1
|
Scanlon F, Morgan RD, Aceves D. Implementing a Treatment for People with Serious Mental Illness in Jail: A Mixed-Methods Study of Stakeholder Perspectives on Feasibility and Acceptability. Adm Policy Ment Health 2024:10.1007/s10488-024-01380-4. [PMID: 38662179 DOI: 10.1007/s10488-024-01380-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 04/26/2024]
Abstract
People with mental illness are over-represented in the U.S. criminal legal system. Jail presents an optimal opportunity to provide needed mental health care as the entry point to corrections. However, there is a lack of programming available in jails, which may be partly due to limited understanding of how to successfully implement interventions in this complex setting. We implemented a nine-session psychotherapeutic intervention for people with serious mental illness in a county jail. As part of a larger implementation-effectiveness hybrid study, we gathered mixed-methods data from stakeholders (treatment recipients and jail administrators) on the feasibility and acceptability of the intervention's implementation. In focus group discussions and qualitative interviews, treatment recipients (n = 29) provided qualitative and quantitative data on their perceptions of the implementation's feasibility and acceptability. Jail administrators (n = 6) completed two quantitative self-report measures on their perceptions of the treatment's feasibility and acceptability. Qualitative analyses were conducted by two coders using inductive thematic template analysis; seven global themes relating to treatment recipients' perceptions of the assets and hindrances to feasibility and acceptability were developed and are presented with supporting quotations. Quantitatively, all treatment recipients endorsed the intervention's feasibility (100%), and nearly all (97%) endorsed its acceptability. On both self-report measures, jail administrators' mean scores fell above a-priori thresholds indicating feasibility and acceptability. We found qualitative and quantitative support for the use of this intervention in jail from both sets of stakeholders. These results have implications for clinical service and policy in jail, where service providers struggle to meet the considerable demand for mental health services.
Collapse
|
2
|
Sasaki N, Shimazu T, Takeno H, Ogawa S, Sawada U, Tsutsumi A, Imamura K. Implementation of an internet-based stress management program in micro- and small-sized enterprises: a study protocol for a pre-post feasibility study of the effectiveness-implementation hybrid type 2 trial. Pilot Feasibility Stud 2024; 10:56. [PMID: 38581058 PMCID: PMC10996202 DOI: 10.1186/s40814-024-01481-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/12/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Although internet-based stress management programs are proven effective in improving mental health among workers, micro- and small-sized enterprises (MSEs), lacking in occupational healthcare services, face challenges implementing them. To address this gap, this study will develop the program with stakeholders at MSEs to aim for real-world implementation. OBJECTIVES This paper describes a study protocol for a pre-post feasibility study of an effectiveness-implementation hybrid type 2 trial of text-based internet-based programs ("WellBe-LINE") in MSEs with less than 50 employees. This feasibility study primarily aims to evaluate trial methods for future effectiveness-implementation hybrid type 2 trials. METHODS For this study protocol, an internet- and text-based self-care intervention program using the LINE app (a popular message tool in Japan) will be prepared according to evidence-based psychoeducational topics. Based on our online survey findings, personalized algorithms will be implemented according to employees' gender, age, and psychological distress levels. A personalized program using a popular pre-existing text app is expected to reduce employees' burdens and be attractive to them, resulting in successful implementation outcomes and mental health benefits. A pre-post design feasibility study will be conducted on ten companies to evaluate trial methods (e.g., recruitment and procedures). The primary outcome will involve individual-level penetration, defined as the proportion of the number of employees who register for the program divided by the total number of invited employees at the company. The progression criterion to go next trial specifies that more than 50% of the recruited companies obtain 60% individual penetration, which is set based on the findings of the prior survey of employees at MSEs and of interviews of stakeholders involved in this study, and will be measured by LINE system. Finally, acceptability, appropriateness, and feasibility will be measured using internet-based questionnaires and interviews. DISCUSSION This pre-post feasibility study for future effectiveness-implementation hybrid type 2 trials will provide in-depth knowledge about the successful implementation of text-based, semi-personalized, self-care mental health interventions in real-world settings using both quantitative and qualitative data. CONCLUSIONS This feasibility study will help validate the effectiveness of text-based interventions using a widely used social networking service (SNS) tool for employees in MSEs. TRIAL REGISTRATION UMIN clinical trial registration, UMIN000046960. Registered on February 21, 2022. https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000053570.
Collapse
Affiliation(s)
- Natsu Sasaki
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taichi Shimazu
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Hajime Takeno
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sayaka Ogawa
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Utako Sawada
- Department of Psychiatric Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akizumi Tsutsumi
- Department of Public Health, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kotaro Imamura
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
- Department of Digital Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
| |
Collapse
|
3
|
McGourty CA, Castillo F, Donzelli G, Keenan BP, Gilbreth M, Santhosh L. Creation of a sustainable longitudinal women in Leadership Development (WILD) curriculum focused on graduate medical education trainees. BMC Med Educ 2024; 24:374. [PMID: 38580971 PMCID: PMC10996076 DOI: 10.1186/s12909-024-05369-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 03/28/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Although women comprise the majority of medical students, gender disparities emerge early and remain at the highest levels of academia. Most leadership courses focus on faculty or students rather than women graduate medical education (GME) trainees. AIM To promote the leadership development of women GME trainees through empowerment, community building, networking and mentorship, and concrete leadership skills development. SETTING University of California, San Francisco. PARTICIPANTS 359 women residents and fellows from 41 specialties. PROGRAM DESCRIPTION A longitudinal curriculum of monthly workshops designed to support leadership development for women trainees. Sessions and learning objectives were designed via needs assessments and literature review. PROGRAM EVALUATION A mixed-methods evaluation was performed for 3 years of WILD programming. Quantitative surveys assessed participant satisfaction and fulfillment of learning objectives. Structured interview questions were asked in focus groups and analyzed qualitatively. DISCUSSION 23% of invited participants attended at least one session from 2018 to 2021, despite challenging trainee schedules. Surveys demonstrated acceptability and satisfaction of all sessions, and learning objectives were met at 100% of matched sessions. Focus groups highlighted positive impact in domains of community-building, leadership skills, mentorship, and empowerment. This program has demonstrated WILD's longitudinal sustainability and impact for women trainees.
Collapse
Affiliation(s)
- Colleen A McGourty
- University of California, San Francisco, 505 Parnassus Ave., 94143, San Francisco, CA, USA
| | - Francine Castillo
- University of California, San Francisco, 505 Parnassus Ave., 94143, San Francisco, CA, USA
| | - Grace Donzelli
- University of California, San Francisco, 505 Parnassus Ave., 94143, San Francisco, CA, USA
| | - Bridget P Keenan
- University of California, San Francisco, 505 Parnassus Ave., 94143, San Francisco, CA, USA
| | - Margaret Gilbreth
- University of California, San Francisco, 505 Parnassus Ave., 94143, San Francisco, CA, USA
| | - Lekshmi Santhosh
- University of California, San Francisco, 505 Parnassus Ave., 94143, San Francisco, CA, USA.
| |
Collapse
|
4
|
Ali M, Alsreaya A, Alqarzi A, Alzahrani Y, Alhomood I, Alruhaimi A, Hijri A, Mobarki A, Najie M, Mashyakhi M, Bajawi A. Exploring the effectiveness of pharmacy curriculum in Saudi Arabia in developing leadership skills among pharmacy students from their perspective: A mixed-methods study. Saudi Pharm J 2024; 32:101995. [PMID: 38405043 PMCID: PMC10891323 DOI: 10.1016/j.jsps.2024.101995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/14/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Leadership is an important component of pharmacy education. This study helps identify the strengths and limitations of the pharmacy curriculum in developing leadership skills among pharmacy students in Saudi Arabia and suggest how to improve the curriculum to better prepare them to become effective leaders in the healthcare profession. Methods This study employed a mixed-methods research design with a sequential exploratory design. Phase I involved semi-structured interviews with student leaders of pharmacy student clubs/societies from different universities in Saudi Arabia. Interviews were recorded and transcribed verbatim. The written transcriptions were analyzed using thematic analysis. Phase II used a survey questionnaire to collect data from a larger sample of pharmacy students and interns from different universities in Saudi Arabia and the data is mainly presented as frequencies and percentages. Results Eleven eligible participants were interviewed. Thematic analysis generated 288 codes which were categorized into 17 subthemes. These subthemes were further categorized into five overarching themes: Leadership development and acquisition; Skills and characteristics of effective leaders; Challenge and support for student leaders; Personal growth and benefits of leadership; Vision, goals and responsibilities of student leaders. The findings informed the development of the survey questionnaire which was completed by 484 students/interns. Mixed opinions were received regarding whether the pharmacy curriculum/program is helping or has helped the respondents develop leadership skills as well as whether the college has provided (or is providing) adequate support, resources or opportunities for the development of leadership skills. Eighty-eight per cent of the participants requested that the pharmacy curriculum in their college should include more courses or workshops focused on leadership development. They favoured several options from the listed topics to be included in these courses or workshops of which effective communication was the most prominent. Conclusion This study highlights that pharmacy curriculum/colleges in Saudi Arabia promote essential leadership skills through various pedagogical approaches and support mechanisms to some extent. However, the students identified that the pharmacy curriculum needs to be revised in order to better prepare them for leadership positions.
Collapse
Affiliation(s)
- Majid Ali
- Department of Basic Sciences, College of Medicine, Sulaiman Al-Rajhi University, Al-Bukayriyah, Saudi Arabia
| | - Aseel Alsreaya
- Pharmaceutical Care Administration, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia
| | - Abdulrahman Alqarzi
- Pharmaceutical Care Administration, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia
| | - Yazeed Alzahrani
- Pharmaceutical Care Administration, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia
| | - Ibrahim Alhomood
- Pharmaceutical Care Administration, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia
| | - Abdulaziz Alruhaimi
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulrahman Hijri
- Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Ahmed Mobarki
- Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Mohammed Najie
- Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Mohammed Mashyakhi
- Pharmaceutical Care Administration, Najran Armed Forces Hospital, Najran, Saudi Arabia
| | | |
Collapse
|
5
|
Sheinfil AZ, Firkey M, Bucci V, Gjoka M, Woolf-King SE. A Mixed-Methods Approach to Develop a Combined Model of U.S. College Student Alcohol-Associated Condomless Sex. Arch Sex Behav 2024; 53:1499-1518. [PMID: 38429569 DOI: 10.1007/s10508-024-02826-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/17/2024] [Accepted: 01/30/2024] [Indexed: 03/03/2024]
Abstract
Unhealthy alcohol use and sexually transmitted infections (STIs) are significant public health concerns for US college students. Because alcohol use and condomless sex often co-occur in this population, alcohol-associated condomless sex has been identified as a behavioral intervention target. Existing theoretical frameworks have not garnered sufficient empirical support to serve as the foundation for interventions. The primary goal of the current study was to use a mixed-methods approach to develop a model of college student alcohol-associated condomless sex that combines elements from well-established health behavior theories. In Aim 1, multilevel modeling was used to predict condomless vaginal sex in a sample of heterosexual college student drinkers (N = 53). Aim 2 consisted of in-depth interviews (n = 18) to gather perceptions about the role of alcohol in sexual activity and identify supplemental constructs omitted from theories in Aim 1. The multilevel model explained a significant proportion of variance in condomless vaginal sex at the between- and within-person level. Themes derived from the in-depth interviews identified complementary elements of condom use decision-making. Findings from both aims were synthesized to construct a combined model of alcohol-associated condomless sex. This model can be further refined and ultimately serve as the foundation of an alcohol-STI prevention-intervention.
Collapse
Affiliation(s)
- Alan Z Sheinfil
- Center of Innovation in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, 2450 Holcombe Blvd., Houston, TX, 77021, USA.
- Department of Veterans Affairs, South Central Mental Illness Research Education Clinical Center, Houston, TX, USA.
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
| | - Madison Firkey
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Veronica Bucci
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Mikaela Gjoka
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | | |
Collapse
|
6
|
Obeid N, Silva-Roy P, Booij L, Coelho JS, Dimitropoulos G, Katzman DK. The financial and social impacts of the COVID-19 pandemic on youth with eating disorders, their families, clinicians and the mental health system: a mixed methods cost analysis. J Eat Disord 2024; 12:43. [PMID: 38553730 PMCID: PMC10979568 DOI: 10.1186/s40337-024-00986-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/08/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND The onset of the COVID-19 pandemic has had an adverse impact on children, youth, and families with eating disorders (EDs). The COVID-19 pandemic exacerbated pre-existing personal and financial costs to youth, caregivers, and health professionals accessing or delivering ED services. The objectives of this mixed methods study were to (1) understand the indirect, direct medical and non-medical costs reported by youth, caregivers, and clinicians; (2) understand how the COVID-19 pandemic may have impacted these costs, and (3) explore implications of these costs with regards to barriers and resources to inform future decisions for the ED system of care. METHODS Youth (aged 16-25 years) with lived/living experience, primary caregivers, clinicians, and decision-makers were recruited with support from various partners across Canada to complete group specific surveys. A total of 117 participants responded to the survey. From those respondents, 21 individuals volunteered to further participate in either a discussion group or individual interview to provide additional insights on costs. RESULTS Youth and primary caregivers reported costs relating to private services, transportation and impacts of not attending school or work. Additionally, primary caregivers reported the top direct medical cost being special food or nutritional supplements (82.8%). In discussion groups, youth and caregivers elaborated further on the challenges with long waitlists and cancelled services, impact on siblings and effect on family dynamics. Clinicians and decision-makers reported increased work expectations (64.3%) and fear/isolation due to COVID-19 in the workplace (58.9%). Through discussion groups, clinicians expanded further on the toll these expectations took on their personal life. Approximately 1 in 3 health professionals reported contemplating leaving their position in 1-2 years, with greater than 60% of this group stating this is directly related to working during the pandemic. CONCLUSIONS Findings demonstrate the need for increased support for youth and caregivers when accessing ED services both during crisis and non-crisis times. Additionally, attention must be given to acknowledging the experience of health professionals to support better retention and resource management as they continue to navigate challenges in the health care system.
Collapse
Affiliation(s)
- Nicole Obeid
- Eating Disorders Research Lab, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada.
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.
| | - Patricia Silva-Roy
- Eating Disorders Research Lab, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Linda Booij
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Jennifer S Coelho
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, Vancouver, BC, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Gina Dimitropoulos
- Calgary Eating Disorder Program, Alberta Health Services, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Debra K Katzman
- Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
7
|
Razavinia F, Abedi P, Iravani M, Mohammadi E, Cheraghian B, Jahanfar S, Najafian M. The effect of a midwifery continuity of care program on clinical competence of midwifery students and delivery outcomes: a mixed-methods protocol. BMC Med Educ 2024; 24:338. [PMID: 38532384 PMCID: PMC10967075 DOI: 10.1186/s12909-024-05321-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 03/15/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND The midwifery continuity of care model is one of the care models that have not been evaluated well in some countries including Iran. We aimed to assess the effect of a program based on this model on the clinical competence of midwifery students and delivery outcomes in Ahvaz, Iran. METHODS This sequential embedded mixed-methods study will include a quantitative and a qualitative phase. In the first stage, based on the Iranian midwifery curriculum and review of seminal midwifery texts, a questionnaire will be developed to assess midwifery students' clinical competence. Then, in the second stage, the quantitative phase (randomized clinical trial) will be conducted to see the effect of continuity of care provided by students on maternal and neonatal outcomes. In the third stage, a qualitative study (conventional content analysis) will be carried out to investigate the students' and mothers' perception of continuity of care. Finally, the results of the quantitative and qualitative phases will be integrated. DISCUSSION According to the nature of the study, the findings of this research can be effectively used in providing conventional midwifery services in public centers and in midwifery education. TRIAL REGISTRATION This study was approved by the Ethics Committee of Ahvaz Jundishapur University of Medical Sciences (IR.AJUMS.REC.1401.460). Also, the study protocol was registered in the Iranian Registry for Randomized Controlled Trials (IRCT20221227056938N1).
