a quantitative component, which used presurvey descriptive data, and a qualitative component, which involved SWOT analysis via focus groups. Participants were recruited via email. Volunteers responded to survey questions regarding the COVID-19 pandemic. Ten focus groups were created and conducted in February 2022. Responses were transcribed and coded by 2 independent investigators and a third to resolve disagreement. Group consensus determined the themes.

RESULTS

On the survey (n = 55), over half of respondents noted lack of motivation and attention deficit emerging during the pandemic. However, less than half felt that they had access to appropriate support/services. Regarding mental health, some reported increased anxiety, loneliness, depression, and sleep disorders, yet a small percentage of respondents felt that they were provided with support to mitigate these issues. Focus group sessions resulted in 404 statements, which determined the following 8 themes: communication, pivoting the learning and assessment process, COVID-19 safety, interpersonal relationships, health and wellness, finances, student services, and competition in the job market. The top strength was in pivoting the learning process, top weakness was in university communications, and the top opportunities and threats were in pivoting to virtual learning.

CONCLUSION

As the country continues to experience COVID-19 waves, it is important to reflect on and understand the effects of the previous reactions, and explore ways to increase and sustain motivation, limit lasting negative effects, and remain proactive and prepared for the future.

The use of the Capability-Opportunity- Motivation Behavior (COM-B) model to identify barriers to medication adherence and the application of mobile health technology in adults with coronary heart disease: A qualitative study

Objective

Among patients with coronary heart disease, we sought to address the research questions of: 1) What is the acceptability of applying a technology-enabled approach to support medication adherence?; and 2) What are barriers to medication adherence using the Capability-Opportunity-Motivation Behavior (COM-B) model as a guiding framework?

Methods

Applying qualitative research methods, we employed a series of 3 focus groups per individual (total 9 sessions). Coded data from thematic analysis were mapped to the COM-B model components for meaningful associations.

Results

Fourteen participants were recruited (median age 69.5 ± 11, 50% female). Barriers to medication adherence were organized along these COM-B domains: psychological capability (forgetfulness, distractions, fear of side effects), physical opportunity (inaccessible medications, inability to renew prescriptions), reflective (burdening family members), and automatic motivation (medication fatigue, health decline).

Conclusions

Tailored text messaging and mobile phone apps were perceived as helpful tools for medication adherence. The COM-B model was useful to provide a comprehensive, theory-driven evaluation of patients' beliefs and motivations on whether to engage in medication adherence.

Innovation

To date, text messaging and mobile applications have not been widely implemented in the clinical setting and provide a major opportunity to innovate on approaches to address medication adherence.

Experiences of UK and Irish family carers of people with profound and multiple intellectual disabilities during the COVID-19 pandemic

BACKGROUND

People with profound and multiple intellectual disabilities (PMID) have high and intensive support needs that ordinarily place significant strain on family carers. This was further heightened by the removal of many external supports during the COVID-19 pandemic. We sought to explore the experiences of family carers of people with PMID during the COVID-19 pandemic and understand what the longer-term impact might be on their lives.

METHODS

Focus group interviews (n = 32) were conducted with family carers (n = 126) from the four countries of the UK and the Republic of Ireland. Participants were asked questions relating to their experiences of the COVID-19 pandemic, coping strategies, and challenges faced. All focus groups were conducted using the online platform, Zoom. These were audio recorded, transcribed verbatim and analysed employing inductive thematic analysis.

FINDINGS

Three main themes were generated from the data including (1.0) COVID-19 as a double-edged sword (2.0), The struggle for support (3.0), Constant nature of caring. These included 11 subthemes. (1.1) 'COVID-19 as a catalyst for change', (1.2) 'Challenges during COVID-19: dealing with change', (1.3) 'Challenges during COVID-19: fear of COVID-19', (1.4); 'The online environment: the new normal' (2.1) 'Invisibility of male carers', (2.2) 'Carers supporting carers', (2.3) 'The only service you get is lip service: non-existent services', (2.4); 'Knowing your rights' (3.1) 'Emotional response to the caring role: Feeling devalued', (3.2) 'Emotional response to the caring role: Desperation of caring', (3.3) 'Multiple demands of the caring role.'

