Patient experiences on the quality of cerebrovascular diseases counselling using digital solutions in hospital-A qualitative research study

AIM

To describe patients' experiences of the quality of counselling to develop new digital counselling solutions for patients with cerebrovascular disease.

DESIGN

A descriptive, qualitative approach.

METHODS

Semi-structured in-person interviews were conducted among 22 patients diagnosed with acute cerebrovascular disease and treated as inpatients at a single university hospital in Finland between September 2021 and February 2022. Data were analysed using deductive and inductive content analysis.

RESULTS

The identified facilitators, barriers and possible solutions for the development of new digital counselling solutions were deductively categorized into five main categories: (1) background factors, (2) resources, (3) implementation, (4) sufficiency, and (5) effects and 12 generic categories. Patients with cerebrovascular diseases worry about symptoms affecting their ability to receive information and valued a supportive atmosphere. Staff should have more time for counselling and use motivational digital counselling solutions in plain language, moderate length and with multimedia content. Patients desired reminders, easy search functions and possibilities for two-way communication.

CONCLUSION

New digital counselling solutions could be beneficial in supporting the patients' knowledge, emotions and adherence. For the success of such solutions, patients' special needs concerning different levels of cognitive impairment need to be considered.

IMPACT

The results of this study may benefit healthcare organizations in the development of digital counselling solutions that meet the patients' needs.

REPORTING METHOD

We have adhered to relevant EQUATOR guidelines with the COREQ reporting method.

PATIENT OR PUBLIC CONTRIBUTION

Patients were involved as the study population.

Coping with Animal Companion Loss: A Thematic Analysis of Pet Bereavement Counselling

Face-to-face 'Pet Bereavement Counselling' (PBC) has been established in private practice to support bereaved animal companion owners, however, to date no research has been conducted on PBC. This study aimed to contribute to the existing knowledge base on animal companion loss and provide a preliminary research base on the potential salience of PBC. Six qualified and accredited PBC therapists were recruited and took part in semi-structured interviews. An inductive thematic analysis revealed participants' perspectives on the acknowledgement of animal companion loss societally and within counselling professions, the diverse ways animal companion loss can impact on bereaved owners, as well as the distinctive attributes and delivery of PBC. The findings have implications for how animal companion loss is conceptualised within counselling professions, teaching and research. Future research recommendations include exploring how bereaved owners experience PBC and how mental health professionals can build upon the support provided to bereaved owners.

Nurses' experiences of competence in lifestyle counselling with adult patients in healthcare settings: A qualitative systematic literature review

AIMS AND OBJECTIVES

To identify and synthesise nurses' experiences of competence in lifestyle counselling with adult patients in healthcare settings.

BACKGROUND

Modifiable lifestyle risk behaviours contribute to an increased prevalence of chronic diseases worldwide. Lifestyle counselling is part of nurses' role which enables them to make a significant contribution to patients' long-term health in various healthcare contexts, but requires particular competence.

DESIGN

Qualitative systematic literature review and meta-aggregation.

METHOD

The review was guided by Joanna Briggs Institute's methodology for conducting synthesis of qualitative studies. PRISMA-checklist guided the review process. Relevant original studies were search from databases (CINAHL, PubMed, Scopus, Medic and Psych Articles, Ebscho Open Dissertations and Web of Science). After researcher consensus was reached and quality of the studies evaluated, 20 studies were subjected to meta-aggregation.

RESULTS

From 20 studies meeting the inclusion criteria, 75 findings were extracted and categorised into 13 groups based on their meaning, resulting in the identification of 5 synthesised findings for competence description: Supporting healthy lifestyle adherence, creating interactive and patient-centred counselling situations, acquiring competence through clinical experience and continuous self-improvement, collaborating with other professionals and patients, planning lifestyle counselling and managing work across various stages of the patient's disease care path.

CONCLUSION

The review provides an evidence base that can be used to support nurses' competence in lifestyle counselling when working with adult patients in healthcare settings. Lifestyle counselling competence is a complex and rather abstract phenomenon. The review identified, analysed and synthesised the evidence derived from nurses' experience which shows that lifestyle counselling competence is a multidimensional entity which relates to many other competencies within nurses' work.

IMPLICATIONS FOR THE PROFESSION

Recognising the competencies of nurses in lifestyle counselling for adult patients can stimulate nurses' motivation. The acquisition of these competencies can have a positive impact on patients' lives and their health.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

IMPACT

The research may enhance nurses' competence in lifestyle counselling, leading to improved health outcomes, better adherence to recommendations and overall well-being. It may also drive the development of interventions, improving healthcare delivery in lifestyle counselling.