Collapse
Affiliation(s)
- Fatemeh Razavinia
- Midwifery Department, Reproductive Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Midwifery Department, Menopause Andropause Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Parvin Abedi
- Midwifery Department, Menopause Andropause Research Center, Ahvaz Jundisahpur University of Medical Sciences, Golestan BLvd, Ahvaz, Iran.
| | - Mina Iravani
- Reproductive Health Promotion Research Center, Midwifery Department, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Eesa Mohammadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Bahman Cheraghian
- Alimentary Tract Research Center, Clinical Sciences Research Institute, Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shayesteh Jahanfar
- MPH Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, USA
| | - Mahin Najafian
- Department of Obstetrics and Gynecology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| |
Collapse
|
8
|
Merridale-Punter MS, Elias B, Wodajo AL, El-Hage CM, Zewdu H, Tesfaye R, Hailegebreal G, Sori T, Wiethoelter AK, Hitchens PL. Putting the cart before the horse: mixed-methods participatory investigation of working equid harnessing practices in three selected towns of the Oromia national regional state in Ethiopia. BMC Vet Res 2024; 20:113. [PMID: 38519893 PMCID: PMC10958837 DOI: 10.1186/s12917-024-03967-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/04/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Millions of working equids provide socio-economic support for many low-income communities worldwide. With the prevalence of harness-related wounds reported as higher than 60%, this study aims to describe the equipment used by working equids in three locations of the Ethiopian national regional state of Oromia (Fiche, Bishoftu and Shashamene), and the attitudes and practices of equid owners, users and harness makers regarding work equipment. This mixed-methods study consists of cross-sectional surveying of working equids used for taxi or transport of goods or water, as well as cart-driver questionnaires and focus groups (FG) with working equid stakeholders. Activities conducted with FG included participatory ranking of equipment attributes and equipment drawing exercises. Indicators of equipment design and assembly, as well as cart-driver attitudes and practices were described quantitatively. Associations between equipment characteristics and species, work-type and cart-driver indicators were investigated through univariable logistic regression models, whereas focus group discussions were transcribed and analysed thematically. RESULTS In total, 368 working equid surveys and cart-driver questionnaires were completed and 87 participants took part in nine FG. Equipment composition and characteristics differed considerably from ideal animal draught and harnessing principles described in the literature, with none of the observed harnesses adhering to all principles and thus not considered fully adequate. Various harness compositions were used, with only saddles and breast collars present in all. Donkey equipment had fewer components than that of horses, such as swingle trees (OR 0.02; 95% CI 0.01-0.06; p < 0.001) or girths (OR 0.09; 95%CI 0.02-0.4; p = 0.002). Horse equipment was more likely to have functional elements such as breeching (OR 7.8; 95% CI 2.9-20.9; p < 0.001). Of all equipment attributes, FG participants ranked cost, design and impact on animal wellbeing as having the highest importance. Thematic analysis identified motivations and priorities regarding equipment; awareness and knowledge of design and function; barriers to using ideal equipment; and consequences of equipment design and practices as key themes. CONCLUSIONS Various weaknesses of design, assembly and use of equid work equipment were identified. Promoting behavioural change through awareness and training could lead to a sustainable improvement of work equipment quality, access, and prevention of equipment-related problems.
Collapse
Affiliation(s)
| | - Belay Elias
- College of Veterinary Medicine and Agriculture, Addis Ababa University, P.O. Box 34, Bishoftu, Ethiopia
- Faculty of Veterinary Medicine, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
| | - Abel L Wodajo
- College of Veterinary Medicine and Agriculture, Addis Ababa University, P.O. Box 34, Bishoftu, Ethiopia
| | - Charles M El-Hage
- Melbourne Veterinary School, Faculty of Science, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Hanna Zewdu
- College of Veterinary Medicine and Agriculture, Addis Ababa University, P.O. Box 34, Bishoftu, Ethiopia
| | - Reta Tesfaye
- College of Veterinary Medicine and Agriculture, Addis Ababa University, P.O. Box 34, Bishoftu, Ethiopia
| | | | - Teshale Sori
- College of Veterinary Medicine and Agriculture, Addis Ababa University, P.O. Box 34, Bishoftu, Ethiopia
| | - Anke K Wiethoelter
- Melbourne Veterinary School, Faculty of Science, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Peta L Hitchens
- Equine Centre, Melbourne Veterinary School, University of Melbourne, 250 Princes Hwy, Werribee, VIC, 3030, Australia
| |
Collapse
|
9
|
Nicolaou SA, Televantou I, Papageorgiou A, Albert AP, Hitchings AW, McCrorie P, Nicolaou P. Factors affecting pharmacology learning in integrated PBL in diverse medical students: a mixed methods study. BMC Med Educ 2024; 24:324. [PMID: 38515169 PMCID: PMC10958917 DOI: 10.1186/s12909-024-05289-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/11/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Problem-based learning (PBL) was introduced to address passive teaching limitations. However, it is not fully characterised as a teaching modality in pharmacology. The present study investigated the factors affecting pharmacology learning in an integrated PBL-based curriculum in diverse learners. METHODS Year 1 undergraduate medical students from two cohorts at St. George's University of London and University of Nicosia, participated. Statistical analysis of pharmacology knowledge scores, at the beginning (pre-test) and end of the academic year (post-test), investigated readiness to benefit from PBL based on diverse student characteristics (educational background, age, gender, country of origin, ethnicity, native language, PBL experience). Focus groups/interviews and a survey investigated aspects of integrated PBL impacting learning in depth. RESULTS Pre- and post-test scores were positively correlated. Students with biomedical sciences degrees performed better at the pharmacology pre- and post-tests, while post-graduate degree holders performed better only at the pre-test. Effect size was of moderate magnitude. However, progress in learning (post-test performance after controlling for pre-test scores) was unaffected. Qualitative analysis revealed three major themes: 1) PBL as a learning environment; 2) PBL as a learning environment in pharmacology; and 3) PBL as a learning environment and confidence in prescribing. Under theme one, skill development, knowledge acquisition through collaboration and self-directed learning, group dynamics and preferred teaching methods were discussed. Under theme two, contextual learning, depth of knowledge and material correctness were raised. Under theme 3, students expressed variability in prescribing confidence. They perceived that learning could be improved by better integration, further references earlier on, more lectures and PBL facilitators with greater content expertise. The survey findings were consistent with those from focus groups/interviews. CONCLUSION Pharmacology learning in a PBL-based curriculum is facilitated by constructive, collaborative and contextual learning. While baseline pharmacology knowledge may be advantageous, the other aforementioned characteristics studied may not affect readiness to benefit from PBL. However, further instructional scaffolding is needed, for example through further resources, lectures and self-assessment. The results from our study can inform evidence-based curriculum reform to support student learning further. Addressing learning needs could ultimately contribute to reducing medication errors through effective training of future prescribers.
Collapse
Affiliation(s)
- S A Nicolaou
- University of Nicosia Research Foundation, Nicosia, Cyprus
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - I Televantou
- University of Nicosia Research Foundation, Nicosia, Cyprus
- Department of Educational Sciences, European University, Nicosia, Cyprus
| | - A Papageorgiou
- University of Nicosia Research Foundation, Nicosia, Cyprus
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - A P Albert
- Vascular Biology Section, Cardiovascular & Genetics Research Institute, St George's, University of London, London, UK
| | - A W Hitchings
- Institute of Medical, Biomedical and Allied Education, St George's, University of London, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - P McCrorie
- University of Nicosia Research Foundation, Nicosia, Cyprus
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, 2417, Nicosia, Cyprus
| | - Persoulla Nicolaou
- University of Nicosia Research Foundation, Nicosia, Cyprus.
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, 2417, Nicosia, Cyprus.
| |
Collapse
|
10
|
Chiang DF, Guerrero SA, Sexton EC, Gardner SS. Supporting underrepresented students in health sciences: a fuzzy cognitive mapping approach to program evaluation. BMC Med Educ 2024; 24:319. [PMID: 38509539 PMCID: PMC10956253 DOI: 10.1186/s12909-024-05292-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND The Students Training in Academia, Health, and Research (STAHR) Program at the University of Missouri-Kansas City (UMKC) strives to help students from low-income families that have experienced educational challenges due to poverty and prepare them to enter, persist, and graduate from a health sciences degree program at UMKC. Students in the program participated in fuzzy cognitive mapping (FCM) sessions to ensure that all voices of the program were heard to improve program implementation, and student success, and contribute to an equitable educational environment. METHODS Fuzzy Cognitive Mapping sessions for the 2020-2021 cohort of students (n = 52) were conducted to assess the strengths and weaknesses in program implementation, especially through the beginning of the COVID-19 pandemic. Students' maps were coded by a team of researchers and then confirmed using confirmatory factor analysis. RESULTS Statistical analyses reveal that mentorship, workshops, and social support helped students to work toward their goal of obtaining a professional health sciences degree, while a lack of time, remote learning, and outside stressors inhibited their opportunities for success. CONCLUSIONS The findings from a multipronged analysis of mapping data demonstrate the value of this innovative approach to the field, especially when looking to incorporate student voices.
Collapse
Affiliation(s)
- Danielle F Chiang
- The University of Missouri, Institute for Human Development, 5306 Holmes Street, Kansas City, MO, 64110, USA.
| | - Scott A Guerrero
- School of Medicine, The University of Missouri, 2411 Holmes Street, Kansas City, MO, 64108, USA
| | - Emma C Sexton
- Children's Mercy Hospital, 3101 Broadway Boulevard, Kansas City, MO, 64111, USA
| | - Stephen S Gardner
- The University of Missouri, Institute for Human Development, 5306 Holmes Street, Kansas City, MO, 64110, USA
| |
Collapse
|
11
|
Servais J, Vanhoutte B, Aguirre-Sánchez-Beato S, Aujoulat I, Kraus C, T'Sjoen G, Tricas-Sauras S, Godin I. Integrating perspectives of transgender and gender-diverse youth, family members, and professionals to support their health and wellbeing - a mixed-method study protocol. Arch Public Health 2024; 82:40. [PMID: 38500212 PMCID: PMC10949725 DOI: 10.1186/s13690-024-01270-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 03/11/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND The current literature highlights a strong link between the poor health outcomes of transgender and gender diverse (TGD) individuals and their negative experiences in various areas of life. Most of these publications rely on adults' memories, lacking a focus on the current experiences and needs of young transgender and gender-diverse individuals. Furthermore, previous studies on support for these young people often solely consider the perspectives of TGD adults or professionals and rarely involve parents' viewpoints. METHODS This study will use a mixed sequential method with a participatory approach. Firstly, the qualitative phase will explore the difficulties and needs of TGD (15-20 years old) and of the families and professionals who support them. Results from this part will be used to develop the questionnaire for the quantitative phase, with the help of a community board. Secondly, based on participatory epidemiological research, the quantitative phase will use an intersectional perspective to measure the impact of individual and structural factors on the quality of life and well-being of transgender and gender-diverse young people. Finally, a co-creation phase will be undertaken to formulate recommendations based on the results of the first two phases. DISCUSSION This research aims at better understanding the influence of gender identity on the quality of life and health of TGD young people and their families and to identify protective and risk factors that affect their vulnerabilities. ETHICS AND DISSEMINATION This study has been approved by the Ethics Committee of the Erasme Faculty Hospital (CCB B4062023000140). As this research is participatory and part of a PhD dissertation, we aim to disseminate the results through our partners' networks and structures locally, and internationally through conferences and peer-reviewed journals.
Collapse
Affiliation(s)
- Julie Servais
- School of Public Health, Université Libre de Bruxelles, CP 596, Route de Lennik, 808, Brussels, 1070, Belgium.
| | - Bram Vanhoutte
- School of Public Health, Université Libre de Bruxelles, CP 596, Route de Lennik, 808, Brussels, 1070, Belgium
| | - Sara Aguirre-Sánchez-Beato
- Faculty of Psychology and Education, Université Libre de Bruxelles, CP 122, Avenue F.D. Roosevelt, 50, Brussels, 1050, Belgium
| | - Isabelle Aujoulat
- Health and Society Research Institute - UCLouvain, Clos Chapelle-Aux-Champs 30/B1.30.15, Woluwe-Saint-Lambert, 1200, Belgium
| | - Cynthia Kraus
- Faculty of Social and Political Sciences - UNIL, CH-1015, Lausanne, Switzerland
| | - Guy T'Sjoen
- Faculty of Medicine and Health Sciences, Ghent University Hospital, C. Heymanslaan 10, Ghent, 9000, Belgium
| | - Sandra Tricas-Sauras
- School of Public Health, Université Libre de Bruxelles, CP 596, Route de Lennik, 808, Brussels, 1070, Belgium
| | - Isabelle Godin
- School of Public Health, Université Libre de Bruxelles, CP 596, Route de Lennik, 808, Brussels, 1070, Belgium
| |
Collapse
|
12
|
MacKenzie NE, Chambers CT, Cassidy CE, Corkum PV, McGrady ME, Parker JA, Birnie KA. Understanding the unique and common perspectives of partners engaged in knowledge mobilization activities within pediatric pain management: a mixed methods study. BMC Health Serv Res 2024; 24:337. [PMID: 38486223 PMCID: PMC10938714 DOI: 10.1186/s12913-024-10782-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 02/25/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Knowledge mobilization (KM) is essential to close the longstanding evidence to practice gap in pediatric pain management. Engaging various partners (i.e., those with expertise in a given topic area) in KM is best practice; however, little is known about how different partners engage and collaborate on KM activities. This mixed-methods study aimed to understand what different KM partner groups (i.e., health professionals, researchers, and patient/caregiver partners) perceive as supporting KM activities within pediatric pain management. METHODS This study used a convergent mixed-methods design. Ten partners from each of the three groups participated in interviews informed by the Consolidated Framework for Implementation Research, where they discussed what impacted KM activities within pediatric pain. Participants then rated and ranked select factors discussed in the interview. Transcripts were analyzed within each group using reflexive thematic analysis. Group-specific themes were then triangulated to identify convergence and divergence among groups. A matrix analysis was then conducted to generate meta-themes to describe overarching concepts. Quantitative data were analyzed using descriptive statistics. RESULTS Unique themes were developed within each partner group and further analysis generated four meta-themes: (1) team dynamics; (2) role of leadership; (3) policy influence; (4) social influence. There was full agreement among groups on the meaning of team dynamics. While there was partial agreement on the role of leadership, groups differed on who they described as taking on leadership positions. There was also partial agreement on policy influence, where health professionals and researchers described different institutions as being responsible for providing funding support. Finally, there was partial agreement on social influence, where the role of networks was seen as serving distinct purposes to support KM. Quantitative analyses indicated that partner groups shared similar priorities (e.g., team relationships, communication quality) when it came to supporting KM in pediatric pain. CONCLUSIONS While partners share many needs in common, there is also nuance in how they wish to be engaged in KM activities as well as the contexts in which they work. Strategies must be introduced to address these nuances to promote effective engagement in KM to increase the impact of evidence in pediatric pain.
Collapse
Affiliation(s)
- Nicole E MacKenzie
- Department of Psychology and Neuroscience, Dalhousie University, Life Sciences Centre, 1355 Oxford Street, Halifax, NS, B3H4J1, Canada.
- Centre for Pediatric Pain Research, IWK Health, Halifax, NS, Canada.
| | - Christine T Chambers
- Department of Psychology and Neuroscience, Dalhousie University, Life Sciences Centre, 1355 Oxford Street, Halifax, NS, B3H4J1, Canada
- Centre for Pediatric Pain Research, IWK Health, Halifax, NS, Canada
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
- Solutions for Kids in Pain, Halifax, NS, Canada
| | | | - Penny V Corkum
- Department of Psychology and Neuroscience, Dalhousie University, Life Sciences Centre, 1355 Oxford Street, Halifax, NS, B3H4J1, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Department of Pediatrics, IWK Health, Halifax, NS, Canada
| | - Meghan E McGrady
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Kathryn A Birnie
- Department of Psychology and Neuroscience, Dalhousie University, Life Sciences Centre, 1355 Oxford Street, Halifax, NS, B3H4J1, Canada
- Solutions for Kids in Pain, Halifax, NS, Canada
- Department of Anesthesiology, Perioperative, and Pain Medicine, and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
13
|
Stige SH, Torrissen MH, Danielsen YS, Jakobsen R, Morken KTE, Dundas I. Training students to become responsive therapists: implications from a sequential mixed-methods study on situations that therapists find challenging. BMC Med Educ 2024; 24:261. [PMID: 38459480 PMCID: PMC10924412 DOI: 10.1186/s12909-024-05236-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/27/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE To draw implications for training of therapist responsiveness from a sequential mixed-methods study on challenging clinical situations. METHOD Study 1: online survey mapping frequency and perceived difficulty of 15 clinical situations in a representative sample of psychologists. Study 2: online survey mapping frequency and perceived difficulty of 19 clinical situations among therapists in child and adolescent psychiatry. Study 3: focus group study exploring the situations identified through study 1 and 2. RESULTS Study 1 and 2 showed that ratings of each situation varied between individuals and context. Study 3 showed that the degree to which a situation was challenging was described as depending on the characteristics of the therapist and the context. Experientially, challenging situations were characterized by lacking access to necessary information, falling short, and disturbing arousal. Perceiving therapeutic opportunities despite the challenging nature of the situation, collegial support, self-knowledge, and engagement were important resources. CONCLUSION Six implications of the results from the three studies for training of responsiveness are discussed: (1) building self-awareness and conceptualization skills; (2) personalizing training; (3) transforming disturbing arousal into engagement; (4) being exposed to a broad range of clinical situations; (5) training on commonly encountered situations; and (6) building tolerance for uncertainty and capacity to seek support.