CONCLUSIONS

The COVID-19 pandemic presented immense challenges to family carers of people with PMID but also provided some opportunities. Families had already struggled to receive many of the supports and services to which they were entitled to only to have these removed at the onset of the pandemic. The experiences of male carers have been largely absent from the literature with this research showing they want to be included in decision making and require tailored support services. Service providers should see the end of the COVID-19 pandemic as providing opportunity to re-examine current provision and design services with family carers. As the direct threat from COVID-19 diminishes and the experiences of those who lived through this period come to the fore, there is a need to re-examine current models and provision of support to family carers to better meet their needs.

Racism During Pregnancy and Birthing: Experiences from Asian and Pacific Islander, Black, Latina, and Middle Eastern Women

BACKGROUND

Despite persistent racial disparities in maternal health in the USA, there is limited qualitative research on women's experiences of discrimination during pregnancy and childbirth that focuses on similarities and differences across multiple racial groups.

METHODS

Eleven focus groups with Asian American and Pacific Islander (AAPI), Black, Latina, and Middle Eastern women (N = 52) in the USA were conducted to discuss the extent to which racism and discrimination impact pregnancy and birthing experiences.

RESULTS

Participants across groups talked about the role of unequal power dynamics, discrimination, and vulnerability in patient-provider relationships. Black participants noted the influence of prior mistreatment by providers in their healthcare decisions. Latinas expressed fears of differential care because of immigration status. Middle Eastern women stated that the Muslim ban bolstered stereotypes. Vietnamese participants discussed how the effect of racism on mothers' mental health could impact their children, while Black and Latina participants expressed constant racism-related stress for themselves and their children. Participants recalled better treatment with White partners and suggested a gradient of treatment based on skin complexion. Participants across groups expressed the value of racial diversity in healthcare providers and pregnancy/birthing-related support but warned that racial concordance alone may not prevent racism and emphasized the need to go beyond "band-aid solutions."

CONCLUSION

Women's discussions of pregnancy and birthing revealed common and distinct experiences that varied by race, skin complexion, language, immigration status, and political context. These findings highlight the importance of qualitative research for informing maternal healthcare practices that reduce racial inequities.

[Physician assistants as a future model in primary care: Experiences, needs, potentials and barriers]

INTRODUCTION

In the coming decades, demographic change will dramatically increase health care needs, especially for general practitioners (GPs). However, there is a shortage of young primary care physicians, with signs of (impending) underuse already becoming apparent in rural and structurally weak areas. Innovative care concepts are needed to counteract this development and ensure the future of primary care. In addition to medical assistants (MFA), academically trained physician assistants (PAs) could be considered for more demanding delegation tasks and be involved in direct patient care under the responsibility of a physician in the practice team. In England, the Netherlands and the USA, PAs have been a part of the health care systems for many years.

RESEARCH QUESTIONS

1) What are the potentials for delegation/possibilities for PAs working in primary care practices in contrast to medical assistants? 2) What structural requirements are necessary to regularly integrate PAs in primary care practices?

METHODS

After preliminary interviews with PA experts and primary care researchers and practitioners (n=29), four expert interviews (n=4) with GPs and PAs were performed in a case analysis in order to elicit experiences with PAs in family practice. Based on this, three focus groups were conducted with GPs and practice staff (n=15) to discuss the extent, the need and the willingness to delegate physician services to PAs, as well as existing barriers. After transcription, analyses were performed using qualitative content analysis according to Mayring.

RESULTS

The participants acknowledged the potential to reduce physician workloads and showed a high willingness to delegate tasks. Practical examples suggest that a clearly defined delegation of medical tasks to PAs, e.g. participation in infection consultations, is possible after only a few weeks working in family practices. Thus, the cooperation between GPs, PAs and medical assistants can be successful. Uncertainties exist regarding the legal possibilities and limits of delegation as well as the current and future financial reimbursement of PAs.

DISCUSSION

The legal and financial framework for the utilization of PAs in ambulatory care should be reliably clarified as well as transparently communicated so that the considerable potentials of delegating tasks to academically trained staff, e.g. PAs, especially in the GP sector, can be exploited in the future.

CONCLUSION

Participation of PAs in the GP team could be key to overcoming the often threatening or already existing under-provision of medical care in structurally weak regions.

Sex and Female Empowerment (SAFE): Learning from health care providers, men and women to design a sexual health intervention for women with substance use disorders

BACKGROUND

Substance Use Disorder (SUD) treatment is a promising setting to provide sexual health education to women. This study examined barriers and possible solutions to effectively providing sexual health education and services during SUD treatment.