REPORTING METHOD

The review was undertaken and reported using the PRISMA guidelines.

PROTOCOL REGISTRATION

Blinded for the review.

The role of an artificial intelligence model in antiretroviral therapy counselling and advice for people living with HIV

OBJECTIVES

People living with HIV may find personalized access to accurate information on antiretroviral therapy (ART) challenging given the stigma and costs potentially associated with attending physical consultations. Artificial intelligence (AI) chatbots such as ChatGPT may help to lower barriers to accessing information addressing concerns around ART initiation. However, the safety and accuracy of the information provided remains to be studied.

METHODS

We instructed ChatGPT to answer questions that people living with HIV frequently ask about ART, covering i) knowledge of and access to ART; ii) ART initiation, side effects, and adherence, and iii) general sexual health practices while receiving ART. We checked the accuracy of the advice against international HIV clinical practice guidelines.

RESULTS

ChatGPT answered all questions accurately and comprehensively. It recognized potentially life-threatening scenarios such as abacavir hypersensitivity reaction and gave appropriate advice. However, in certain contexts, such as specific geographic locations or for pregnant individuals, the advice lacked specificity to an individual's unique circumstances and may be inadequate. Nevertheless, ChatGPT consistently re-directed the individual to seek help from a healthcare professional to obtain targeted advice.

CONCLUSIONS

ChatGPT may act as a useful adjunct in the process of ART counselling for people living with HIV. Improving access to information on and knowledge about ART may improve access and adherence to ART and outcomes for people living with HIV overall.

Counseling, informed consent, and debriefing for cesarean section in sub-Saharan Africa: A scoping review

BACKGROUND

Counseling as part of the informed consent process is a prerequisite for cesarean section (CS). Postnatal debriefing allows women to explore their CS with their healthcare providers (HCPs).

OBJECTIVES

To describe the practices and experiences of counseling and debriefing, the barriers and facilitators to informed consent for CS; and to document the effectiveness of the interventions used to improve informed consent found in the peer-reviewed literature.

SEARCH STRATEGY

The databases searched were PubMed, EMBASE, PsycINFO, Africa-wide information, African Index Medicus, IMSEAR and LILACS.

SELECTION CRITERIA

English-language papers focusing on consent for CS, published between 2011 and 2022, and assessed to be of medium to high quality were included.

DATA COLLECTION AND ANALYSIS

A narrative synthesis was conducted using Beauchamp and Childress's elements of informed consent as a framework.

MAIN RESULTS

Among the 21 included studies reporting on consent for CS, 12 papers reported on counseling for CS, while only one reported on debriefing. Barriers were identified at the service, woman, provider, and societal levels. Facilitators all operated at the provider level and interventions operated at the service or provider levels.

CONCLUSIONS

There is a paucity of research on informed consent, counseling, and debriefing for CS in sub-Saharan Africa.

Nutrition counselling and clinical outcomes in HIV: A systematic review and meta-analysis

BACKGROUND

People living with the HIV (PLHIV) are at an increased risk of various diseases due to a weakened immune system, particularly if they are naïve or poorly adherent to antiretroviral therapy (ART). Nutrients play a critical role in improving immune health, especially among this population. We systematically reviewed the evidence concerning the impact of nutritional counselling on the occurrence of important clinical outcomes among PLHIV.

METHODS

Medical literature databases (PubMed, EMBASE and Web of Science) were searched from inception to October 2022 for relevant published studies (n = 12) of nutritional counselling and HIV-related outcomes in adults on ART. Random-effects meta-analyses were conducted when the exposure-outcome relationships were similar in three or more studies.

RESULTS

Although the methodologies of nutritional intervention varied across all studies, overall, the evidence from the meta-analysis indicates a nsignificant positive association between nutrition counselling and improvements in CD4 cell count, body mass index and low-density lipoprotein concentration. However, the existing literature does not provide enough evidence to establish a significant impact of nutrition counselling on other immune, anthropometric, and metabolic outcomes including viral load, weight, and lean mass due to the differences in the study designs.

CONCLUSION

Well-powered randomized controlled trials are needed that explore the effect of evidence-based, individualized nutrition counselling on HIV-related clinical outcomes.