Collapse
Affiliation(s)
- Signe Hjelen Stige
- Department of clinical psychology, University of Bergen, Bergen, Norway.
| | | | | | - Reidar Jakobsen
- Department of clinical psychology, University of Bergen, Bergen, Norway
| | - Katharina Teresa Enehaug Morken
- Department of clinical psychology, University of Bergen, Bergen, Norway
- Department of addiction medicine, Haukeland university hospital, Bergen, Norway
| | - Ingrid Dundas
- Department of clinical psychology, University of Bergen, Bergen, Norway
| |
Collapse
|
14
|
Portegijs S, van Beek APA, van Tuyl LHD, Wagner C. Implementing a new living concept for persons with dementia in long-term care: evaluation of a quality improvement process. BMC Health Serv Res 2024; 24:306. [PMID: 38454437 PMCID: PMC10921681 DOI: 10.1186/s12913-024-10765-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 02/21/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Improving quality of nursing home care for residents is a constant focus of stakeholders involved within quality improvement projects. Though, achieving change in long-term care is challenging. Process evaluations provide insight into the nature, exposure and experiences of stakeholders and influencing mechanisms for implementation. The aim of this study is to gain insight into the process and facilitating and hindering mechanisms of implementing a quality improvement project that seeks to create a dementia-friendly community with a nursing home at its core. METHODS For the process evaluation we planned a case study design with an ethnographic approach. Various research methods were used: qualitative observations, focus groups, interviews and questionnaires for various stakeholders and document review. Data collection and analyses in this study is based on the Consolidated Framework for Implementation Research. RESULTS Four main lessons were learned. Firstly, nursing staff are crucial to achieve more freedom for residents. Secondly, high-impact changes in daily care need strong and sustainable focus from the care organisation. Thirdly, dementia-friendly societies should be deployed from multiple actors, which entails long-term collaborations with external stakeholders. Fourthly, the transition to a dementia-friendly society requires meeting spaces for and a focus on both residents and people from the community. Consequently, local residents are shifting from external to internal stakeholders, extending beyond the regular involvement of informal carers and volunteers within the nursing home. CONCLUSIONS Nursing homes are part of the local community and provide opportunities to collaborate on a dementia-friendly society. However, the change that is required (promoting freedom, residents' autonomy and the redesign of care processes) is complex and influenced by various mechanisms. Understanding these mechanisms can benefit other care organisations that strive to implement a similar initiative.
Collapse
Affiliation(s)
- Suzanne Portegijs
- Netherlands Institute for Health Services Research (Nivel), PO Box 1568, 3513 CR, Utrecht, The Netherlands.
- Viva! Zorggroep, Care Organisation, Parlevinkerstraat 23, 1951 AR, Velsen-Noord, The Netherlands.
| | | | | | - Cordula Wagner
- Netherlands Institute for Health Services Research (Nivel), PO Box 1568, 3513 CR, Utrecht, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute (APH), Amsterdam UMC, Vrije Universiteit Amsterdam, Van Der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| |
Collapse
|
15
|
Hoekstra F, Gainforth HL, Broeksteeg R, Corras S, Collins D, Eleftheriadou E, Gaudet S, Giroux EE, Kuipers LS, McCallum S, Ma JK, de Passillé E, Rakiecki D, Rockall S, van den Berg-Emons R, van Vilsteren A, Williamson M, Wilroy J, Martin Ginis KA. The co-development and evaluation of an e-learning course on spinal cord injury physical activity counselling: a randomized controlled trial. BMC Med Educ 2024; 24:240. [PMID: 38448881 PMCID: PMC10916033 DOI: 10.1186/s12909-024-05141-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/06/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Health, fitness and lifestyle professionals can play important roles in promoting physical activity in groups at risk of developing an inactive lifestyle, such as people with spinal cord injury (SCI). Tailored counselling is a promising tool to promote and improve physical activity levels. To support professionals to effectively have a conversation about physical activity with clients with SCI, evidence-based training and resources are needed. This project aimed to (1) co-develop an e-learning course on best practices for SCI physical activity counselling and, (2) examine the effectiveness and usability of this course. METHODS Guided by the technology-enhanced learning (TEL) evaluation framework, we used a systematic, multistep approach to co-develop and evaluate an e-learning course. The development process was informed by input and feedback from a diverse group of end-users and experts (n > 160) via online surveys and (think-aloud) interviews. A randomized controlled trial was used to compare learning outcomes (post-knowledge and self-efficacy) between participants who completed the course (intervention group) and the wait-listed control group. Usability, learning experiences, and satisfaction were assessed among all participants. RESULTS Forty-one participants (21 intervention-group; 20 control-group) with various backgrounds (e.g., lifestyle counsellors, physiotherapists, occupational therapists, recreation therapists, fitness trainers) enrolled in the randomized controlled trial. After completing the course, participants in the intervention group showed significantly improved knowledge on the best practices for SCI physical activity counselling and higher self-efficacy for using these best practices in conversations with clients with SCI compared to the control group (p <.001). Participants reported above average usability scores, positive learning experiences, and high levels of satisfaction when completing the course. CONCLUSION We used a systematic, multi-step, theory-informed approach to co-develop and evaluate an evidence-based e-learning course on SCI physical activity counselling to support professionals to promote physical activity in their daily practices. The overall positive findings demonstrate that the e-learning course is feasible and ready for further implementation in various health and community settings. Implementation of the e-learning course can help professionals improve the physical activity support they provide to their clients, and subsequently increase physical activity participation in people with SCI.
Collapse
Affiliation(s)
- Femke Hoekstra
- School of Health and Exercise Sciences, The University of British Columbia, Kelowna, BC, Canada.
- International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, BC, Canada.
| | - Heather L Gainforth
- School of Health and Exercise Sciences, The University of British Columbia, Kelowna, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, BC, Canada
| | | | - Stephanie Corras
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Delaney Collins
- School of Occupational Therapy, Dalhousie University, Halifax, NS, Canada
| | - Electra Eleftheriadou
- Centre for Teaching and Learning, The University of British Columbia, Kelowna, BC, Canada
| | - Sonja Gaudet
- Spinal Cord Injury British Columbia, Vancouver, BC, Canada
- The Thompson Okanagan Tourism Association, Vernon, BC, Canada
| | - Emily E Giroux
- School of Health and Exercise Sciences, The University of British Columbia, Kelowna, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, BC, Canada
| | | | - Shannon McCallum
- Therapeutic Recreation Program, St. Lawrence College, Kingston, ON, Canada
| | - Jasmin K Ma
- International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, BC, Canada
- Arthritis Research Canada, Vancouver, BC, Canada
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Erica de Passillé
- Horizon Health Network, Stan Cassidy Centre for Rehabilitation, Fredericton, NB, Canada
| | - Diane Rakiecki
- School of Health and Exercise Sciences, The University of British Columbia, Kelowna, BC, Canada
| | - Shannon Rockall
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
- Access Community Therapists, Vancouver, BC, Canada
| | - Rita van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | | | - Jereme Wilroy
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kathleen A Martin Ginis
- School of Health and Exercise Sciences, The University of British Columbia, Kelowna, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, BC, Canada
- Department of Medicine, Division of Physical Medicine & Rehabilitation, The University of British Columbia, Vancouver, BC, Canada
- Centre for Chronic Disease Prevention and Management, The University of British Columbia, Kelowna, BC, Canada
| |
Collapse
|
16
|
Koku EF, Johnson-Yengbeh N, Muhr A. Addressing COVID-19 Vaccine Hesitancy and Uptake Among African Immigrants: Lessons from a Community-Based Outreach Program. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01947-9. [PMID: 38443740 DOI: 10.1007/s40615-024-01947-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/07/2024] [Accepted: 02/13/2024] [Indexed: 03/07/2024]
Abstract
In 2021, the African Cultural Alliance of North America (ACANA) implemented a community-based vaccine education and outreach program to decrease hesitancy and increase COVID-19 vaccine uptake among African immigrants in Philadelphia. The program had three components: (1) tailored messaging on the benefits of vaccines by trusted community health navigators in familiar languages/dialects, (2) use of educational/tabling events, and (3) establishment of a vaccine clinic in community settings. Using secondary data analysis, in-depth interviews, focus group discussions and a self-administered survey, we explored (i) the impact and effectiveness of the outreach program and extent of vaccine uptake, (ii) African immigrants' beliefs about the COVID-19 pandemic and the vaccine, and (iii) barriers and facilitators of vaccine knowledge, uptake, and hesitancy. Our analysis showed that ACANA's outreach program was effective in addressing several cultural, logistic, and systematic barriers to vaccine uptake. The program distributed 2000 educational/informational flyers, reached 3000 community members via social media campaigns, and an additional 2320 through other person-to-person outreach events. The program was effective and resulted in the vaccination of 1265 community members over the course of the outreach. The impact of this outreach underscores the critical role of community-based organizations in addressing COVID-19 vaccine hesitancy and increasing vaccine uptake in underserved and minority communities. The paper concludes with suggestions and recommendations for using community-based outreach programs to increase COVID-19 vaccine uptake and decrease hesitancy.
Collapse
Affiliation(s)
- Emmanuel F Koku
- Department of Sociology, Drexel University, 3201 Arch Street, Room 288, Philadelphia, PA, 19104, USA.
| | - Nettie Johnson-Yengbeh
- Health Department, African Cultural Alliance of North America (ACANA), 5530 Chester Ave, Philadelphia, PA, 19143, USA
| | - Ava Muhr
- Health Department, African Cultural Alliance of North America (ACANA), 5530 Chester Ave, Philadelphia, PA, 19143, USA
- School of Social and Political Science, University of Edinburgh, 15a George Square, EH8 9LD, Edinburgh, UK
| |
Collapse
|
17
|
Tian X, Zheng X, Peng Y, Zhou X, Huang B, Xie Y, Xiao W. The effects of hospice care education on first-year undergraduate nursing students in mainland China: A mixed-methods study. Nurse Educ Today 2024; 134:106095. [PMID: 38266431 DOI: 10.1016/j.nedt.2024.106095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/18/2023] [Accepted: 01/14/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND With the rising number of people with end-stage chronic diseases, the demand for hospice care has increased dramatically. As the future health professionals for the implementation of hospice care, undergraduate nursing students in mainland China still lack knowledge and skills of hospice care, thus hospice care education plays a vital role in its development. OBJECTIVES To understand the effects of hospice care education on nursing students' death attitudes, end-of-life attitudes, humanistic care qualities, and their learning experiences. DESIGN This study used a mixed-methods design. SETTING A University of Chinese Medicine in mainland China. PARTICIPANTS The first-year undergraduate nursing students (n = 65). METHODS A mixed-methods study was conducted to evaluate the impact of a hospice care course from March to June 2021. The quantitative part included a quasi-experimental study designed with pre- and post-intervention measurements and the qualitative part included a descriptive qualitative study with semi-structured individual interviews. RESULTS The quantitative data revealed that after the course, nursing students experienced improvements in their death attitudes, end-of-life attitudes, and humanistic care qualities. Two categories were identified from the qualitative data. The category of "Gain from learning" included 4 themes (Confronting death and thinking about life; Understanding and agreeing with the idea of hospice care; Perceiving the humanistic spirit of medicine; Enhancing of the nursing discipline cognition and professional identity) and the category of "Course feedback" included 2 themes (Expressing recognition for the course arrangement; Making suggestions on the course optimization). CONCLUSIONS Hospice care education had a positive influence on nursing students. Students expressed satisfaction with the course arrangement. However, future hospice care courses should further optimize the curriculum designs by increasing the discussion of death-related topics, sharing more real clinical cases, recruiting students from different majors, and providing clinical practice, to provide high-quality nursing education for the development of hospice care.
Collapse
Affiliation(s)
- Xia Tian
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong, PR China
| | - Xiaoting Zheng
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong, PR China
| | - Yunyi Peng
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong, PR China
| | - Xiaojun Zhou
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong, PR China
| | - Baoxin Huang
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong, PR China
| | - Yaqian Xie
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong, PR China
| | - Wenli Xiao
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong, PR China.
| |
Collapse
|
18
|
Palmer Kelly E, Rush LJ, Eramo JL, Melnyk HL, Tarver WL, Waterman BL, Gustin J, Pawlik TM. Gaps in Patient-Centered Decision-Making Related to Complex Surgery: A Mixed-Methods Study. J Surg Res 2024; 295:740-745. [PMID: 38142577 DOI: 10.1016/j.jss.2023.11.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION We sought to understand the perceptions of surgeons around patient preferred roles in decision-making and their approaches to patient-centered decision-making (PCDM). METHODS A concurrent embedded mixed-methods design was utilized among a cohort of surgeons performing complex surgical procedures. Data were collected through online surveys. Associations between perceptions and PCDM approaches were examined. RESULTS Among 241 participants, most respondents were male (67.2%) with an average age of 47.6 y (standard deviation = 10.3); roughly half (52.4%) had practiced medicine for 10 or more years. Surgeons most frequently agreed (94.2%) with the statement, "Patients prefer to make health decisions on their own after seriously considering their physician's opinion." Conversely, surgeons most frequently disagreed (73.0%) with the statement, "Patients prefer that their physician make health decisions for them." Nearly one-third (30.4%) of surgeon qualitative responses (n = 115) indicated that clinical/biological information would help them tailor their approach to PCDM. Only 12.2% of respondents indicated that they assess patient preferences regarding both decision-making and information needs. CONCLUSIONS Surgeons most frequently agree that patients want to make their own health decisions after seriously considering their physicians opinion. A greater focus on what information surgeons should know before treatment decision-making may help optimize patient experience and outcomes related to complex surgical procedures.
Collapse
Affiliation(s)
| | - Laura J Rush
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Jennifer L Eramo
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Halia L Melnyk
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Willi L Tarver
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio; Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Brittany L Waterman
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jillian Gustin
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| |
Collapse
|
19
|
Adeyemi O, Walker L, Bermudez E, Cuthel AM, Zhao N, Siman N, Goldfeld K, Brody AA, Bouillon-Minois JB, DiMaggio C, Chodosh J, Grudzen CR. Emergency Nurses' Perceived Barriers and Solutions to Engaging Patients With Life-Limiting Illnesses in Serious Illness Conversations: A United States Multicenter Mixed-Method Analysis. J Emerg Nurs 2024; 50:225-242. [PMID: 37966418 PMCID: PMC10939973 DOI: 10.1016/j.jen.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 07/27/2023] [Accepted: 09/06/2023] [Indexed: 11/16/2023]
Abstract
INTRODUCTION This study aimed to assess emergency nurses' perceived barriers toward engaging patients in serious illness conversations. METHODS Using a mixed-method (quant + QUAL) convergent design, we pooled data on the emergency nurses who underwent the End-of-Life Nursing Education Consortium training across 33 emergency departments. Data were extracted from the End-of-Life Nursing Education Consortium post-training questionnaire, comprising a 5-item survey and 1 open-ended question. Our quantitative analysis employed a cross-sectional design to assess the proportion of emergency nurses who report that they will encounter barriers in engaging seriously ill patients in serious illness conversations in the emergency department. Our qualitative analysis used conceptual content analysis to generate themes and meaning units of the perceived barriers and possible solutions toward having serious illness conversations in the emergency department. RESULTS A total of 2176 emergency nurses responded to the survey. Results from the quantitative analysis showed that 1473 (67.7%) emergency nurses reported that they will encounter barriers while engaging in serious illness conversations. Three thematic barriers-human factors, time constraints, and challenges in the emergency department work environment-emerged from the content analysis. Some of the subthemes included the perceived difficulty of serious illness conversations, delay in daily throughput, and lack of privacy in the emergency department. The potential solutions extracted included the need for continued training, the provision of dedicated emergency nurses to handle serious illness conversations, and the creation of dedicated spaces for serious illness conversations. DISCUSSION Emergency nurses may encounter barriers while engaging in serious illness conversations. Institutional-level policies may be required in creating a palliative care-friendly emergency department work environment.
Collapse
Affiliation(s)
- Oluwaseun Adeyemi
- New York University Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New York, USA
| | | | | | - Allison M. Cuthel
- New York University Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New York, USA
| | - Nicole Zhao
- New York University Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New York, USA
- Renaissance School of Medicine, Stony Brook University, Stony Brook NY
| | - Nina Siman
- New York University Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New York, USA
| | - Keith Goldfeld
- New York University Grossman School of Medicine, Department of Population Health, New York, New York, USA
| | - Abraham A. Brody
- New York University Rory Meyers College of Nursing, New York, NY, USA; Hartford Institute for Geriatric Nursing, New York, NY, USA; Division of Geriatric Medicine and Palliative Care, Department of Internal Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Jean-Baptiste Bouillon-Minois
- New York University Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New York, USA
- Emergency Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Charles DiMaggio
- New York University Grossman School of Medicine, Department of Surgery, New York, New York, USA
| | - Joshua Chodosh
- New York University Grossman School of Medicine, Department of Population Health, New York, New York, USA
- New York University Grossman School of Medicine, Department of Medicine, New York, New York, USA
| | - Corita R. Grudzen
- New York University Grossman School of Medicine, Department of Surgery, New York, New York, USA
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | |
Collapse
|
20
|
Koponen L, Magnusson M, Ernberg E. Swedish interpreters' views and experiences of interpreting child forensic interviews. Child Abuse Negl 2024; 149:106605. [PMID: 38171217 DOI: 10.1016/j.chiabu.2023.106605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Child forensic interviewers have expressed concerns regarding the quality of interpreter-mediated child forensic interviews. However, research on interpreters' perspectives on these interviews is scarce and specialized education for interpreters limited. OBJECTIVE This mixed-methods study aimed to explore interpreters' experiences and knowledge of interpreting child forensic interviews. PARTICIPANTS AND SETTING A total of 130 Swedish interpreters with different authorization statuses responded to a digital survey about interpreting child forensic interviews. METHODS Qualitative data were analyzed with reflexive thematic analysis and content analysis, and quantitative data with descriptive and inferential statistics. RESULTS Interpreters reported challenges concerning children's limited language skills, the emotional effects of interpreting child forensic interviews, the limited access to information before interviews, and the complex balance between following interpreters' ethical guidelines and adjusting for situational demands. Regarding practical conditions, interpreters preferred interpreting in person instead of via telephone. Interpreters' general knowledge of child forensic interviewing did not differ between interpreters with different authorization statuses (F(2,108) = 0.80, ω2 = -0.002, p = .45), except from views on using leading questions (H(2) = 17.34, η2 = 0.14, p < .001) and whether interpreters may clarify terms to child interviewees (H(2) = 8.02, η2 = 0.06, p = .02). CONCLUSIONS It is crucial to consider interpreters' perspectives when striving to improve the quality of interpreter-mediated child forensic interviews. Interpreters should be provided sufficient information to prepare and assess their suitability. Interpreters should also be offered education in interpreting child forensic interviews and given appropriate service structures to support their wellbeing.