METHODS

To obtain a full picture of the barriers and solutions, 29 cisgender women and 17 cisgender men in treatment for a SUD and four health care providers in North Carolina were interviewed regarding the domains of pregnancy-planning, barriers to reproductive health services and contraception, selecting a method of contraception and desired aspects and elements of a sexual health intervention.

RESULTS

Eight themes and 12 sub-themes emerged that included how addiction impacts pregnancy planning and pregnancy motivations, the stigma and fear regarding accessing health services, the lack of accurate knowledge of the human reproductive cycle and contraceptive methods and worries about contraception side-effects. Recommendations for interventions to reduce unintended pregnancy in this treatment population included the need for simple and focused information given by trusted communicators in a short time frame in accessible locations, and offering incentives for participation such as food and transportation.

CONCLUSION

As SUD treatment providers and programs look to improve access to sexual health and contraceptive options for women with SUD, these eight themes provide helpful guidance in crafting future interventions.

'Our mind could be our biggest challenge': A qualitative analysis of urban adolescents' sleep experiences and opportunities for mind-body integrative health approaches to improve sleep

Objective

To inform the development of a combined sleep and mind-body integrative health (MBIH) intervention, we explored urban adolescents' sleep experiences and perceptions of MBIH techniques.

Methods

We conducted eight focus groups with school-based health center patients in New York City, exploring sleep experiences; mindfulness, body awareness, tapping, acupressure, and self-hypnosis; and intervention delivery preferences. We recorded, transcribed, and analyzed the discussions applying methods from grounded theory.

Results

Participants (n = 25) were ages 14-17, predominantly female (64%), Latino (60%), and Black (40%). Participants reported social, physical, and internal sleep barriers, but had limited success implementing sleep improvement strategies. Participants viewed MBIH techniques positively, noted audio-guided techniques' accessibility, and were intrigued by less-familiar techniques. Preferences varied around domains of intervention delivery.

Conclusion

Results underscore the need for adolescent-informed interventions offering sleep improvement strategies. Participants' interest and willingness to engage in MBIH techniques present an opportunity for practitioners to develop and deliver sleep interventions incorporating MBIH components to urban adolescents. Varied intervention preferences highlight the need to be adaptable to adolescents' lived experiences, comfort levels, and learning styles.

Innovation

This study elucidates the perspectives of underrepresented adolescents whose perspectives on MBIH have rarely been explored, an important first step in developing tailored interventions.

What does consumer and community involvement in health-related education look like? A mixed methods study

Consumer and community involvement (also referred to as patient and public involvement) in health-related curricula involves actively partnering with people with lived experience of health and social care systems. While health professions education has a long history of interaction with patients or consumers, a shift in the way consumer and community engage in health-related education has created novel opportunities for mutual relationships valuing lived experience expertise and shifting traditional education power relations. Drawing on a mixed methods design, we explored consumer and community involvement practices in the design and delivery of health-related education using the capability, opportunity, motivation and behaviour framework (COM-B). In our results, we describe educator capabilities, opportunities and motivations, including identifying barriers and enablers to consumer and community involvement in health-related education. Educators have varying philosophical reasons and approaches for involving consumers and community. There is a focus on augmenting student learning through inclusion of lived and living experience, and on mutual transformative learning through embedding lived experience and co-creating learning. How these philosophical positionings and motivations shape the degree by which educators involve consumers and community members in health-related curricula is important for further understanding these educational partnerships within universities.

Understanding COVID-19 vaccine hesitancy in the Hispanic adult population of South Carolina: a complex mixed-method design evaluation study

BACKGROUND

In August 2021, only 47.6% of all eligible residents in South Carolina (SC) had received at least one dose of the COVID-19 vaccine, with only 41% having completed their vaccination series. Additionally, only 27% of all Hispanics in SC had completed their vaccination series compared to 34.1% of non-Hispanics. Vaccine hesitancy is a complex phenomenon that is context and vaccine-specific. Focusing on unvaccinated Hispanics living in rural areas of SC, this study aimed to identify barriers to vaccination and provide an educational intervention designed to address vaccine hesitancy.

METHODS

A complex mixed-methods evaluation design was used to conduct this study. First, in-person vaccine educational sessions were implemented, along with a pre-post-test survey, to assess changes in knowledge, attitudes, motivations, barriers, and intentions to receive COVID-19 vaccination. Second, in-person follow-up focus groups were held with the same participants to gather in-depth insight about participants' knowledge and attitudes about the COVID-19 vaccination. Third, an online follow-up survey was conducted to assess the effect of the training and discussion session on COVID-19 vaccination. Study outcomes were assessed among the 17 individuals who participated in the educational sessions and focus group discussions.