Ten Years Analysis of Parental Counselling-in-Continuum in Paediatric Surgery: Psychosocial and Medico-legal Outcome

BACKGROUND

Parents are anxious and apprehensive about the health of their children. A standardised, reproducible and meticulous parental counselling is helpful to both the parents and the treating doctors, as well as markedly reduces instances of scrimmage and medico-legal litigations. The aim of this study is to assess the psychosocial and medico-legal outcomes of parental counselling-in-continuum (PCiC) in paediatric surgery.

MATERIALS AND METHODS

The study was conducted at two government-run Tertiary Healthcare Centres in North India. The study design involves prospective feedback-based study. It included all the admitted paediatric surgery patients. Periodic multisession PCiC was done for each patient by three paediatric surgery teams from 2011 to 2021. At the time of discharge, feedback was taken to assess the psychosocial outcome of PCiC, and the medico-legal outcome was calculated based on the number of litigations.

RESULTS

A total of 22,353 admissions were done in paediatric wards at these institutes. 1574 cases were managed conservatively and 20,779 patients who underwent surgeries were included in the study. 4758 (22.89%) were emergency procedures and 16,021 (77.11%) were elective procedures. Parents rated the counselling efforts excellent in 18,285 (81.80%), good in 3162 (14.14%), satisfactory in 876 (3.91%) and poor in 30 (0.13%) cases with zero medico-legal litigations and 12 incidents of scrimmage.

CONCLUSIONS

PCiC, being a novel concept, should form a centerpiece of paediatric surgical management as it maximally enhances the patient satisfaction level and protects the treating paediatric surgical team from scrimmage and medico-legal litigations.

Development of the generic Community Infant and Young Child Feeding Counselling Package

Infant and young child feeding (IYCF) promotion is a key component in the set of high impact interventions to improve nutrition. The literature provides evidence of the positive impact of IYCF promotion through various platforms, including communities. In 2009, UNICEF and WHO agreed that a global, "generic" IYCF package of resources and tools to plan, implement, and monitor community-based IYCF programmes and to build skills of community-based workers was needed. In 2010, the UNICEF Community Infant and Young Child Feeding Counselling Package was finalized and field tested under a strategic collaboration between UNICEF New York and Nutrition Policy and Practice and the Center for Human Services/University Research Company. The Package includes 11 tools to guide adaptation of the materials, the design, planning, and implementation of IYCF programmes and the training, monitoring, supervision, and mentoring of community workers, using an interactive and experiential adult learning approach. The Package was rolled out from 2011 onwards and by 2017 was implemented in 87 countries. In 2013, UNICEF and the United States Agency for International Development-funded Strengthening Partnerships, Results, and Innovations in Nutrition Globally project started planning the evaluation, and a study site was selected in Nigeria to assess the efficacy and effectiveness of the Package on IYCF practices, knowledge, and worker skills. This article describes the need for and development of the Package, its content and approach to skills building, as well as its current implementation. Finally, it makes the case for the evaluation of the Package, which is covered in the other papers in the Supplement in relation to the Nigeria evaluation.

The Urgent Need for an Evidence-Based Digital Mental Health Practice Model of Care for Youth

Australian providers of mental health services and support for young people include private and public allied health providers, government initiatives (eg, headspace), nongovernment organizations (eg, Kids Helpline), general practitioners (GPs), and the hospital system. Over 20 years of research has established that many young people prefer to seek mental health support online; however, clear client pathways within and between online and offline mental health services are currently lacking. The authors propose a Digital Mental Health Practice model of care for youth to assist with digital mental health service mapping. The proposed model offers accessible pathways for a client to engage with digital mental health services, provides clear navigation to access support for individual needs, and facilitates a seamless connection with offline mental health services using a transferable electronic health records system. This future-looking model also includes emerging technologies, such as artificial intelligence and the metaverse, which must be accounted for as potential tools to be leveraged for digital therapies and support systems. The urgent need for a user-centered Digital Mental Health Practice model of care for youth in Australia is discussed, highlighting the shortcomings of traditional and existing online triage models evident during the COVID-19 pandemic, and the complex challenges that must be overcome, such as the integration of diverse mental health care providers and establishment of a robust electronic health records system. Potential benefits of such a model include reduced pressure on emergency rooms, improved identification of immediate needs, enhanced referral practices, and the establishment of a cost-efficient national digital mental health care model with global applicability. The authors conclude by stressing the consequences of inaction, warning that delays may lead to more complex challenges as new technologies emerge and exacerbate the long-term negative consequences of poor mental health management on the economic and biopsychosocial well-being of young Australians.