Collapse
Affiliation(s)
- Linnea Koponen
- Department of Psychology, University of Gothenburg, Box 500, 40530 Gothenburg, Sweden.
| | - Mikaela Magnusson
- Department of Psychology, University of Gothenburg, Box 500, 40530 Gothenburg, Sweden
| | - Emelie Ernberg
- Department of Psychology, University of Gothenburg, Box 500, 40530 Gothenburg, Sweden
| |
Collapse
|
21
|
Coelho J, Oliveira T, Neves C, Karatzas S. Adoption of digital twins as a sustainable energy solution: Determinants to adoption in household. Heliyon 2024; 10:e25782. [PMID: 38375314 PMCID: PMC10875425 DOI: 10.1016/j.heliyon.2024.e25782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 02/21/2024] Open
Abstract
Digital Twin (DT) consists of a recent technology that can enable sustainability. However, Digital Twins are still in early stages of adoption, especially in households, and so the determinants to this adoption have not yet been determined. The aim of this study is to fill this research gap through providing a conceptual model of the drivers to the adoption of Digital Twins in households and it's relation to well-being. This study is developed as a mixed-methods research. The model is produced qualitatively, based on literature discoveries and key findings from interviews with experts and possible consumers. Afterwards, the model was validated with data collected through a questionnaire with 149 respondents. Results show that a set of informational, social, environmental and utility factors can influence the intention to adopt Digital Twins as a sustainable energy solution, and consequently the perceived well-being.
Collapse
Affiliation(s)
- Joana Coelho
- NOVA Information Management School (NOVA IMS), Universidade Nova de Lisboa, Campus de Campolide, 1070-312, Lisboa, Portugal
| | - Tiago Oliveira
- NOVA Information Management School (NOVA IMS), Universidade Nova de Lisboa, Campus de Campolide, 1070-312, Lisboa, Portugal
| | - Catarina Neves
- NOVA Information Management School (NOVA IMS), Universidade Nova de Lisboa, Campus de Campolide, 1070-312, Lisboa, Portugal
| | | |
Collapse
|
22
|
Balt E, Mérelle S, Popma A, Creemers D, Heesen K, van Eijk N, van den Brand I, Gilissen R. Sociodemographic and psychosocial risk factors of railway suicide a mixed-methods study combining data of all suicide decedents in the Netherlands with data from a psychosocial autopsy study. BMC Public Health 2024; 24:607. [PMID: 38408949 PMCID: PMC10895750 DOI: 10.1186/s12889-024-18120-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/15/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Railway suicide has profound implications for the victims and their family, and affects train drivers, railway personnel, emergency services and witnesses. To inform a multilevel prevention strategy, more knowledge is required about psychosocial and precipitating risk factors of railway suicide. METHODS Data from Statistics Netherlands of all suicides between 2017 and 2021 (n = 9.241) of whom 986 died by railway suicide and interview data from a psychosocial autopsy of railway suicide decedents (n = 39) were integrated. We performed logistic regression analyses to identify sociodemographic predictors of railway suicide compared to other methods of suicide. The Constant Comparative Method was subsequently employed on interview data from the psychosocial autopsy to identify patterns in psychosocial risk factors for railway suicide. RESULTS The strongest predictors of railway suicide compared to other suicide methods were young age (< 30 years old), native Dutch, a high educational level, living in a multi-person household (especially living with parents or in an institution), living in a rural area and a high annual household income of > 150.000 euros. Several subgroups emerged in the psychosocial autopsy interviews, which specifically reflect populations at risk of railway suicide. These subgroups were [1] young adult males with autism spectrum disorder who strived for more autonomy and an independent life, [2] young adult females with persistent suicidal thoughts and behaviours, [3] middle-aged males with a persistent mood disorder who lived with family and who faced stressors proximal to the suicide in personal and professional settings, [4] male out-of-the-blue suicides and [5] persons with psychotic symptoms and a rapid deterioration. CONCLUSIONS based on our findings we propose and discuss several recommendations to prevent railway suicide. We must continue to invest in a safe railway environment by training personnel and installing barriers. Additionally, we should adopt prevention strategies that align the needs of subgroups at increased risk, including young females who have attempted other methods of suicide and young males with autism spectrum disorder. Future research should determine the cost-effectiveness and feasibility of low-maintenance, automated interventions near crossings and psychiatric facilities.
Collapse
Affiliation(s)
- Elias Balt
- 113 Suicide Prevention, Amsterdam, Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Alnasser A, Abaalkhail A. Digital food behaviours, motivations, and delivery application usage among saudis during COVID-19: A mixed-methods study. Heliyon 2024; 10:e24903. [PMID: 38317926 PMCID: PMC10840008 DOI: 10.1016/j.heliyon.2024.e24903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 02/07/2024] Open
Abstract
Food delivery apps (FDAs) and smartphones in Saudi Arabia have become ubiquitous and increasingly popular methods for food ordering and consumption. Such app use during the COVID-19 pandemic has become a convenient and popular response to pandemic restrictions. However, the motivations and preferences behind FDA use are complex, as are the perceptions of FDA users regarding nutrition and healthy foods. To explore FDA usage, motivations, perceptions, and food behaviours in the unique cultural context of Saudi Arabia at the intersection of two epidemics, COVID-19 and obesity, a convergent parallel mixed-methods study design was used with 566 Saudis in the quantitative phase and 17 continuing to the qualitative phase. Of the respondents, 71.9 % reported using FDA typically once a week. Frequent FDA usage was reported by 33.3 % of the participants aged 30-40 years (P = .049). Nearly two-thirds of the sample (62 %) reported that time and convenience were the driving factors in using FDAs. Qualitatively, six main themes were identified: 'Perceived benefits and drawbacks', 'Effects of Promotions and Food Preferences', 'Nutritional information and dietary guidelines', 'Concepts of healthy food', 'Obstacles to healthy food consumption', and 'Maintaining Customs and Traditions'. Although convenience and taste were the primary drivers of FDA usage, the roles of tradition and culture in Saudi Arabia were also important FDA usage factors. Overall, understanding the determinants of how Saudis engage with FDAs, in concert with a deeper understanding of food preferences, perceptions, and nutritional knowledge, should help guide future efforts in nutrition education, app development, and public health policy.
Collapse
Affiliation(s)
- Aroub Alnasser
- Food Science and Nutrition Dept., College of Food and Agriculture Sciences, King Saud University, Riyadh, 11495, Saudi Arabia
| | - Alreem Abaalkhail
- Food Science and Nutrition Dept., College of Food and Agriculture Sciences, King Saud University, Riyadh, 11495, Saudi Arabia
| |
Collapse
|
24
|
Millard T, Elliott JH, Green S, McGloughlin S, Turner T. Exploring the use and impact of the Australian living guidelines for the clinical care of people with COVID-19: where to from here? J Clin Epidemiol 2024; 166:111234. [PMID: 38072175 DOI: 10.1016/j.jclinepi.2023.111234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVES The Australian National COVID-19 Clinical Evidence Taskforce has been developing, maintaining, and disseminating living guidelines and decision support tools (clinical flowcharts) for the care of people with suspected or confirmed COVID-19 since 2020. Living guidelines, a form of living evidence, are a relatively new approach; hence, more work is required to determine how to optimize their use to inform practice, policy, and decision-making and to explore implementation, uptake, and impact implications. An update of an earlier impact evaluation was conducted to understand sustained awareness and use of the guidelines; the factors that facilitate the widespread adoption of the guidelines and to explore the perceived strengths and opportunities for improvement of the guidelines. STUDY DESIGN AND SETTING A mixed-methods impact evaluation was conducted. Surveys collected both quantitative and qualitative data and were supplemented with qualitative interviews. Participants included Australian healthcare practitioners providing care to individuals with suspected or confirmed COVID-19 and people involved in policy-making. Data were collected on awareness, use, impact, strengths, and opportunities for improvement of the guidelines and flow charts. RESULTS A total of 148 participants completed the survey and 21 people were interviewed between January and March 2022. Awareness of the work of the Taskforce was high and more than 75% of participants reported that the guidelines were used within their workplace. Participants described the Taskforce website and guidelines as trustworthy, valuable, and reliable sources of up-to-date evidence-based information. The evaluation highlighted the varied ways the guidelines were being used across a range of settings and the diverse impacts they have from those at a clinical level to impacts at a policy level. Barriers to and enablers of impact and uptake of the guideline were explored. CONCLUSION This evaluation highlights the value of living guidelines during a pandemic when the evidence base is rapidly changing and expanding. It presents useful understanding of the ways clinicians and others use living evidence to inform their clinical practice and decision-making and the diverse impacts the guidelines are having around Australia.
Collapse
Affiliation(s)
- Tanya Millard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Julian H Elliott
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sally Green
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Steve McGloughlin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tari Turner
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
25
|
Beaudoin M, Belzile EL, Gélinas C, Trépanier D, Émond M, Gagnon MA, Bérubé M. Level of implementation of pain management and early mobilization strategies to prevent delirium in geriatric trauma patients: A mixed-methods study. Int J Orthop Trauma Nurs 2024; 52:101050. [PMID: 37848364 DOI: 10.1016/j.ijotn.2023.101050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/31/2023] [Accepted: 09/09/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Pain management and early mobilization strategies are recommended in clinical practice guidelines for the prevention of delirium in older adults. However, available data on the implementation of these strategies in trauma are limited. AIMS To describe the use of pain management and early mobilization strategies in older adults at a level I trauma center, as well as the facilitators and barriers to their implementation. METHODS A convergent mixed methods study was used. Quantitative data were collected from sixty medical records. Qualitative data was collected through a focus group with healthcare providers to explore their perspectives regarding the use of the target practices and on barriers and facilitators to their implementation. Descriptive statistics were calculated, and a thematic analysis using an inductive and deductive interpretative descriptive approach was undertaken. RESULTS A question on the presence/absence of pain was the most frequently documented pain assessment method. Pain assessment was poorly documented. Frequencies of non-opioid and opioid administrations were similar, but non-pharmacological strategies were not widely used. The first mobilization was performed quickly and was most commonly to a chair. The focus group discussion confirmed many of the data collected in the medical records. Barriers to implementing the targeted strategies were primarily related to organizational context and facilitation processes. CONCLUSIONS Areas for improvement were identified including pain assessment, the use of non-pharmacological pain management strategies and ambulation as a mobilization strategy. Our findings will serve as a starting point for optimizing and adapting practices for geriatric trauma patients and evaluating their impact.
Collapse
Affiliation(s)
- Maryline Beaudoin
- Faculty of Nursing, Laval University, Quebec City, QC, Canada; Research Center of the CHU of Quebec- Laval University, Quebec City, QC, Canada; Quebec Pain Research Network, Sherbrooke, QC, Canada.
| | - Etienne L Belzile
- Research Center of the CHU of Quebec- Laval University, Quebec City, QC, Canada; Department of Orthopaedic Surgery, CHU de Quebec- Laval University, Quebec, QC, Canada
| | - Céline Gélinas
- Quebec Pain Research Network, Sherbrooke, QC, Canada; Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital - CIUSSS West-Central-Montreal, Montreal, QC, Canada; Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - David Trépanier
- Department of Emergency and Family Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Marcel Émond
- Research Center of the CHU of Quebec- Laval University, Quebec City, QC, Canada; Department of Emergency and Family Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Marc-Aurèle Gagnon
- Research Center of the CHU of Quebec- Laval University, Quebec City, QC, Canada; Population Health and Optimal Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Laval University Research Center (Enfant-Jesus Hospital), Quebec City, Quebec City, QC, Canada
| | - Mélanie Bérubé
- Faculty of Nursing, Laval University, Quebec City, QC, Canada; Research Center of the CHU of Quebec- Laval University, Quebec City, QC, Canada; Quebec Pain Research Network, Sherbrooke, QC, Canada; Population Health and Optimal Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Laval University Research Center (Enfant-Jesus Hospital), Quebec City, Quebec City, QC, Canada
| |
Collapse
|
26
|
Tubbs RM, White F, Rotundo N, Heard-Booth A. Collaborative Assessment in the Gross Anatomy Lab. Med Sci Educ 2024; 34:57-69. [PMID: 38510406 PMCID: PMC10948708 DOI: 10.1007/s40670-023-01908-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 03/22/2024]
Abstract
Purpose In 2018, the Michigan State University College of Human Medicine incorporated two-stage examinations into the gross anatomy curriculum. Multiple studies have investigated two-stage examinations and have largely reported positive findings. Here, we used a mixed-methods approach to further investigate the feasibility and student perceptions of the two-stage examination in the context of a medical school curriculum that emphasizes longitudinal group-based learning and formative assessments. Methods Three student cohorts were assessed with a formative two-stage examination at the end of their first-year anatomy experience. Data for the quantitative analysis included examination scores from the individual and group portions of the two-stage examination. For the qualitative stage of this project, we utilized a constructivist grounded theory methodology in which data, including both post-examination survey results and one-on-one semi-structured student interviews, were transcribed (interviews), coded, inductively and iteratively reviewed, and thematically interpreted. Results Survey and interview results revealed an overwhelmingly positive perception of the collaborative assessment experience. Student comments demonstrated educational value in the immediate feedback provided by this examination format and suggested that collaboration during the examination transformed the assessment into a learning experience. Conclusions While two-stage examinations have the potential to positively transform an assessment into a learning experience, we also identified complex relationships between content knowledge and anxiety that may affect student perceptions. In addition, examination logistics (e.g., curricular timing) have the potential to negatively affect student perceptions, indicating that faculty should consider these factors when implementing collaborative assessments into their curriculum.
Collapse
Affiliation(s)
- Ryan Maureen Tubbs
- Michigan State University College of Human Medicine, Grand Rapids, MI USA
| | - Felicia White
- Michigan State University College of Human Medicine, Grand Rapids, MI USA
- Department of Pediatrics, Corewell Health Helen DeVos Children’s Hospital, Grand Rapids, MI USA
| | - Nathan Rotundo
- Michigan State University College of Human Medicine, Grand Rapids, MI USA
- Present Address: Internal Medicine and Pediatrics, University of Rochester Medical Center, Rochester, NY USA
| | - Amber Heard-Booth
- Michigan State University College of Human Medicine, Grand Rapids, MI USA
| |
Collapse
|
27
|
Rotsaert A, Vanhamel J, Vanbaelen T, Vuylsteke B, van der Loeff MS, Hensen B, Kielmann K, Callens S, Reyniers T. HIV Pre-exposure Prophylaxis (PrEP) Care in Belgium: A mixed-methods Study on PrEP Users' Experiences and Service Delivery Preferences. AIDS Behav 2024; 28:393-407. [PMID: 38038778 DOI: 10.1007/s10461-023-04232-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/02/2023]
Abstract
In Belgium, HIV pre-exposure prophylaxis (PrEP) services are mainly provided through specialised HIV clinics. To optimise PrEP uptake and retention in care, we require insights into users' perspectives on PrEP care. We aimed to elicit experiences with, and preferences for, PrEP service delivery among PrEP users in Belgium, including willingness to involve their family physician (FP) in PrEP care. We adopted a sequential mixed-methods design. We used a web-based longitudinal study among 326 PrEP users that consisted of two questionnaires at six-month intervals, and complemented this with 21 semi-structured interviews (September 2020-January 2022). We conducted descriptive analyses and logistic regression to examine factors associated with willingness to involve their FP in PrEP care. Interviews were analysed using thematic analysis. Survey respondents reported high satisfaction with care received in HIV clinics [median score 9 (IQR 8-10), 10='very satisfied']. Interviews revealed the importance of regular HIV/STI screening, and the expertise and stigma-free environment of HIV clinics. Yet, they also contextualised service delivery barriers reported in the questionnaire, including the burden of cost and challenges integrating PrEP visits into their private and professional lives. Although 63.8% (n = 208/326) of baseline respondents preferred attending an HIV clinic for PrEP follow-up, 51.9% (n = 108/208) of participants in the follow-up questionnaire reported to be willing to have their FP involved in PrEP care. Participants reporting trust in FPs' PrEP and sexual health expertise, or who didn't feel judged by their FP, were more likely to be willing to involve them in PrEP care. Therefore, we recommend a differentiated PrEP service delivery approach, including involving FPs, to make PrEP care more client-centred.