RESULTS

Findings revealed that for unvaccinated Hispanics living in South Carolina; vaccine hesitancy was primarily driven by: 1) misinformation and information coming from unverified sources and 2) negative perceptions of the safety and effectiveness of the COVID-19 vaccines. Specifically, participants were fearful that the vaccine development was rushed and that the vaccines might contain questionable ingredients that could cause strong side effects or even death. Participants were also concerned that vaccination might cause them to get sick and be hospitalized, which would have financial implications since they could not afford healthcare or take time off work.

CONCLUSIONS

Program implementation and mass communication campaigns should focus on COVID-19 vaccine safety and effectiveness, including side effects, what to expect after being vaccinated, and how to look for information from reputable sources. The educational session implemented proved to be effective and helped reduce vaccine hesitancy since most participants (80%) self-reported receiving a COVID-19 vaccine after program participation.

Introducing a triage and Nurse on Call model in primary health care - a focus group study of health care staff's experiences

BACKGROUND

With the increased demand for health care services and with simultaneous staff shortages, new work models are needed in primary health care. In November 2015, a Swedish primary health care centre introduced a work model consisting of a structured patient sorting system with triage and Nurse on Call. The aim of this study was to describe the staff's experiences of introducing the triage and Nurse on Call model at the primary health care centre.

METHODS

Five focus group discussions with staff (n = 39) were conducted 4 years after the introduction of the work model. Groups were divided by profession: medical secretaries, nursing assistants, physicians, primary health care nurses, and registered nurses. The transcribed text from the discussions was analysed using qualitative inductive content analysis.

RESULTS

The analysis generated one overarching theme: The introduction of triage and Nurse on Call addresses changed preconditions in primary health care, but the work culture, organization, and acquisition of new knowledge are lagging behind. The overarching theme had five categories: (1) Changed preconditions in primary health care motivate new work models; (2) The triage and Nurse on Call model improves teamwork and may increase the quality of care; (3) Unclear purpose and vague leadership make introducing the work model difficult; (4) Difficulties to adopt the work model as it challenges professional autonomy; and (5) The triage and Nurse on Call model requires more knowledge and competence from nurses in primary health care.

CONCLUSIONS

This study contributes with knowledge about implications of a new work model in primary health care from the perspective of health care staff. The work model using triage and Nurse on Call in primary health care was perceived by participants to increase availability and optimize the use of resources. However, before introduction of new work models, it is important to identify barriers to and facilitators for successful improvements in the local health care context. Additional education for the health care staff is important if the transition is to be successful. Complementary skills and teamwork, supported by a facilitator seems important to ensure a well-prepared workforce.

Focus groups with post-treatment breast cancer survivors in Greece

The present study aimed to identify the factors that prohibit or enable breast cancer survivors from adopting a healthy lifestyle, as well as to record patients' suggestions towards developing a weight-loss lifestyle intervention. Twenty-three breast cancer survivors participated in four online, semi-structured focus groups in Greece. All discussions were video-recorded and transcribed verbatim. Participants were 50⋅5 ± 7⋅4 years old with a current mean BMI of 29⋅1 ± 3⋅4 kg/m2. Four main themes emerged from thematic analysis: (1) dietary and lifestyle practices, (2) the effects of cancer on body weight, (3) the impact of cancer on psychology, and (4) the effect of the environment on body weight. Lack of information from healthcare professionals and lack of time were the main barriers to body weight management, whereas the main facilitators were support from their social environment, along with a comfortable physical environment, and the facility of technology. Participants suggested that an effective weight-loss lifestyle intervention should include psychological and social support, guidance and education, collaboration, flexible recommendations, personalised goals, and a follow-up plan. The needs of breast cancer survivors need to be considered when designing weight-loss lifestyle interventions. A personalised approach may prove more effective in promoting a healthy lifestyle and improving patients' care.

Finding the right words: A focus group investigation of nurses' experiences of writing diaries for intensive care patients with a poor prognosis

BACKGROUND

The overall purpose of diaries written during an intensive care stay is to help patients fill in memory gaps from the illness trajectory, which might promote long-term psychological recovery. Diaries have also been shown to benefit nurses in maintaining a view of the patient as a person in the highly technical environment and to promote reflection. There is a lack of research on how nurses might be affected by writing a diary for critically ill patients with a poor prognosis.