Navigating fertility dilemmas across the lifespan in girls with Turner syndrome-a scoping review

BACKGROUND

Girls with Turner syndrome (TS) lack a partial or complete sex chromosome, which causes an accelerated decline of their ovarian reserve. Girls have to deal with several dilemmas related to their fertility, while only a limited number of them are referred to a fertility specialist and counselled about options of family planning on time.

OBJECTIVE AND RATIONALE

This scoping review provides an update of the literature on fertility in girls with TS throughout their lifespan and aims to propose a clinical practice guideline on fertility in TS.

SEARCH METHODS

Databases of PubMed, Embase, and Web of science were searched using the following key terms: Turner syndrome, fertility, puberty, pregnancy, sex-hormones, karyotype, fertility preservation, assisted reproductive techniques, and counselling, alongside relevant subject headings and synonymous terms. English language articles published since 2007 were critically reviewed. Pregnancies after using donated oocytes and data about girls with TS with Y-chromosomal content were excluded.

OUTCOMES

This search identified 1269 studies of which 120 were extracted for the review. The prevalence of natural conception ranged from 15% to 48% in women with 45,X/46,XX, 1% to 3% in women with 45,X, and 4% to 9% in women with other TS karyotypes. When assessing a girl's fertility potential, it was crucial to determine the karyotype in two cell lines, because hidden mosaicism may exist. In addition to karyotype, assessment of anti-Müllerian hormone (AMH) played a significant role in estimating ovarian function. Girls with AMH above the detection limit were most likely to experience spontaneous thelarche, menarche, and ongoing ovarian function during the reproductive lifespan. Fertility preservation became more routine practice: vitrification of oocytes was reported in 58 girls with TS and a median of five oocytes were preserved per stimulation. Ovarian tissue cryopreservation has demonstrated the presence of follicles in approximately 30% of girls with TS, mostly in girls with mosaic-TS, spontaneous puberty, and AMH above the detection limit. Although girls and their parents appreciated receiving counselling on fertility in TS, only one in ten girls with TS received specialized counselling. Unfamiliarity with fertility preservation techniques or uncertainties regarding the eligibility of a girl for fertility preservation constituted barriers for healthcare professionals when discussing fertility with girls with TS.

WIDER IMPLICATIONS

There currently is a high demand for fertility preservation techniques in girls with TS. A reliable prognostic model to determine which girls with TS might benefit from fertility preservation is lacking. Only a minority of these girls received comprehensive fertility counselling on the full spectrum of fertility, including uncertainties of fertility preservation, pregnancy risks, and alternatives, such as adoption. Fertility preservation could be a viable option for girls with TS. However, the question remains whether enough oocytes can be obtained for a realistic prospect of a live birth. It is important that girls and parents are empowered with the necessary information to make a well-informed decision.

Considering multifetal pregnancy reduction in triplet pregnancies: do we forget the emotional impact on fathers? A qualitative study from The Netherlands

STUDY QUESTION

What factors influence the decision-making process of fathers regarding multifetal pregnancy reduction or maintaining a triplet pregnancy, and how do these decisions impact their psychological well-being?

SUMMARY ANSWER

For fathers, the emotional impact of multifetal pregnancy reduction or caring for triplets is extensive and requires careful consideration.

WHAT IS KNOWN ALREADY

Multifetal pregnancy reduction is a medical procedure with the purpose to reduce the number of fetuses to improve chances of a healthy outcome for both the remaining fetus(es) and the mother, either for medical reasons or social considerations. Aspects of the decision whether to perform multifetal pregnancy reduction have been rarely investigated, and the impact on fathers is unknown.

STUDY DESIGN, SIZE, DURATION

Qualitative study with semi-structured interviews between October 2021 and February 2023.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Fathers either after multifetal pregnancy reduction from triplet to twin or singleton pregnancy or ongoing triplet pregnancies 1-6 years after the decision were included. The interview schedule was designed to explore key aspects related to (i) the decision-making process whether to perform multifetal pregnancy reduction and (ii) the emotional aspects and psychological impact of the decision. Thematic analysis was used to identify patterns and trends in the father's data. The process involved familiarization with the data, defining and naming themes, and producing a final report. This study was a collaboration between a regional secondary hospital (OLVG) and a tertiary care hospital (Amsterdam University Medical Center, Amsterdam UMC), both situated in Amsterdam, The Netherlands.