Collapse
Affiliation(s)
- Anke Rotsaert
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, B-2000, Belgium
| | - Jef Vanhamel
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, B-2000, Belgium.
| | - Thibaut Vanbaelen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, B-2000, Belgium
| | - Maarten Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity (AII), Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute (APH), Amsterdam, the Netherlands
| | - Bernadette Hensen
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, B-2000, Belgium
| | - Karina Kielmann
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, B-2000, Belgium
| | - Steven Callens
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Thijs Reyniers
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, B-2000, Belgium
| |
Collapse
|
28
|
Raatikainen KJ, Tupala AK, Niemelä R, Laulumaa AM. The intricate diversity of human-nature relations: Evidence from Finland. Ambio 2024; 53:181-200. [PMID: 37775714 PMCID: PMC10774321 DOI: 10.1007/s13280-023-01933-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 05/08/2023] [Accepted: 09/04/2023] [Indexed: 10/01/2023]
Abstract
Supporting sustainability requires understanding human-nature relations, which we approached as social constructions that can be studied through nature-related discourses. We examined human-nature relations in Finland by combining approaches from environmental social sciences and arts-based research into a mixed-methods design. A public online survey (n = 726) and post-performance audience interviews (n = 71) portrayed nature positively. Respondents' ideas of nature ranged from natural scientific to philosophical; from dualistic to holistic; and from ecocentric to anthropocentric. A factor analysis revealed discourses focusing on wellbeing, conservation, ecoanxiety, pro-environmentalism, outdoor activity, and enjoying nature. Interviews added spiritual and over-generational aspects and revealed the importance of embodied experiences in nature relations. We identified dimensions that structure the relations, including human-nature positionality, engagement and contact with nature, and conception and thought. The emotional and experiential aspects, and nature-related practices, deserve further research. We demonstrate how a diversity of human-nature relations co-exists and co-evolves.
Collapse
Affiliation(s)
- Kaisa J Raatikainen
- Societal Change Unit, Finnish Environment Institute (Syke), Survontie 9A, 40500, Jyväskylä, Finland.
- Department of Biological and Environmental Science, School of Resource Wisdom, University of Jyvaskyla, P.O.Box 35, 40014, Jyväskylä, Finland.
| | - Anna-Kaisa Tupala
- Department of Biological and Environmental Science, School of Resource Wisdom, University of Jyvaskyla, P.O.Box 35, 40014, Jyväskylä, Finland
- Regional Council of Central Finland, Lutakonaukio 7, 40100, Jyväskylä, Finland
| | - Riikka Niemelä
- Department of Biological and Environmental Science, School of Resource Wisdom, University of Jyvaskyla, P.O.Box 35, 40014, Jyväskylä, Finland
- School of History, Culture and Art Studies, University of Turku, 20014, Turku, Finland
| | - Anna-Mari Laulumaa
- Department of Biological and Environmental Science, School of Resource Wisdom, University of Jyvaskyla, P.O.Box 35, 40014, Jyväskylä, Finland
- Kiertotie 12 as 2, 40250, Jyväskylä, Finland
| |
Collapse
|
29
|
Triandafilidis Z, Carr S, Davis D, Jeong SYS, Hensby J, Wong D, Attia J, Goodwin N. Improving end-of-life care for people with dementia: a mixed-methods study. BMC Palliat Care 2024; 23:30. [PMID: 38291401 PMCID: PMC10825990 DOI: 10.1186/s12904-023-01335-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/20/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Improving palliative and end-of-life care for people with dementia is a growing priority globally. This study aimed to integrate multiple perspectives on end-of-life care for people with dementia and carers, to identify clinically relevant areas for improvement. METHODS The mixed-methods study involved surveys, interviews, and workshops with two participant groups: healthcare professionals and carers (individuals who provided care and support to a family member or friend). Healthcare professionals were invited to complete an online adapted version of the Australian Commission on Safety and Quality in Health Care, End-of-Life Care Toolkit: Clinician Survey Questions. Carers completed a hard copy or online adapted version of the Views of Informal Carers-Evaluation of Services (Short form) (VOICES-SF) questionnaire. Interview schedules were semi-structured, and workshops followed a co-design format. Findings were integrated narratively using a weaving approach. RESULTS Five areas in which we can improve care for people with dementia at the end of life, were identified: 1) Timely recognition of end of life; 2) Conversations about palliative care and end of life; 3) Information and support for people with dementia and carers; 4) Person-and-carer-centred care; 5) Accessing quality, coordinated care. CONCLUSIONS There are multiple areas where we can improve the quality of end-of-life care people with dementia receive. The findings demonstrate that the heterogeneous and challenging experiences of living with and caring for people with dementia necessitate a multidisciplinary, multifaceted approach to end-of-life care. The identified solutions, including care coordination, can guide local development of co-designed models of end-of-life care for people with dementia.
Collapse
Affiliation(s)
- Zoi Triandafilidis
- Central Coast Research Institute, Gosford, NSW, Australia.
- Central Coast Local Health District, Gosford, NSW, Australia.
- University of Newcastle, Newcastle, NSW, Australia.
| | - Sally Carr
- Central Coast Local Health District, Gosford, NSW, Australia
| | - Daneill Davis
- Central Coast Local Health District, Gosford, NSW, Australia
| | - Sarah Yeun-Sim Jeong
- Central Coast Local Health District, Gosford, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Jacinta Hensby
- Central Coast Local Health District, Gosford, NSW, Australia
| | - Daniel Wong
- Central Coast Local Health District, Gosford, NSW, Australia
- University of Newcastle, Newcastle, NSW, Australia
| | - John Attia
- University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Nicholas Goodwin
- Central Coast Research Institute, Gosford, NSW, Australia.
- Central Coast Local Health District, Gosford, NSW, Australia.
- University of Newcastle, Newcastle, NSW, Australia.
| |
Collapse
|
30
|
O'Neill M, Michalski C, Hayman K, Hulme J, Dube S, Diemert LM, Kornas K, Schoffel A, Rosella LC, Boozary A. "Whatever journey you want to take, I'll support you through": a mixed methods evaluation of a peer worker program in the hospital emergency department. BMC Health Serv Res 2024; 24:147. [PMID: 38287378 PMCID: PMC10826204 DOI: 10.1186/s12913-023-10532-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 12/27/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND People who are unhoused, use substances (drugs and/or alcohol), and who have mental health conditions experience barriers to care access and are frequently confronted with discrimination and stigma in health care settings. The role of Peer Workers in addressing these gaps in a hospital-based context is not well characterized. The aim of this evaluation was to 1) outline the role of Peer Workers in the care of a marginalized populations in the emergency department; 2) characterize the impact of Peer Workers on patient care, and 3) to describe how being employed as a Peer Worker impacts the Peer. METHODS Through a concurrent mixed methods evaluation, we explore the role of Peer Workers in the care of marginalized populations in the emergency department at two urban hospitals in Toronto, Ontario Canada. We describe the demographic characteristics of patients (n = 555) and the type of supports provided to patients collected through a survey between February and June 2022. Semi-structured, in-depth interviews were completed with Peer Workers (n = 7). Interviews were thematically analyzed using a deductive approach, complemented by an inductive approach to allow new themes to emerge from the data. RESULTS Support provided to patients primarily consisted of friendly conversations (91.4%), discharge planning (59.6%), tactics to help the patient navigate their emotions/mental wellbeing (57.8%) and sharing their lived experience (50.1%). In over one third (38.9%) of all patient interactions, Peer Workers shared new information about the patient with the health care team (e.g., obtaining patient identification). Five major themes emerged from our interviews with Peer Workers which include: (1) Establishing empathy and building trust between the patient and their care team through self-disclosure; (2) Facilitating a person-centered approach to patient care through trauma-informed listening and accessible language; (3) Support for patient preferences on harm reduction; (4) Peer worker role facilitating self-acceptance and self-defined recovery; and (5) Importance of supports and resources to help Peer Workers navigate the emotional intensity of the emergency department. CONCLUSIONS The findings add to the literature on Peer Worker programs and how such interventions are designed to best meet the needs of marginalized populations.
Collapse
Affiliation(s)
- Meghan O'Neill
- Population Health Analytics Lab, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Camilla Michalski
- Population Health Analytics Lab, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Kate Hayman
- University Health Network, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jennifer Hulme
- University Health Network, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Sané Dube
- University Health Network, Toronto, ON, Canada
- Gattuso Centre for Social Medicine and Population Health, University Health Network, Toronto, ON, Canada
| | - Lori M Diemert
- Population Health Analytics Lab, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Kathy Kornas
- Population Health Analytics Lab, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Alice Schoffel
- University Health Network, Toronto, ON, Canada
- Gattuso Centre for Social Medicine and Population Health, University Health Network, Toronto, ON, Canada
| | - Laura C Rosella
- Population Health Analytics Lab, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Andrew Boozary
- University Health Network, Toronto, ON, Canada.
- Gattuso Centre for Social Medicine and Population Health, University Health Network, Toronto, ON, Canada.
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
31
|
Gerger H, van Dijk-de Vries A, Moser A, Jochem I, Veenstra M, Perry M, van Bokhoven M. Adjusting advance care planning to older people's needs: results from focus groups and interviews. BMC Health Serv Res 2024; 24:51. [PMID: 38200528 PMCID: PMC10782636 DOI: 10.1186/s12913-023-10491-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Advance care planning (ACP) is becoming increasingly important in medical care. Some suggest standardized approaches to initiate ACP with all older adults. However, the idea of patient-centered care suggests more nuanced approaches tailored to individual older adults' needs. This study investigated how older adults with different views and needs about ACP can be approached in an adequate and most beneficial way by health care professionals. METHODS We used questionnaires, interviews, focus groups and informal conversations with older adults, living in their own homes, who volunteered to take part in our research. The research was participatory as we collaborated closely with practice partners and we used the obtained findings immediately and continuously to inform the next steps of our research throughout the process. RESULTS We identified three subgroups of older adults with differential needs regarding ACP-related activities: The first group avoids talking about their needs and wishes for care towards the end of life. These older people benefit from activities, which aim at motivating them to concern themselves with ACP-related topics. The second group consists of older adults who are in principle open for ACP-conversations but do not initiate these themselves. This group either trusts their next-of-kin or their healthcare professional to act in accordance with their wishes or does not bring up the topic in order to avoid confronting relevant others with possibly unpleasant topics. This group of people benefits from information about ACP and from healthcare professionals initiating the ACP process. The third group of older people initiates the ACP process themselves, gathers information, and takes the necessary steps for ACP. With this group it remains relevant to check carefully whether they have indeed taken all relevant steps and shared the information with all relevant involved care institutions and relatives. CONCLUSIONS We propose a model to simplify adjustments of ACP to individuals' needs. Our suggested approach might contribute to increasing the motivation of older people to engage in ACP conversations if these are more closely related to their own needs. Further, it might also contribute to simplifying the individual shaping of the ACP process for healthcare professionals as our suggested model offers clear guidance for approaching different types of older people in different ways. The suggested approach may in future be used for training health care professionals in the conduct of ACP conversations.
Collapse
Affiliation(s)
- Heike Gerger
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
| | - Anneke van Dijk-de Vries
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Albine Moser
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Research Centre Autonomy and Participation of Chronically Ill People, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | | | | | - Marieke Perry
- Department of Primary Care Medicine and Geriatrics, Radboudumc, Nijmegen, the Netherlands
| | - Marloes van Bokhoven
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
32
|
Fleischmann-Struzek C, Rose N, Ditscheid B, Draeger L, Dröge P, Freytag A, Goldhahn L, Kannengießer L, Kimmig A, Matthäus-Krämer C, Ruhnke T, Reinhart K, Schlattmann P, Schmidt K, Storch J, Ulbrich R, Ullmann S, Wedekind L, Swart E. Understanding health care pathways of patients with sepsis: protocol of a mixed-methods analysis of health care utilization, experiences, and needs of patients with and after sepsis. BMC Health Serv Res 2024; 24:40. [PMID: 38191398 PMCID: PMC10773042 DOI: 10.1186/s12913-023-10509-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/20/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Sepsis is associated with about 20% of deaths worldwide. It often presents with non-specific initial symptoms, making its emergency treatment an interdisciplinary and cross-sectoral challenge. Three in four sepsis survivors suffers from new cognitive, psychological, or physical sequelae for which specific treatment concepts are scarce. The AVENIR project aims to improve the understanding of patient pathways, and subjective care experiences and needs along the entire healthcare pathway before, with and after sepsis. Based on this, concrete recommendations for the organization of care and patient information materials will be developed with close patient participation. METHODS Mixed-methods study including (1) analysis of anonymized nationwide health claims data from Germany, (2) linkage of health claims data with patient care reports (PCR) of emergency medical services from study regions in two federal states within Germany, and (3) qualitative exploration of the patient, relative, and care provider perspective on sepsis care. In (1), we analyze inpatient and outpatient health care utilization until 30 days pre-sepsis; clinical sepsis care including intra- and inter-hospital transfers; and rehabilitation, inpatient and outpatient aftercare of sepsis survivors as well as costs for health care utilization until 24 months post-sepsis. We attempt to identify survivor classes with similar health care utilization by Latent Class Analyses. In (2), PCR are linked with health claims data to establish a comprehensive database outlining care pathways for sepsis patients from pre-hospital to follow-up. We investigate e.g., whether correct initial assessment is associated with acute (e.g., same-day lethality) and long-term (e.g., new need for care, long-term mortality) outcomes of patients. We compare the performance of sepsis-specific screening tools such as qSOFA, NEWS-2 or PRESEP in the pre-clinical setting. In (3), semi-structured interviews as well as synchronous and asynchronous online focus groups are conducted and analyzed using qualitative content analyses techniques. DISCUSSION The results of the AVENIR study will contribute to a deeper understanding of sepsis care pathways in Germany. They may serve as a base for improvements and innovations in sepsis care, that in the long-term can contribute to reduce the personal, medical, and societal burden of sepsis and its sepsis sequelae. TRIAL REGISTRATION Registered at German Clinical Trial Register (ID: DRKS00031302, date of registration: 5th May 2023).
Collapse
Affiliation(s)
- Carolin Fleischmann-Struzek
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Stoystraße 3, 07743, Jena, Germany.
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany.
| | - Norman Rose
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Stoystraße 3, 07743, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - Bianka Ditscheid
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - Lea Draeger
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | | | - Antje Freytag
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - Ludwig Goldhahn
- Institute of Social Medicine and Health Systems Research (ISMHSR), Otto-Von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Lena Kannengießer
- Institute of Social Medicine and Health Systems Research (ISMHSR), Otto-Von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Aurelia Kimmig
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Stoystraße 3, 07743, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - Claudia Matthäus-Krämer
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Stoystraße 3, 07743, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | | | - Konrad Reinhart
- Sepsis Foundation, Berlin, Germany
- Department of Anesthesiology and Operative Intensive Care Medicine, Charité University Medicine Berlin, Berlin, Germany
| | - Peter Schlattmann
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
| | - Konrad Schmidt
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
- Institute of General Practice and Family Medicine, Charité University Medicine Berlin, Berlin, Germany
| | - Josephine Storch
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - Ruben Ulbrich
- Institute of Social Medicine and Health Systems Research (ISMHSR), Otto-Von-Guericke-University Magdeburg, Magdeburg, Germany
| | | | - Lisa Wedekind
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
| | - Enno Swart
- Institute of Social Medicine and Health Systems Research (ISMHSR), Otto-Von-Guericke-University Magdeburg, Magdeburg, Germany
| |
Collapse
|
33
|
El Ayadi AM, Obore S, Kirya F, Miller S, Korn A, Nalubwama H, Neuhaus J, Getahun M, Eyul P, Twine R, Andrew EVW, Barageine JK. Identifying opportunities for prevention of adverse outcomes following female genital fistula repair: protocol for a mixed-methods study in Uganda. Reprod Health 2024; 21:2. [PMID: 38178156 PMCID: PMC10768188 DOI: 10.1186/s12978-023-01732-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 12/28/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Female genital fistula is a traumatic debilitating injury, frequently caused by prolonged obstructed labor, affecting between 500,000-2 million women in lower-resource settings. Vesicovaginal fistula causes urinary incontinence, and other morbidity may occur during fistula development. Women with fistula are stigmatized, limit social and economic engagement, and experience psychiatric morbidity. Improved surgical access has reduced fistula consequences yet post-repair risks impacting quality of life and well-being include fistula repair breakdown or recurrence and ongoing or changing urine leakage or incontinence. Limited evidence on risk factors contributing to adverse outcomes hinders interventions to mitigate adverse events. This study aims to quantify these adverse risks and inform clinical and counseling interventions to optimize women's health and quality of life following fistula repair through: identifying predictors and characteristics of post-repair fistula breakdown and recurrence (Objective 1) and post-repair incontinence (Objective 2), and to identify feasible and acceptable intervention strategies (Objective 3). METHODS This mixed-methods study incorporates a prospective cohort of women with successful vesicovaginal fistula repair at approximately 12 fistula repair centers in Uganda (Objectives 1-2) followed by qualitative inquiry among key stakeholders (Objective 3). Cohort participants will have a baseline visit at the time of surgery followed by data collection at 2 weeks, 6 weeks, 3 months and quarterly thereafter for 3 years. Primary predictors to be evaluated include patient-related factors, fistula-related factors, fistula repair-related factors, and post-repair behaviors and exposures, collected via structured questionnaire at all data collection points. Clinical exams will be conducted at baseline, 2 weeks post-surgery, and for outcome confirmation at symptom development. Primary outcomes are fistula repair breakdown or fistula recurrence and post-repair incontinence. In-depth interviews will be conducted with cohort participants (n ~ 40) and other key stakeholders (~ 40 including family, peers, community members and clinical/social service providers) to inform feasibility and acceptability of recommendations. DISCUSSION Participant recruitment is underway. This study is expected to identify key predictors that can directly improve fistula repair and post-repair programs and women's outcomes, optimizing health and quality of life. Furthermore, our study will create a comprehensive longitudinal dataset capable of supporting broad inquiry into post-fistula repair health. Trial Registration ClinicalTrials.gov Identifier: NCT05437939.