OBJECTIVES

The aim of this study was to investigate nurses' experience of writing diaries for intensive care patients with a poor prognosis.

METHODS

This study has a qualitative descriptive design and was inspired by the methodology of interpretive description. Twenty-three nurses from three Norwegian hospitals with a well-established practice of writing diaries participated in four focus groups. Reflexive thematic analysis was used. The study was reported according to the Consolidated Criteria for Reporting Qualitative Research checklist.

FINDINGS

The overarching theme resulting from our analysis was "Finding the right words". This theme represents the challenge of writing in view of the uncertainty of the patient's survival and of who would read the diary. It was important to strike the right tone with these uncertainties in mind. When the patient's life could not be saved, the purpose of the diary expanded to comforting the family. To put an extra effort into making the diary something special when the patient was dying was also a meaningful activity for the nurses.

CONCLUSIONS

Diaries may serve other purposes than helping patients to understand their critical illness trajectory. In cases of a poor prognosis, nurses adapted their writing to comfort the family rather than informing the patient. Diary writing was meaningful for the nurses in managing care of the dying patient.

"We are everyone's ASHAs but who's there for us?" a qualitative exploration of perceptions of work stress and coping among rural frontline workers in Madhya Pradesh, India

OBJECTIVE

More than a million female village-level lay providers called 'Accredited Social Health Activists (ASHAs)', who deliver primary care, face high levels of stress due to work demands and low compensation, within the context of poverty and gender inequality. Evidence on ASHAs has focused on workplace challenges from a system perspective, without sufficient probing into individual-level stress. This study aims to gain perspectives into the experiences of work stress, the related health symptoms, and the responses to stress among ASHAs in India.

METHODS

Focus group discussions (FGDs) conducted with ASHAs in Sehore district, Madhya Pradesh, were audio-recorded and transcribed. Grounded theory was used to generate themes under the various domains of ASHAs' work and domestic life. We identified pathways between the conditions that trigger stressful events, experiences of these events, resulting perceptions, effects on health and wellbeing, and approaches used by ASHAs to respond to stress.

RESULTS

Six FGDs with 59 ASHAs generated the following themes: (a) Facility: Workload, undue pressures, unstructured work; ASHAs' relationships with seniors (e.g., feelings of being disrespected, blamed, or targeted), and low access to physical and administrative resources; (b) Home: Feelings of guilt for putting less time for family/child care; disrespect by the elderly for a poorly incentivised job; (c) Community: Low acceptance by the villagers; caste- and gender-bias; difficult community-level relationships (emotional labour, fear/stigma towards her services); (d) Somatic and psychological symptoms: headache, exhaustion, depressive symptoms (to cite a few); and (e) Responses to stress: Motivation (support from peers, family, a sense of identity/pride, incentives), Individual strengths (e.g., social responsibility), and spiritual recourse mechanisms.

CONCLUSIONS

This study will inform the development of a strengths-based coaching intervention to address work stress among ASHAs. The findings are relevant to building the evidence on alleviation of work stress among female frontline cadres in low-resource settings globally.

Evaluation of a blended training solution for critical care nurses' work environment: Lessons learned from focus groups in four European countries

AIM

The aim of this study was to evaluate a blended pilot training course on Healthy Work Environments (HWEs) for critical care nurses as follows: 1) to explore the experience of trainees and trainers who took part in the training; and 2) to identify the strengths and weaknesses of the training program in its potential transferability to nursing practice in Intensive Care Units (ICUs).

BACKGROUND

Despite the evidence supporting the association between HWEs and job satisfaction, nursing retention, and patient outcomes, nurses still have high rates of burnout, mental health problems and intent to leave. To address this challenge, a blended training was created and piloted with the aim to highlight the relevance and impact of HWEs, enhancing its transferability to daily practice. The training was based on the six standards of HWEs as proposed by the American Association of Critical Care Nurses and created within an Erasmus + project. The pilot was delivered by trainers (critical care nursing educators) to critical care nurses and included six workshops of eight hours each (48 h in total) in each country.

DESIGN

After the pilot testing, a qualitative approach, with focus group discussions was used.