Collapse
Affiliation(s)
- Alison M El Ayadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA.
| | - Susan Obore
- Department of Urogynecology, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
| | - Fred Kirya
- School of Health Sciences, Soroti University, Soroti, Uganda
| | - Suellen Miller
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA
| | - Abner Korn
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA
| | - Hadija Nalubwama
- Department of Obstetrics and Gynecology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - John Neuhaus
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Monica Getahun
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Patrick Eyul
- Infectious Disease Research Collaboration, Kampala, Uganda
| | - Robert Twine
- Infectious Disease Research Collaboration, Kampala, Uganda
| | | | - Justus K Barageine
- Department of Urogynecology, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
- Department of Obstetrics and Gynecology, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Obstetrics and Gynaecology, Kampala International University, Kampala, Uganda
| |
Collapse
|
34
|
Heier L, Schellenberger B, Schippers A, Nies S, Geiser F, Ernstmann N. Interprofessional communication skills training to improve medical students' and nursing trainees' error communication - quasi-experimental pilot study. BMC Med Educ 2024; 24:10. [PMID: 38172793 PMCID: PMC10765820 DOI: 10.1186/s12909-023-04997-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Interprofessional communication is of extraordinary importance for patient safety. To improve interprofessional communication, joint training of the different healthcare professions is required in order to achieve the goal of effective teamwork and interprofessional care. The aim of this pilot study was to develop and evaluate a joint training concept for nursing trainees and medical students in Germany to improve medication error communication. METHODS We used a mixed-methods, quasi-experimental study with a pre-post design and two study arms. This study compares medical students (3rd year) and nursing trainees (2nd year) who received an interprofessional communication skills training with simulation persons (intervention group, IG) with a control group (CG). Both cohorts completed identical pre- and post-training surveys using the German Interprofessional Attitudes Scale (G-IPAS) and a self-developed interprofessional error communication scale. Descriptive statistics, Mann-Whitney-U-test and Wilcoxon-test were performed to explore changes in interprofessional error communication. RESULTS A total of 154 were medical students, and 67 were nursing trainees (IG: 66 medical students, 28 nursing trainees / CG: 88 medical students, 39 nursing trainees). After training, there were significant improvements observed in the "interprofessional error communication" scale (p < .001) and the "teamwork, roles, and responsibilities" subscale (p = .012). Median scores of the subscale "patient-centeredness" were similar in both groups and remained unchanged after training (median = 4.0 in IG and CG). CONCLUSIONS Future studies are needed to find out whether the training sustainably improves interprofessional teamwork regarding error communication in acute care.
Collapse
Affiliation(s)
- Lina Heier
- Center for Health Communication and Health Services Research, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.
- Chair of Health Services Research, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center, Maastricht, The Netherlands.
- CARIM School for Cardiovascular Disease, Maastricht University, Maastricht, The Netherlands.
| | - Barbara Schellenberger
- Center for Health Communication and Health Services Research, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
- Chair of Health Services Research, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anna Schippers
- Center for Health Communication and Health Services Research, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Sebastian Nies
- Centrum für Aus- & Weiterbildung, University Hospital Bonn, Bonn, Germany
| | - Franziska Geiser
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
- Chair of Health Services Research, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| |
Collapse
|
35
|
Treitler P, Enich M, Bowden C, Mahone A, Lloyd J, Crystal S. Implementation of an office-based addiction treatment model for Medicaid enrollees: A mixed methods study. J Subst Use Addict Treat 2024; 156:209212. [PMID: 37935350 PMCID: PMC10842178 DOI: 10.1016/j.josat.2023.209212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/31/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Medications for opioid use disorder (MOUD) are the most effective treatment for opioid use disorder (OUD) but remain underutilized. To reduce barriers to MOUD prescribing and increase treatment access, New Jersey's Medicaid program implemented the Office-Based Addiction Treatment (OBAT) Program in 2019, which increased reimbursement for office-based buprenorphine prescribing and established newly reimbursable patient navigation services in OBAT clinics. Using a mixed-methods design, this study aimed to describe stakeholder experiences with the OBAT program and to assess implementation and uptake of the program. METHODS This study used a concurrent, triangulated mixed-methods design, which integrated complementary qualitative (semi-structured interviews) and quantitative (Medicaid claims) data to gain an in-depth understanding of the implementation of the OBAT program. We elicited stakeholder perspectives through interviews with 22 NJ Medicaid MOUD providers and 8 policy key informants, and examined trends in OBAT program utilization using 2019-2020 NJ Medicaid claims for 5380 Medicaid enrollees who used OBAT services. We used cross-case analysis (provider interviews) and a case study approach (key informant interviews) in analyzing qualitative data, and calculated descriptive statistics and trends for quantitative data. RESULTS Provider enrollment and utilization of OBAT services increased steadily during the first two years of program implementation. Interviewees reported that enhanced reimbursements for office-based MOUD incentivized greater MOUD prescribing, while coverage of patient navigation services improved patient care. Despite increasing enrollment in the OBAT program, the proportion of primary care physicians in the state who enrolled in the program remained limited. Key barriers to enrollment included: requirements for a patient navigator; concerns about administrative burdens and reimbursement delays from Medicaid; lack of awareness of the program; and beliefs that patients with OUD were better served in comprehensive care settings. Patient navigation was highlighted as a critical and valuable element of the program, but navigator enrollment and reimbursement challenges may have prevented greater uptake of this service. CONCLUSIONS Implementation of an OBAT model that enhanced reimbursement and provided coverage for patient navigation likely expanded access to MOUD in NJ. Results support initiatives like the OBAT program in improving access to MOUD, but program adaptations, where feasible, could improve uptake and utilization.
Collapse
Affiliation(s)
- Peter Treitler
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, Rutgers, the State University of New Jersey, 112 Paterson St. 3rd Floor, New Brunswick, NJ 08901, United States of America; Boston University School of Social Work, 264 Bay State Rd., Boston, MA 02215, United States of America.
| | - Michael Enich
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, Rutgers, the State University of New Jersey, 112 Paterson St. 3rd Floor, New Brunswick, NJ 08901, United States of America; School of Social Work, Rutgers, the State University of New Jersey, 120 Albany St., New Brunswick, NJ 08901, United States of America
| | - Cadence Bowden
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, Rutgers, the State University of New Jersey, 112 Paterson St. 3rd Floor, New Brunswick, NJ 08901, United States of America
| | - Anais Mahone
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, Rutgers, the State University of New Jersey, 112 Paterson St. 3rd Floor, New Brunswick, NJ 08901, United States of America; School of Social Work, Rutgers, the State University of New Jersey, 120 Albany St., New Brunswick, NJ 08901, United States of America
| | - James Lloyd
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, Rutgers, the State University of New Jersey, 112 Paterson St. 3rd Floor, New Brunswick, NJ 08901, United States of America
| | - Stephen Crystal
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, Rutgers, the State University of New Jersey, 112 Paterson St. 3rd Floor, New Brunswick, NJ 08901, United States of America; School of Social Work, Rutgers, the State University of New Jersey, 120 Albany St., New Brunswick, NJ 08901, United States of America; School of Public Health, Rutgers, the State University of New Jersey, 683 Hoes Lane West, Piscataway, NJ 08854, United States of America
| |
Collapse
|
36
|
Holton S, Nelson C, Rasmussen B, Levidiotis V. Co-design of a question prompt list about pregnancy and childbearing for women with polycystic kidney disease: an exploratory sequential mixed-methods study. BMC Pregnancy Childbirth 2023; 23:852. [PMID: 38082383 PMCID: PMC10714568 DOI: 10.1186/s12884-023-06154-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Although women with polycystic kidney disease (PKD) generally have healthy pregnancies and babies, pregnancy is associated with a greater risk of maternal complications and requires planning and management of their condition. Given these possible complications, routine communication about childbearing between women with PKD and their treating team is important. A question prompt list (QPL), a structured list of questions used by patients during consultations with healthcare providers, may be beneficial in assisting women with PKD to discuss their childbearing concerns with, and seek related information from, their treating team. The aims of this study were to co-design a QPL about pregnancy and childbearing for women with PKD, and evaluate its comprehensibility, salience, and acceptability. METHODS An exploratory sequential mixed-methods study of women of reproductive age with PKD living in Australia, using an experience-based co-design approach with two phases. Women were recruited from a metropolitan public health service and via social media and invited to complete an anonymous online survey about the development of the PKD QPL (phase one) and participate in an online discussion group about its refinement (phase two). RESULTS Sixteen women completed the development survey and seven participated in the evaluation discussion group. Participants reported that women with PKD would value and use a QPL to prompt discussions with and seek further information about pregnancy and childbearing from their healthcare providers. Women identified four main topics for the QPL: 'thinking about having a baby', 'pregnancy', 'my medications' and 'after my baby is born'. Within each section a series of questions was developed. Based on the findings, a QPL about pregnancy and childbearing for women with PKD was co-designed. CONCLUSIONS Women with PKD often find it difficult to access information and have discussions with their health care providers about pregnancy and childbearing. The PKD QPL co-designed in this study was perceived to be an acceptable tool which will, from the perspectives of participants, assist women with PKD to access information more easily about pregnancy, childbearing and PKD; ask more targeted questions of their treating team; and make informed childbearing decisions.
Collapse
Affiliation(s)
- Sara Holton
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia.
- The Centre for Quality and Patient Safety Research in the Institute of Health Transformation, Deakin University - Western Health Partnership, St Albans, VIC, 3021, Australia.
| | - Craig Nelson
- Department of Nephrology, Western Health, St Albans, VIC, 3021, Australia
- Department of Medicine - Western Health, University of Melbourne, Parkville, VIC, 3010, Australia
- Western Health Chronic Disease Alliance, Western Health, St Albans, VIC, 3021, Australia
- Department of Medicine, Deakin University, Geelong, VIC, 3220, Australia
| | - Bodil Rasmussen
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia
- The Centre for Quality and Patient Safety Research in the Institute of Health Transformation, Deakin University - Western Health Partnership, St Albans, VIC, 3021, Australia
- Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes Center, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vicki Levidiotis
- Department of Nephrology, Western Health, St Albans, VIC, 3021, Australia
- Department of Medicine - Western Health, University of Melbourne, Parkville, VIC, 3010, Australia
| |
Collapse
|
37
|
Hadjistavropoulos HD, Hill TG, Philipp-Muller AE, Dear B, Titov N. Perceptions of client stories in internet-delivered cognitive behaviour therapy: A mixed-methods evaluation. Internet Interv 2023; 34:100692. [PMID: 38099092 PMCID: PMC10719527 DOI: 10.1016/j.invent.2023.100692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 12/17/2023] Open
Abstract
Internet-delivered Cognitive-Behavioural Therapy (ICBT) aims to support people with mental health concerns using online treatment materials. Client stories (either real or a composite based on many clients) are often used in ICBT to facilitate learning. However, these stories remain understudied in terms of how they are perceived by clients, as well as their relationship to ICBT engagement, satisfaction, and outcomes. Among a sample of 324 clients enrolled in transdiagnostic ICBT targeting symptoms of depression and anxiety, we examined client perceptions of stories through mixed-method qualitative (open-ended) and quantitative (closed-ended) data collection. Specifically, 234 (72.22 %) clients responded to questions about stories at 4 weeks and 221 (68.21 %) responded to questions at 8 weeks. Most clients who responded to questions endorsed reviewing at least some stories (79.06 % at 4 weeks, 71.95 % at 8 weeks). Moreover, they rated stories positively in terms of being relatable, making clients feel less alone, increasing knowledge, providing ideas for how to use skills, and motivating clients to use skills. These perceptions of stories remained stable over the course of treatment. Stories were perceived more positively among those with lower symptom severity at 8 weeks as well as those who were more satisfied with ICBT at 8 weeks. Story perceptions at 4 weeks were predictive of decreased post-treatment anxiety symptom severity but not depression while controlling for baseline scores, age, and education. 26.49 % of clients at 4 weeks who reviewed stories and 33.33 % at 8 weeks provided suggestions about how to improve stories. In a qualitative analysis, we found 5 categories of suggestions including increasing the variety of issues and relatability of stories, ensuring the stories are realistic, refining the formatting, and making the stories shorter. Overall, this study provides insights into how client stories could be improved to play a more significant role in future ICBT programs.
Collapse
Affiliation(s)
- Heather D. Hadjistavropoulos
- Department of Psychology, University of Regina, Regina, Canada
- Online Therapy Unit, University of Regina, Regina, Canada
| | - Taylor G. Hill
- Department of Psychology, University of Regina, Regina, Canada
- Department of Psychology and Neuroscience, Dalhousie University, Canada
- Healthy Populations Institute, Dalhousie University, Canada
- Online Therapy Unit, University of Regina, Regina, Canada
| | - Aaron E. Philipp-Muller
- Department of Psychology, University of Regina, Regina, Canada
- Online Therapy Unit, University of Regina, Regina, Canada
| | | | | |
Collapse
|
38
|
Adam F, Favez N, Pirard C, Wyns C, Equeter C, Grimm E, Michaux N. Assessment of sexual function before medically assisted procreation: A mixed-methods study among a sample of infertile women and men cared for in a fertility center. Sex Reprod Healthc 2023; 38:100922. [PMID: 37951081 DOI: 10.1016/j.srhc.2023.100922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 10/19/2023] [Accepted: 10/31/2023] [Indexed: 11/13/2023]
Abstract
A mixed-methods study was conducted to investigate sexual function among infertile patients undergoing medically assisted procreation for the first time. The study employed an interview and content analysis approach, involving 45 infertile patients prior to their medically assisted procreation procedures. The findings revealed that infertile patients are a group at risk for sexual distress. Furthermore, patients with sexual dysfunctions exhibited lower levels of sexual activity, potentially diminishing their chances of achieving pregnancy. Participants faced challenges in openly discussing their sexual problems and demonstrated limited knowledge of sexual functioning. Among infertile women with sexual dysfunctions, the most frequently reported issues were sexual interest/arousal disorders, with a majority also experiencing pain during sexual activity and associated genital-pelvic pain disorders. In contrast, delayed ejaculation and erectile disorder seem to be more common in infertile men, while sexual desire and excitement disorders and premature ejaculation disorders appeared to be as common as in the general population. While the relationship between infertility and sexuality is complex, our study suggests that sexual dysfunctions or the absence of sexual activity may explain infertility. Therefore, it is imperative for clinicians to evaluate the sexual functioning of both men and women undergoing medically assisted procreation treatment, to increase their chances of procreation and offer them sexological support if needed. Future studies should expand their scope to include a larger sample size and delve into the potential etiological factors associated with sexual dysfunctions.
Collapse
Affiliation(s)
- Françoise Adam
- Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium; Department of Psychology of Sexuality, Faculty of Psychological Sciences and Education, University of Liège, Liège, Belgium.
| | - Nicolas Favez
- Unit of Clinical Psychology of Interpersonal Relations, Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland
| | - Céline Pirard
- Department of Gynecology and Andrology, University Hospital Saint-Luc, Belgium
| | - Christine Wyns
- Department of Gynecology and Andrology, University Hospital Saint-Luc, Belgium
| | - Charline Equeter
- Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
| | - Elise Grimm
- Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
| | - Nathalie Michaux
- Gynecology, Andrology, and in vitro Fertilization, University Hospital CHU UCLouvain Namur, Belgium
| |
Collapse
|
39
|
Reszel J, Daub O, Leese J, Augustsson H, Bellows DM, Cassidy CE, Crowner BE, Dunn SI, Goodwin LB, Hoens AM, Hunter SC, Lynch EA, Moore JL, Rafferty MR, Romney W, Stacey D, Graham ID. Essential content for teaching implementation practice in healthcare: a mixed-methods study of teams offering capacity-building initiatives. Implement Sci Commun 2023; 4:151. [PMID: 38012798 PMCID: PMC10680357 DOI: 10.1186/s43058-023-00525-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Applying the knowledge gained through implementation science can support the uptake of research evidence into practice; however, those doing and supporting implementation (implementation practitioners) may face barriers to applying implementation science in their work. One strategy to enhance individuals' and teams' ability to apply implementation science in practice is through training and professional development opportunities (capacity-building initiatives). Although there is an increasing demand for and offerings of implementation practice capacity-building initiatives, there is no universal agreement on what content should be included. In this study we aimed to explore what capacity-building developers and deliverers identify as essential training content for teaching implementation practice. METHODS We conducted a convergent mixed-methods study with participants who had developed and/or delivered a capacity-building initiative focused on teaching implementation practice. Participants completed an online questionnaire to provide details on their capacity-building initiatives; took part in an interview or focus group to explore their questionnaire responses in depth; and offered course materials for review. We analyzed a subset of data that focused on the capacity-building initiatives' content and curriculum. We used descriptive statistics for quantitative data and conventional content analysis for qualitative data, with the data sets merged during the analytic phase. We presented frequency counts for each category to highlight commonalities and differences across capacity-building initiatives. RESULTS Thirty-three individuals representing 20 capacity-building initiatives participated. Study participants identified several core content areas included in their capacity-building initiatives: (1) taking a process approach to implementation; (2) identifying and applying implementation theories, models, frameworks, and approaches; (3) learning implementation steps and skills; (4) developing relational skills. In addition, study participants described offering applied and pragmatic content (e.g., tools and resources), and tailoring and evolving the capacity-building initiative content to address emerging trends in implementation science. Study participants highlighted some challenges learners face when acquiring and applying implementation practice knowledge and skills. CONCLUSIONS This study synthesized what experienced capacity-building initiative developers and deliverers identify as essential content for teaching implementation practice. These findings can inform the development, refinement, and delivery of capacity-building initiatives, as well as future research directions, to enhance the translation of implementation science into practice.
Collapse
Affiliation(s)
- Jessica Reszel
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada.
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada.
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Canada.
| | - Olivia Daub
- School of Communication Sciences and Disorders, Western University, London, Canada
| | - Jenny Leese
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Hanna Augustsson
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine (CES), Stockholm, Sweden
| | - Danielle Moeske Bellows
- School of Physical Therapy, Massachusetts College of Pharmacy and Health Sciences, Worcester, USA
| | - Christine E Cassidy
- School of Nursing, Dalhousie University, Halifax, Canada
- IWK Health Centre, Halifax, Canada
| | | | - Sandra I Dunn
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Canada
| | - Lisa B Goodwin
- Inpatient Rehabilitation, University of Vermont Medical Center, Colchester, USA
| | - Alison M Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Sarah C Hunter
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Elizabeth A Lynch
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Jennifer L Moore
- Regional Rehabilitation Knowledge Center, Sunnaas Hospital, Oslo, Norway
- Institute for Knowledge Translation, Carmel, Indiana, USA
| | - Miriam R Rafferty
- Shirley Ryan AbilityLab and Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, USA
| | - Wendy Romney
- Physical Therapy, Sacred Heart University, Fairfield, USA
| | - Dawn Stacey
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Ian D Graham
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| |
Collapse
|
40
|
Otabil KB, Basáñez MG, Ankrah B, Bart-Plange EJ, Babae TN, Kudzordzi PC, Darko VA, Raji AS, Datsa L, Boakye AA, Yeboah MT, Fodjo JNS, Schallig HDFH, Colebunders R. Non-adherence to ivermectin in onchocerciasis-endemic communities with persistent infection in the Bono Region of Ghana: a mixed-methods study. BMC Infect Dis 2023; 23:805. [PMID: 37974087 PMCID: PMC10655298 DOI: 10.1186/s12879-023-08806-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The World Health Organization has proposed that onchocerciasis elimination (interruption) of transmission be verified in 12 (approximately a third) endemic countries by 2030. The strategy to reach this goal is based on ivermectin Mass Drug Administration (MDA) with high geographical and therapeutic coverage. In addition to coverage, high levels of treatment adherence are paramount. We investigated factors associated with ivermectin intake in an area of Ghana with persistent Onchocerca volvulus infection. METHODS In August 2021, a cross-sectional mixed-methods study was conducted in 13 onchocerciasis-endemic communities in the Bono Region of Ghana. Individuals aged ≥ 10 years were invited to participate in a questionnaire survey. A total of 48 focus group discussions and in-depth interviews with 10 community drug distributors and 13 community leaders were conducted. RESULTS A total of 510 people participated in the study [median age: 32, interquartile range 30 (20‒50) years]; 274 (53.7%) were females. Of the total, 320 (62.7%) declared that they adhered to each treatment round and 190 (37.3%) admitted they had not taken ivermectin during at least one MDA round, since becoming eligible for treatment. Of 483 participants with complete information, 139 (28.8%) did not take ivermectin during the last round (March 2021), and 24 (5.0%) had never taken ivermectin (systematic non-adherers). Reasons for not taking ivermectin included previous experience/fear of side-effects, being absent during MDA, pregnancy, the desire to drink alcohol, and drug distribution challenges. Being male, having good knowledge and perception of the disease, and not having secondary or higher level of formal education were significantly associated with higher odds of ivermectin intake. CONCLUSIONS A relatively high level of non-adherence to ivermectin treatment was documented. There is a need for targeted educational and behavioural change campaigns to reverse these trends and ensure a steady course toward meeting onchocerciasis elimination targets in Ghana.
Collapse
Affiliation(s)
- Kenneth Bentum Otabil
- Centre for Research in Applied Biology, School of Sciences, University of Energy and Natural Resources, Sunyani, Bono Region, Ghana.
- Department of Biological Science, School of Sciences, University of Energy and Natural Resources, Sunyani, Bono Region, Ghana.
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - María-Gloria Basáñez
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis (MRC GIDA), London Centre for Neglected Tropical Disease Research, School of Public Health, Imperial College London, London, UK
| | - Blessing Ankrah
- Centre for Research in Applied Biology, School of Sciences, University of Energy and Natural Resources, Sunyani, Bono Region, Ghana
| | - Emmanuel John Bart-Plange
- Centre for Research in Applied Biology, School of Sciences, University of Energy and Natural Resources, Sunyani, Bono Region, Ghana
| | - Theophilus Nti Babae
- Centre for Research in Applied Biology, School of Sciences, University of Energy and Natural Resources, Sunyani, Bono Region, Ghana
| | - Prince-Charles Kudzordzi
- Centre for Research in Applied Biology, School of Sciences, University of Energy and Natural Resources, Sunyani, Bono Region, Ghana
| | - Vera Achiaa Darko
- Centre for Research in Applied Biology, School of Sciences, University of Energy and Natural Resources, Sunyani, Bono Region, Ghana
- STU Clinic, Sunyani Technical University, Sunyani, Bono Region, Ghana
| | - Abdul Sakibu Raji
- Department of Biological Science, School of Sciences, University of Energy and Natural Resources, Sunyani, Bono Region, Ghana
| | - Lydia Datsa
- Deo Gratias Medical Laboratories, Sunyani, Bono Region, Ghana
| | | | - Michael Tawiah Yeboah
- Ghana Health Service, Regional Neglected Tropical Diseases (RNTD) Office, Regional Health Directorate, Sunyani, Bono Region, Ghana
| | - Joseph Nelson Siewe Fodjo
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Henk D F H Schallig
- Department of Medical Microbiology, Experimental Parasitology Unit, Academic Medical Centre at the University of Amsterdam, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Robert Colebunders
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
41
|
Rice B, Buller AM, Boccia D, Bazan C, Miranda R, Cea X, Laro R, Fontes M, Hayes R, de Wit M, Carter DJ, Plowright A, Chadwick M, Gafos M. Establishing the health and wellbeing needs of mining host community in Brazil, Chile and Peru: a mixed-method approach to identify priority areas for action to help communities meet their SDG3 targets. BMC Public Health 2023; 23:2218. [PMID: 37950177 PMCID: PMC10636873 DOI: 10.1186/s12889-023-17017-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND The global mining industry is an important partner in advancing the 2030 Agenda for Sustainable Development. In 2018, Anglo American plc published their Sustainable Mining Plan, containing a goal for improving health and wellbeing aligned with the Sustainable Development Goal 3 (SDG3) targets. Having formed an independent multidisciplinary research consortium, we designed and implemented a mixed-methods approach to attain a deeper understanding of SDG3 priorities within the local context of communities hosting Anglo American mining operations located in Latin America. METHODS In 2019, within the host communities of three mining operations in Chile, three in Brazil, and one in Peru, we conducted a qualitative study which included stakeholder workshops and key informant interviews. We also quantitatively appraised existing health data. Findings emerging from the qualitative and quantitative assessments were compared to identify health and wellbeing priority areas for action relevant to each community. RESULTS Across the three countries, 120 people took part in workshops and 35 in interviews. In these workshops and interviews, non-communicable diseases (SDG3.4), harmful alcohol consumption (SDG3.5), and pollution, particularly air pollution (SDG3.9), were consistently identified as areas for priority action. There were similarities in the reporting of individual, interpersonal, community, societal, and structural factors underlying these priority areas across the different communities. The availability of quantitative data was generally good at the state level, becoming increasing sparse as we focused on smaller geographies. The priorities identified in the quantitative assessments generally aligned with those highlighted in the qualitative data. CONCLUSIONS We highlight the importance of engaging with local populations to understand and address health needs. To address the priorities identified, intervention packages tailored to the specific needs of host communities, that tackle associated upstream societal level factors, are required. To facilitate this, appropriate monitoring systems and epidemiological investigations should be implemented to better understand the local context and quantify health issues. In the host communities, it is essential for the mining sector to be a key health partner in promoting integrated programmes that contribute to achieving the priority objectives and targets aligned with the SDG3 agenda.
Collapse
Affiliation(s)
- Brian Rice
- London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
- Sheffield Centre for Health and Related Research (SCHARR), School of Medicine and Population Health, University of Sheffield, Sheffield, UK.
| | - Ana Maria Buller
- London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Delia Boccia
- London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Cesar Bazan
- Innovation for Development (I4D), Lima, Peru
| | - Rafael Miranda
- Innovation for Development (I4D), Lima, Peru
- Universidad Continental del Peru, Junín, Peru
| | - Ximena Cea
- Innovation for Development (I4D), Lima, Peru
- Universidad Andrés Bello, Santiago, Chile
| | | | | | - Rosalie Hayes
- London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Mariken de Wit
- London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Daniel J Carter
- London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | | | | | - Mitzy Gafos
- London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| |
Collapse
|
42
|
Brennan N, Langdon N, Gale T, Humphries N, Knapton A, Bryce M. Exploring recent patterns of migration of doctors to the United Kingdom: a mixed-methods study. BMC Health Serv Res 2023; 23:1204. [PMID: 37924092 PMCID: PMC10625180 DOI: 10.1186/s12913-023-10199-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/23/2023] [Indexed: 11/06/2023] Open
Abstract
INTRODUCTION A shortage of doctors is currently one of the biggest challenges faced by the healthcare workforce in the United Kingdom (UK). While plans are in place to increase the number of medical school places, in the short-term this gap will need to continue to be filled by the international recruitment of doctors. The aim of this study is to identify key factors that explain the patterns of migration of doctors to the UK, in order to aid the development of policies to recruit and retain a sustainable workforce. METHODS We analysed General Medical Council (GMC) secondary data on the patterns of migration of internationally trained doctors (2009-2019). Qualitative interviews were conducted with 17 stakeholders by videoconferencing which were audio-recorded, transcribed and thematically analysed using NVivo. RESULTS In 2019, 34.5% of UK doctors were trained internationally mainly in India, Pakistan, Italy, Nigeria, Greece, Romania and Egypt. Most new registrations by internationally trained doctors from 2009-2019 did not have a specialty at the time of initial registration (96.2% in 2019). Only a relatively small number of these doctors go on to gain specialist or GP registration (11.6% within 5 years and 27.2% within 10 years of registration). The stakeholder interviews highlighted training opportunities and career progression as the main drivers of migration. The barriers internationally trained doctors face regarding specialty training included differences between UK and destination health systems, systematic bias, bureaucracy and selection processes not being accessible. CONCLUSION This study makes a contribution to the literature by identifying recent patterns in the migration of doctors to the UK. The UK's dependence on internationally trained doctors has important global implications as source countries are losing skilled health workers which is undermining their health systems. In keeping with the WHO Global Code on the International Recruitment of Healthcare Personnel, policymakers need to consider how to reduce the UK's reliance on internationally trained doctors, particularly from countries on the safeguard list whilst continuing the drive to increase medical school places. Additional support is required for internationally trained doctors, to ensure that they get on the training programmes they seek, enabling their career progression.
Collapse
Affiliation(s)
- N Brennan
- CAMERa, Peninsula Medical School, Faculty of Health, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK.
| | - N Langdon
- CAMERa, Peninsula Medical School, Faculty of Health, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK
| | - T Gale
- CAMERa, Peninsula Medical School, Faculty of Health, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK
| | - N Humphries
- Graduate School of Healthcare Management, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - A Knapton
- Strategic Modelling Analysis and Planning Limited (SMAP), Winchester, UK
| | - M Bryce
- CAMERa, Peninsula Medical School, Faculty of Health, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK
| |
Collapse
|
43
|
May S, Könsgen N, Glatt A, Bruch D, Muehlensiepen F, Mählmann S, von Peter S, Pieper D, Neugebauer E, Prediger B. Does the second opinion directive in Germany reach the patient? A parallel-convergent mixed-methods study. BMC Health Serv Res 2023; 23:1198. [PMID: 37924040 PMCID: PMC10623803 DOI: 10.1186/s12913-023-10197-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/23/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND A Second Opinion Directive (SOD) was introduced in Germany in December 2018 for elective surgeries such as hysterectomy, tonsillotomy, tonsillectomy, and shoulder arthroscopy. The aim of the SOD is to avoid surgeries which are not medically induced and to support patients in their decision-making process. A physician who indicates an SOD-relevant procedure must inform the patient about the SOD and its specifications. At this time, it is not clear whether physicians provide information about the SOD to patients and whether and how the SOD is implemented in daily practice. Furthermore, nothing is known about how patients react when they are told that they have the right to seek a second opinion according to the SOD. METHODS To assess this, we undertook a parallel-convergent mixed-methods study with a qualitative and quantitative phase. Qualitative data were analysed by structured qualitative content analysis and survey data were analysed descriptively. RESULTS 26 interviews were conducted with patients for whom one of the above-mentioned surgeries was indicated. In parallel, a questionnaire survey with 102 patients was conducted. The results show that the SOD is not implemented in Germany for the selected indications because patients were not informed as intended. At the same time, when the right to obtain a second opinion was explained, it seemed to have a positive effect on the physician-patient relationship from patients` perspective. CONCLUSIONS It is possible that there is a lack of information for physicians, which in turn leads to an information deficit for patients. Better information for physicians might be part of the solution, but a negative attitude towards the SOD might also result in the low education rate. Therefore, in addition, potential patients or even the general population should be better informed about the possibility of obtaining a second opinion.
Collapse
Affiliation(s)
- Susann May
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, 15562, Rüdersdorf, Germany
| | - Nadja Könsgen
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany
| | - Angelina Glatt
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany
| | - Dunja Bruch
- Department of Cardiovascular Surgery, Brandenburg Heart Center, Brandenburg Medical School Theodor Fontane, 16321, Bernau bei Berlin, Germany
- Faculty of Health Sciences, Brandenburg Medical School Theodor Fontane, 16816, Neuruppin, Germany
| | - Felix Muehlensiepen
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, 15562, Rüdersdorf, Germany
- Faculty of Health Sciences, Brandenburg Medical School Theodor Fontane, 16816, Neuruppin, Germany
| | - Sonja Mählmann
- Institute for Health Services and Health System Research, Faculty for Health Sciences, Brandenburg Medical School, 15562, Rüdersdorf, Germany
| | | | - Dawid Pieper
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, 15562, Rüdersdorf, Germany
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany
- Institute for Health Services and Health System Research, Faculty for Health Sciences, Brandenburg Medical School, 15562, Rüdersdorf, Germany
| | - Edmund Neugebauer
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, 15562, Rüdersdorf, Germany
| | - Barbara Prediger
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany.
| |
Collapse
|
44
|
Nagase H, Ito R, Ishii M, Shibata H, Suo S, Mukai I, Zhang S, Rothnie KJ, Trennery C, Yuanita L, Ishii T. Relationship Between Asthma Control Status and Health-Related Quality of Life in Japan: A Cross-Sectional Mixed-Methods Study. Adv Ther 2023; 40:4857-4876. [PMID: 37698717 PMCID: PMC10567960 DOI: 10.1007/s12325-023-02660-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/21/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION There is limited information regarding multidimensional relationships between asthma control and health-related quality of life (HRQoL), work productivity, and asthma symptom burden in Japan. Furthermore, systematic qualitative investigations about asthma burden have not been performed. METHODS This cross-sectional, mixed-methods study included Japanese patients (≥ 20 years) with asthma adherent to inhaled corticosteroids/long-acting β2-agonists (ICS/LABA). The primary endpoint was impact of asthma on HRQoL, measured using the Asthma Health Questionnaire-33 (AHQ-33). Secondary endpoints were cough burden (Japanese-adapted Leicester Cough Questionnaire [J-LCQ]) and impact of asthma on work/activities (asthma-specific Work Productivity and Activity Impairment Questionnaire [WPAI:Asthma]). Quantitative data were assessed for the overall population and for well-controlled (WC) and not well-controlled (NWC) asthma subgroups. Qualitative verbal interviews further assessed the impact of NWC asthma on patients' HRQoL; emergent themes were extracted using thematic analyses. RESULTS Of 454 patients, 45.2% (n = 205) had NWC asthma. Patients with NWC asthma had significantly worse asthma- and cough-related HRQoL across all AHQ-33 and J-LCQ domains and significantly greater work and activity impairment versus patients with WC asthma, across all assessed WPAI:Asthma domains. AHQ-33 total score was highly correlated with J-LCQ total and domain scores (r = - 0.8132 to r = - 0.7407). Nine themes emerged from qualitative interviews and confirmed that patients with NWC asthma had considerable HRQoL impairment due to asthma symptoms. CONCLUSIONS Patients with NWC asthma had higher symptom burden and worse HRQoL than patients with WC asthma, despite ICS/LABA adherence. Cough burden correlated with HRQoL, suggesting cough may be one of the key markers to inform treatment strategy for patients with asthma.