METHODS

All the trainees (n=82), who had attended at least one workshop were invited to participate in the focus groups. Overall, eight focus groups were held with critical care nurses who participated as trainees (n=39) from four testing countries: Cyprus, Croatia, Spain and Poland. One international focus group was held with trainers who conducted the training (n=4). Four more trainers completed the questionnaire online. All focus group were video recorded, and transcribed verbatim. Then, the national transcripts were translated into English. An inductive thematic analysis was carried out.

FINDINGS

Three themes were identified: 1) Valuing the relevance of the training program and a positive learning experience; 2) A powerful insight leading to increased awareness and empowerment in personal and professional life; 3) Challenges identified in terms of training, follow up and management of change. Both trainees and trainers expressed a positive opinion with regard to the content of the training and the didactic methods used. They emphasized the strong influence of the training on their understanding of a HWEs, its impact in an ICU context and the need for action, mainly related to communication issues.

CONCLUSION

The proposed blended training program may be used by trainers, who can enable nurses develop the competencies required to influence their work environment, in a context of shared responsibility.

"I guess it's quite trendy": A qualitative insight into young meat-eaters' sustainable food consumption habits and perceptions towards current and future protein alternatives

As the market for sustainable food continues to expand, there is a need to understand how consumers' consumption habits and perceptions are changing. Targeting the younger populations is of interest as they arguably will shape the future of food. Therefore, the present study aimed to provide in-depth consumer insights on a range of topics from current consumption habits (i.e., meat reduction, plant-based meat/seafood (PBM/S)), towards future protein alternatives (i.e., cell-based meat/seafood (CBM/S), precision fermented dairy (PFD)). Online focus groups were conducted in the UK with meat-eaters (n = 38) aged 18-34. Codebook thematic analysis was applied using the Framework Matrix as a tool for data analysis. Key themes were presented using the COM-B model (Capability, Opportunity, Motivation), which identified areas of behavioural change. Results found a trend towards meat reduction, partially initiated by moving away from home and limited food budgets. Overall, participants acknowledged the environmental impact of food, but a notable knowledge gap was apparent when quantifying the effect, especially for dairy and seafood. Compared to PBM, few participants had tried PBS products, partially due to lower availability and familiarity. Enablers for PBM/S included convenience, positive sensory experiences and the influence of others, whilst barriers related to negative health connotations and over-processing. For CBM/S and PFD, animal welfare, curiosity and optimised nutrition acted as enablers, whilst barriers related to wider consumer acceptance, affordability and unnaturalness. In general, participants felt changing food consumption habits can have an impact on climate change and were optimistic about novel technologies supporting future protein transitions. Increasing public understanding around the environmental impact of food, especially seafood and dairy, and prioritising the affordability of sustainable food are suggested as intervention strategies to encourage sustainable food consumption.

"Sorry for laughing, but it's scary": humor and silence in discussions of Colorectal Cancer with Urban American Indians

BACKGROUND

Given high rates of cancer mortality in Native communities, we examined how urban American Indian and Alaska Native elders talk about colorectal cancer (CRC) and CRC screening.

METHODS

We conducted seven focus groups with a total of 46 participants in two urban clinics in the Pacific Northwest to assess participant awareness, perceptions, and concerns about CRC and CRC screening. Using speech codes theory, we identified norms that govern when and how to talk about CRC in this population.

RESULTS

Our analyses revealed that male participants often avoided screening because they perceived it as emasculating, whereas women often avoided screening because of embarrassment and past trauma resulting from sexual abuse. Both men and women used humor to mitigate the threatening nature of discussions about CRC and CRC screening.

CONCLUSIONS

We offer our analytic results to assist others in developing culturally appropriate interventions to promote CRC screening among American Indians and Alaska Natives.

Determinants of caregiving grandparents' physical activity and sedentary behavior: a qualitative study using focus group discussions

BACKGROUND

Evidence on the factors influencing physical activity (PA) and sedentary behavior (SB) in middle-aged and older adults taking care of their grandchild(ren) is limited, even though this knowledge seems imperative when considering the unique relationship between grandparents and their grandchild(ren) as well as the rising popularity of intergenerational interventions targeting these energy-expenditure related behaviors. Therefore, this explorative qualitative study aimed to identify the determinants of PA and SB levels among Flemish caregiving grandparents in the presence of their grandchild(ren) aged between 0-5 years.

METHODS

Six online focus group discussions were conducted via Microsoft Teams, all of which were audio- and videotaped with permission granted by the participating grandparents. In total, nine caregiving grandfathers and 28 caregiving grandmothers (overall mean age = 60.9 ± 4.1y) participated in this study. An inductive content analysis approach was used to derive subcategories, categories and themes from the verbatim transcribed data using NVivo R1.

RESULTS

Caregiving grandparents' levels of PA and SB were both influenced by personal determinants (e.g., physical health, grandparental perceptions and responsibilities), interpersonal determinants (e.g., characteristics of the grandchild(ren), such as age-related physical/motor development and family interaction), and environmental determinants (e.g., weather and seasonal circumstances). PA levels of caregiving grandparents were further affected by additional personal determinants (e.g., age of the grandparent, planning and location) and interpersonal determinants (e.g., characteristics of the grandchild(ren), such as new experiences of the grandchild(ren)). Additionally, some personal determinants (e.g., perception of educational value) and interpersonal determinants (e.g., characteristics of the grandchild(ren), such as age-related cognitive development and health of the grandchild(ren)) were strictly mentioned to influence caregiving grandparents' SB.

CONCLUSIONS

Acknowledging the unique relationship between grandparents and their grandchild(ren), the current study identified specific factors determining grandparents' PA and SB levels during the provision of grandchild care. Besides, it turned out of importance to take the interplay between the different determinants into account. Especially, for those grandparents with older grandchild(ren), within the studied 0-5 years age range, more attention should be paid to grandchild characteristics as part of the interpersonal determinants when setting up interventions to improve levels of PA and SB in caregiving grandparents.

"There is no one who helps you with it": experiences of people with long COVID regarding medical care, therapeutic measures, and barriers in the German healthcare system: results of a qualitative study with four focus groups

BACKGROUND

Many people experience long-term symptoms such as fatigue, cognitive problems, or shortness of breath after an acute infection with COVID-19. This emerging syndrome, known as long COVID, is new and complex in many aspects. This study aims to collect the experiences of people with long COVID with ambulatory healthcare structures.

METHODS

Four focus groups were conducted with a total of 23 adults with long COVID in June and July 2022. These discussions were audio-recorded, subsequently transcribed, and analyzed using the qualitative content analysis of Mayring and Kuckartz.

RESULTS

Fourteen out of 19 participants who had a primary care encounter regarding their long COVID symptoms did not perceive it as helpful. Many respondents reported that their general practitioners did not take their long COVID symptoms seriously and did not refer them to specialists or made therapeutic recommendations. However, some participants reported that they were prescribed non-pharmaceutical therapies (e.g., group meetings supported by psychotherapists, occupational therapy, etc.) that improved their condition. 14 of 23 respondents perceived care barriers such as providers' lack of awareness of long COVID, poor access to specialists, a lack of specialized care (e.g., long COVID clinics), or high bureaucratic hurdles for specific healthcare services. To improve medical care, participants suggested campaigns to raise awareness of long COVID among healthcare providers and the general population, increase research and government investments regarding the development of treatment structures for long COVID, expanding existing therapeutic services, and establishing one-stop shops for integrated specialist healthcare for people with long COVID.

CONCLUSIONS

Several implications for healthcare professionals and policymakers can be derived from this study: (1) general practitioners should take the symptoms of long COVID seriously, assume a care coordinating role, make referrals, and establish contact with long COVID clinics; (2) care planners should focus on developing interprofessional evidence-based care and treatment approaches for long COVID; (3) existing care structures such as long COVID outpatient clinics should be expanded. The overarching goal must be to develop consistent guidelines for long COVID diagnosis, care, and treatment.

TRIAL REGISTRATION

The study is registered in the German register for clinical trials (DRKS00026007, first registration on 09/09/2021).

Assessing readiness to implement long-acting injectable HIV antiretroviral therapy: provider and staff perspectives

BACKGROUND

Long-acting injectable antiretroviral therapy (LAI-ART) represents the next innovation in HIV therapy. Pre-implementation research is needed to develop effective strategies to ensure equitable access to LAI-ART to individuals living with HIV.

METHODS

We conducted focus group discussions (FGDs) with providers and staff affiliated with HIV clinics in San Francisco, Chicago, and Atlanta to understand barriers to and facilitators of LAI-ART implementation. Participants also completed a short survey about implementation intentions. FGDs were held via video conference, recorded, transcribed, and thematically analyzed using domains associated with the Consolidated Framework for Implementation Research (CFIR).