Collapse
Affiliation(s)
- Hiroyuki Nagase
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
| | - Risako Ito
- Value Evidence and Outcomes, GSK, 1-8-1 Akasaka, Minato-ku, Tokyo, 107-0052, Japan.
| | - Moe Ishii
- Mebix, Inc., Minato-ku, Tokyo, Japan
| | | | | | - Isao Mukai
- Medical Affairs Asthma & COPD, GSK, Minato-ku, Tokyo, Japan
| | - Shiyuan Zhang
- Value Evidence and Outcomes, GSK, Collegeville, PA, USA
| | | | | | - Liza Yuanita
- Medical Affairs Asthma & COPD, GSK, Minato-ku, Tokyo, Japan
| | - Takeo Ishii
- Value Evidence and Outcomes, GSK, 1-8-1 Akasaka, Minato-ku, Tokyo, 107-0052, Japan
| |
Collapse
|
45
|
Sivak L, Reilly R, Lockton J, Treloar C, Roe Y, McKetin R, Butt J, Ezard N, Winkenweder H, Ward J. Psychosocial stress and methamphetamine use: A mixed-methods study of intersectional stigma and Aboriginal and Torres Strait Islander methamphetamine use. Int J Drug Policy 2023; 121:104189. [PMID: 37708599 DOI: 10.1016/j.drugpo.2023.104189] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/09/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Regular methamphetamine use can cause a range of physical, psychological and social harms. Stigma is one factor that impacts engagement and successful completion of treatment. In Australia, Aboriginal and Torres Strait Islander people who regularly use methamphetamine experience multiple stigmas, which further compounds access to treatment and quality of life. This paper explores the cumulative and compounding effects of participating in a stigmatised activity such as illicit drug use in relation to the stigma experienced by Aboriginal and Torres Strait Islander people as a population marginalised through colonisation. METHODS Ten sites nationally participated in a cross-sectional survey measuring a range of factors including psychosocial stress in methamphetamine users. The survey sample size was 734, with 59% identifying as Aboriginal and Torres Strait Islander (n = 433). In addition, a total of 147 mainly Aboriginal and Torres Strait Islander people who use methamphetamine, community and family members, and service providers took part in a total of 19 focus groups and 7 interviews. RESULTS Aboriginal and Torres Strait Islander participants experienced multiple psychosocial stressors at significantly higher rates than non-Indigenous participants. These stressors include diminished access to health care (33%), experiences of racism (34%), grief and sorrow (39%), worry for family (46%), and child welfare experiences (46%). The qualitative findings highlight the cumulative impact of historical, political and social stressors on an already stigmatised population. CONCLUSIONS The findings of this unique analysis demonstrate the disruptive impact of methamphetamine use on the lives of those who use methamphetamines and their family members. They also illustrate challenges, such as stigma, that may confront those seeking assistance for drug-related issues. Aboriginal and Torres Strait Islander community involvement is necessary to provide support and education for the individual, the family, and the community as a whole. Stigma reduction is therefore a worthy target for intervention.
Collapse
Affiliation(s)
- Leda Sivak
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Australia.
| | - Rachel Reilly
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Australia; School of Psychology, University of Adelaide, Australia
| | - Jane Lockton
- School of Psychology, University of Adelaide, Australia
| | - Carla Treloar
- Centre for Social Research in Health and the Social Policy Research Centre, University of New South Wales, Australia
| | - Yvette Roe
- Molly Wardaguga Research Centre, Charles Darwin University, Australia
| | - Rebecca McKetin
- National Drug and Alcohol Research Centre, University of New South Wales, Australia
| | - Julia Butt
- School of Arts and Humanities, Edith Cowan University, Australia
| | - Nadine Ezard
- National Drug and Alcohol Research Centre, University of New South Wales, Australia
| | | | - James Ward
- Poche Centre for Indigenous Health, University of Queensland, Australia
| |
Collapse
|
46
|
Whelan M, Ghosh I, Bell L, Oyebode O. How and to what extent did the Coventry City of Culture 'City Host' volunteer programme effect the volunteers' mental wellbeing? A qualitative study. BMC Public Health 2023; 23:2044. [PMID: 37858071 PMCID: PMC10588047 DOI: 10.1186/s12889-023-16862-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND A team of volunteers, known as City Hosts, were recruited to support UK City of Culture 2021 awarded to Coventry. City Hosts held various roles facilitating cultural event delivery and promoting a positive experience for visitors. This study aimed to (i) understand how and to what extent the volunteering programme impacted volunteer subjective wellbeing, and (ii) explore the mechanisms of change and intermediate outcomes between volunteering and subjective wellbeing. METHODS This qualitative study comprised inductive and deductive analysis of data collected through semi-structured interviews, conducted between December 2021-May 2022 with City Hosts. This was complimented with secondary qualitative analysis of free text responses within Monitoring and Evaluation data collected from City Hosts in surveys conducted in August and November 2021, and April 2022. RESULTS Approximately 180 City Hosts responded to the free text questions in each survey and 27 completed interviews. Analysis of data collected from City Hosts suggested positive wellbeing impacts from volunteering and supported theorised pathways to improved wellbeing. Strengths of the City Host programme included (i) facilitating the full range of mechanisms of change that mediate improved volunteer wellbeing, particularly promoting social connections and developing a strong role and group identity and (ii) flexibility around what volunteers do, how much, and how often. CONCLUSIONS This study offers lessons for others designing volunteering programmes who wish to promote wellbeing among associated volunteers. We also offer evidence that exposure to culture may be one mechanism by which volunteering can improve wellbeing.
Collapse
Affiliation(s)
- Maxine Whelan
- Institute for Health and Wellbeing , Coventry University, Coventry, UK
| | - Iman Ghosh
- Warwick Evidence, University of Warwick, Coventry, UK
| | - Lauren Bell
- Institute for Health and Wellbeing , Coventry University, Coventry, UK
| | - Oyinlola Oyebode
- Queen Mary University of London, Wolfson Institute of Population Health, London, UK.
| |
Collapse
|
47
|
Cross FL, Wileden L, Buyuktur AG, Platt J, Morenoff JD, Aramburu J, Militzer M, Esqueda AP, Movva P, Zhao Z, Sawant K, Valbuena F, Bailey S, Israel B, Marsh EE, Woolford SJ. MICEAL Black and Latinx Perspectives on COVID-19 Vaccination: A Mixed-Methods Examination. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01815-y. [PMID: 37815755 DOI: 10.1007/s40615-023-01815-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/19/2023] [Accepted: 09/19/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVES To describe the differences and similarities in perceptions and attitudes regarding COVID-19 vaccination among Black and Latinx Michiganders. METHODS Utilizing a convergent mixed-methods approach, forty interviews were conducted with 24 Black and 16 Latinx community members between December 2020 and June 2021 across four Michigan counties disproportionately affected by COVID-19. Survey data were collected from a representative sample of 1598 individuals living in Detroit between January and March 2021. RESULTS Vaccine hesitancy was a more prevalent theme among Black interview participants than Latinx participants. Trust in experts and vaccine access were significantly more influential in the decision to vaccinate for Latinx residents compared to Black residents. Latinx individuals reported greater intention to receive a COVID-19 vaccine compared to Black respondents. Multinomial logit models revealed that 30% of Black participants expressed hesitancy about the COVID-19 vaccine compared to 10% of Latinx respondents. CONCLUSIONS AND IMPLICATIONS This study provides a deeper understanding of key differences and similarities in vaccine acceptance/hesitancy across race/ethnicity. The findings can enhance health interventions and outcomes by informing the development of culturally responsive practices tailored to specific communities.
Collapse
Affiliation(s)
- Fernanda L Cross
- School of Social Work, University of Michigan, Ann Arbor, MI, USA.
| | - Lydia Wileden
- Mansueto Institute for Urban Innovation, Division of the Social Sciences, University of Chicago, Chicago, IL, USA
| | - Ayse G Buyuktur
- School of Information, University of Michigan, Ann Arbor, MI, USA
| | - Jodyn Platt
- Department of Learning Health Sciences, Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey D Morenoff
- Gerald R. Ford School of Public Policy, Department of Sociology, and Population Studies Center, University of Michigan, Ann Arbor, MI, USA
| | - Jasmin Aramburu
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Maria Militzer
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Pranati Movva
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Ziyu Zhao
- Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kashmira Sawant
- School of Information, University of Michigan, Ann Arbor, MI, USA
| | - Felix Valbuena
- Community Health and Social Services Center, Detroit, MI, USA
| | - Sarah Bailey
- Michigan Institute for Clinical & Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Barbara Israel
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Erica E Marsh
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Susan J Woolford
- Susan B Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
48
|
Hardin B, Graboyes M, Kosty D, Cioffi C. Vaccine decision making among people who inject drugs: Improving on the WHO's 3C model of vaccine hesitancy. Prev Med Rep 2023; 35:102341. [PMID: 37593355 PMCID: PMC10428103 DOI: 10.1016/j.pmedr.2023.102341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/19/2023] Open
Abstract
The objectives of this study were to 1) identify vaccination rates among PWID in Oregon at a time when vaccines were easily accessible, 2) quantitatively identify convergence with demographic correlates of vaccination willingness and uptake to promote generalizability, and 3) explore the factors PWID were considering when deciding whether or not to receive the COVID-19 vaccine. We conducted a mixed-methods study design including 260 quantitative surveys and 41 in-depth qualitative interviews with PWID, conducted July - September 2021 at syringe services programs in Lane County, Oregon. Among the 260 survey respondents, 37.3% indicated that they had received a COVID-19 vaccine by October 1, 2021. In the same period, an estimated 70.1% of the total Lane County population had completed their COVID-19 vaccinations (not including booster rounds). We explored alignment with the WHO's 3C model of vaccine hesitancy and identified, instead, five common factors as key motivators for vaccine decisions: confidence, convenience, concern, communication, and community implications among PWID. Interviews with PWID describe systemic barriers which prevented them from accessing healthcare resources. We highlight that our proposed 5C model may more accurately depict how PWID navigate vaccine decisions by incorporating the ways that social inequities, infrastructural barriers, and community values influence an individual's vaccine deliberation.
Collapse
Affiliation(s)
- Blake Hardin
- Department of Global Studies, University of Oregon, United States
| | | | - Derek Kosty
- Prevention Science Institute, University of Oregon, United States
| | - Camille Cioffi
- Prevention Science Institute, University of Oregon, United States
| |
Collapse
|
49
|
Mendenhall R, Lee MJ, Cole SW, Morrow R, Rodriguez-Zas SL, Henderson L, Turi KN, Greenlee A. Black Mothers in Racially Segregated Neighborhoods Embodying Structural Violence: PTSD and Depressive Symptoms on the South Side of Chicago. J Racial Ethn Health Disparities 2023; 10:2513-2527. [PMID: 36715821 PMCID: PMC9885931 DOI: 10.1007/s40615-022-01432-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 01/31/2023]
Abstract
This study employs multi-level and mixed-methods approaches to examine how structural violence affects the health of low-income, single Black mothers. We use multilevel regression models to examine how feeling "trapped" in racially segregated neighborhoods with high levels of violence on the South Side of Chicago affects mothers' (N = 69) reports of posttraumatic stress disorder and depressive symptoms. The relationship between feeling "trapped" and variations in expression of mRNA for the glucocorticoid receptor gene NR3C1 using microarray assays was also examined. The regression models revealed that feeling "trapped" significantly predicted increased mental distress in the form of PTSD, depressive symptoms, and glucocorticoid receptor gene regulation. The mothers' voices revealed a nuanced understanding about how a lack of financial resources to move out of the neighborhood creates feelings of being "trapped" in dangerous situations.
Collapse
Affiliation(s)
- Ruby Mendenhall
- Department of African American Studies, Carle Illinois College of Medicine, 702 S. Wright Ave, Urbana, IL 61822 USA
- Department of Sociology, University of Illinois, Urbana-Champaign, 702 South Wright St, Champaign, IL 61820 USA
| | - Meggan J. Lee
- Department of Sociology, University of Illinois, Urbana-Champaign, 702 South Wright St, Champaign, IL 61820 USA
| | - Steven W. Cole
- Department of Psychiatry & Biobehavioral Sciences and Medicine, UCLA School of Medicine, 11-934 Factor Building, Los Angeles, CA 90095 USA
| | - Rebecca Morrow
- Department of Criminal Justice, Tarleton State University, 1333 Washington Street, Stephenville, TX T-0665 USA
| | - Sandra L. Rodriguez-Zas
- Department of Animal Sciences, University of Illinois, Urbana-Champaign, 306 Animal Sciences Laboratory, 1207 W. Gregory Dr., Urbana, IL 61801 USA
| | - Loren Henderson
- School of Public Policy, University of Maryland, Baltimore County, Public Policy Building, Fourth Floor, 1000 Hilltop Circle, Baltimore, MD 21250 USA
| | - Kedir N. Turi
- Center for Asthma Research, Vanderbilt University School of Medicine, 1215 21ts Ave South, 6000 Medical Center East, North Tower, Nashville, TN 37232 USA
| | - Andrew Greenlee
- Department of Urban and Regional Planning, University of Illinois, Urbana-Champaign 611 Taft Drive, Champaign, IL 61820 USA
| |
Collapse
|
50
|
Lukey A, Mackay M, Hasan K, Rush KL. A Pre-Post, Mixed-Methods Study to Pilot Test a Gamified Heart Failure Self-Care Education Intervention. Games Health J 2023; 12:385-396. [PMID: 37582271 DOI: 10.1089/g4h.2022.0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Abstract
Objective: Self-care is essential to improving heart failure patient outcomes. However, the knowledge and behaviours necessary for self-care decision making, such as symptom perception and management, are complex and require patient education. The objective of this study was to test the feasibility, acceptability, and potential effectiveness of a web-based, gamified heart failure patient education solution, Heart Self-Care Patient Education (HeartSCaPE), that used narrative and virtual reward gamification techniques. Materials and Methods: This mixed-methods study used a pre-post-test design with an embedded explanatory qualitative phase. Patients completed the Self-Care of Heart Failure Index, that measured self-care behaviour change and the Dutch Heart Failure Knowledge Scale, used to measure heart failure knowledge. Usability measures of HeartSCaPE were tracked using Google Analytics and the System Usability Scale. Results: Nineteen patients completed the study, with a subset of six participating in semi-structured interviews. We found increases in HF knowledge despite high baseline knowledge scores. Post-intervention self-reported HF self-care behaviours (maintenance, management and confidence), as measured by the Self-Care of Heart Failure Index, were also improved. Knowledge and self-care scores were not correlated. Participants also scored HeartSCaPE as highly usable. In interviews, participants described valuing the opportunity to practice self-care decision-making. There were mixed opinions regarding the use of virtual rewards. Conclusion: We found that a gamified web-based solution that uses narrative and reward-based gamification techniques has the potential to improve HF patient knowledge and self-care. Further research is needed to confirm the study's clinical benefits and address technology literacy inequities.
Collapse
Affiliation(s)
- Alexandra Lukey
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Martha Mackay
- School of Nursing, University of British Columbia, Vancouver, Canada
- Center for Health Evaluation and Outcomes Sciences, Vancouver, Canada
| | - Khalad Hasan
- Computer Science, University of British Columbia Okanagan, Kelowna, Canada
| | - Kathy L Rush
- School of Nursing, University of British Columbia Okanagan, Kelowna, Canada
| |
Collapse
|