RESULTS

Between September 2020 and April 2021, we led 10 FDGs with 49 participants, of whom ~60% were prescribing providers. Organizational readiness for implementing change was high, with 85% agreeing to being committed to figuring out how to implement LAI-ART. While responses were influenced by the unique inner and outer resources available in each setting, several common themes, including implementation mechanisms, dominated: (1) optimism and enthusiasm about LAI-ART was contingent on ensuring equitable access to LAI-ART; (2) LAI-ART shifts the primary responsibility of ART adherence from the patient to the clinic; and (3) existing clinic systems require strengthening to meet the needs of patients with adherence challenges. Current systems in all sites could support the use of LAI-ART in a limited number of stable patients. Scale-up and equitable use would be challenging or impossible without additional personnel. Participants outlined programmatic elements necessary to realize equitable access including centralized tracking of patients, capacity for in-depth, hands-on outreach, and mobile delivery of LAI-ART. Sites further specified unknown logistical impacts on implementation related to billing/payer source as well as shipping and drug storage.

CONCLUSIONS

Among these HIV care sites, clinic readiness to offer LAI-ART to a subset of patients is high. The main challenges to implementation include concerns about unequal access and a recognition that strengthening the clinic system is critical.

Emotional barriers and facilitators of deprescribing for older adults with cancer and polypharmacy: a qualitative study

PURPOSE

To describe emotional barriers and facilitators to deprescribing (the planned reduction or discontinuation of medications) in older adults with cancer and polypharmacy.

METHODS

Virtual focus groups were conducted over Zoom with 5 key informant groups: oncologists, oncology nurses, primary care physicians, pharmacists, and patients. All groups were video- and audio-recorded and transcribed verbatim. Focus group transcripts were analyzed using inductive content analysis, and open coding was performed by two coders. A codebook was generated based on the initial round of open coding and updated throughout the analytic process. Codes and themes were discussed for each transcript until consensus was reached. Emotion coding (identifying text segments expressing emotion, naming the emotion, and assigning a label of positive or negative) was performed by both coders to validate the open coding findings.

RESULTS

All groups agreed that polypharmacy is a significant problem. For clinicians, emotional barriers to deprescribing include fear of moral judgment from patients and colleagues, frustration toward patients, and feelings of incompetence. Oncologists and patients expressed ambivalence about deprescribing due to role expectations that physicians "heal with med[ication]s." Emotional facilitators of deprescribing included the involvement of pharmacists, who were perceived to be neutral, discerning experts. Pharmacists described emotionally aware communication strategies when discussing deprescribing with other clinicians and expressed increased awareness of patient context.

CONCLUSION

Deprescribing can elicit strong and predominantly negative emotions among clinicians and patients which could inhibit deprescribing interventions. The involvement of pharmacists in deprescribing interventions could mitigate these emotional barriers.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05046171 . Date of registration: September 16, 2021.

Development and feasibility of an exercise training program in primary care for patients with COPD experiencing an acute exacerbation

BACKGROUND

Starting rehabilitation soon after an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is crucial to diminish the detrimental effects of this acute event on muscle function. However, uptake in outpatient pulmonary rehabilitation is low.

OBJECTIVES

To design and test a feasible, acceptable and accessible exercise training program (ETP) in primary care for patients experiencing an AECOPD.

DESIGN

(1) A literature review and qualitative study to develop an ETP and (2) A feasibility study of the ETP implemented in primary care.

METHODS

(1) The development of the ETP proceeded in several phases with input from different stakeholders through focus group discussions. (2) Patients experiencing a moderate or severe AECOPD were included and followed the ETP for two weeks with a physiotherapist in primary care. Interviews with the participants took place and patients were given the choice to complete the eight-week program.

RESULTS

(1) Six discussion sessions took place. The ETP contained a flexible set of progressively more difficult exercises applicable in a primary care practice. (2) Eight patients experiencing a moderate (n = 1) or severe (n = 7) AECOPD were included. Patients started the first physiotherapy session 5 (2-6) days after the start of their symptoms or hospital discharge. Seven patients wanted to complete the ETP.

CONCLUSIONS

An ETP in primary care is feasible, acceptable and accessible for patients experiencing a moderate or severe AECOPD, and for physiotherapists. The effectiveness of this ETP on muscle function and physical activity is currently under investigation in a RCT. CONTRIBUTION OF THE PAPER.