MAIN RESULTS AND THE ROLE OF CHANCE

Data saturation was achieved after 12 interviews. Five main themes were identified: (i) initial responses and emotional complexity, (ii) experiencing disparities in counselling quality and post-decision care, (iii) personal influences on the decision journey, (iv) navigating parenthood: choices, challenges, and emotional adaptation, and (v) shared wisdom and lessons. For fathers, the decision whether to maintain or reduce a triplet pregnancy is complex, in which medical, psychological but mainly social factors play an important role. In terms of psychological consequences after the decision, this study found that fathers after multifetal pregnancy reduction often struggled with difficult emotions towards the decision; some expressed feelings of doubt or regret and were still processing these emotions. Several fathers after an ongoing triplet had experienced a period of severe stress in the first years after the pregnancy, with major consequences for their mental health. Help in emotional processing was not offered to any of the fathers after the decision or birth.

LIMITATION, REASONS FOR CAUTION

While our study focuses on the multifetal pregnancy reduction process in the Amsterdam region, we recognize the importance of further investigation into how this process may vary across different regions in The Netherlands and internationally. We acknowledge the potential of selection bias, as fathers with more positive experiences might have been more willing to participate. Caution is needed in interpreting the role of the mother in the recruitment process. Additionally, the time span of 1-6 years between the decision and the interviews may have influenced emotional processing and introduced potential reporting bias.

WIDER IMPLICATIONS OF THE FINDINGS

The emotional impact of multifetal pregnancy reduction or caring for triplets is significant, emphasizing the need for awareness among caregivers regarding the emotional challenges faced by fathers. A guided trajectory might optimize the decision-making and primarily facilitate the provision of appropriate care thereafter to optimize outcomes around decisions with potential traumatic implications.

STUDY FUNDING/COMPETING INTEREST(S)

This study received no funding. The authors have no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

N/A.

Physical activity promotion among pregnancy - the role of physician from the women's perspective

Objective

The clear benefits of planned and supervised physical activity (PA) during pregnancy make it imperative that women are encouraged and educated about this activity. This study aimed to investigate how effectively physician promote physical activity and exercise among pregnant women. It also examines pro-health changes in selected health behaviours during pregnancy.

Methods

This cross-sectional study recruited a total of 353 pregnant women in Wielkopolskie Voivodship in Poland. An anonymous survey (on-line or in-paper) was used to assess physical activity before and during pregnancy (with Pregnancy Physical Activity Questionnaire), physical activity self-efficacy, well-being (WHO-5 Well-Being Index), and guidance received from physicians on physical activity during pregnancy.

Results

Only 41% of women surveyed followed WHO recommendations for PA before pregnancy, and they were much more likely to discuss safety and the need to change the intensity or type of PA with their doctor or gynaecologist. Only 23% of women were asked about their PA before pregnancy and less than 40% were encouraged to be active during pregnancy. We observed a higher probability of poor well-being among pregnant women who were inactive before pregnancy (OR = 1.873, 95%CI 1.026 to 3.421, p = 0.041).

Conclusion

Health professionals infrequently educate and motivate women to be physically active during pregnancy. Physician advice, as it is currently perceived by women, seems to be insufficient to help pregnant women meet the recommendations for PA during pregnancy.

Treatments related to temporomandibular disorders among patients with prevalent types of Ehlers-Danlos syndrome in Sweden

The aim of this study was to assess the received TMD treatment modalities and the perceived outcome among the frequent types of EDS. A digital questionnaire was sent to the member of the National Swedish EDS Association during January-March 2022. The subsamples of hypermobile and classical EDS were constructed. Almost 90% reported TMD symptoms. Bite splint therapy, counselling, jaw training and occlusal adjustment were reported as the most common treatments with no statistically significant difference in terms of good effect between the two subsamples. Hypermobile and classical EDS might consider as an entity with regards to TMD.

Identification of Intervention Characteristics Within Diabetes Prevention Programs Using the Template for Intervention Description and Replication: A Scoping Review

OBJECTIVES

Diabetes prevention programs (DPPs) targeting dietary and physical activity behaviour change have been shown to decrease the incidence of type 2 diabetes; however, a more thorough reporting of intervention characteristics is needed to expedite the translation of such programs into different communities. In this scoping review we aim to synthesize how DPPs are being reported and implemented.

METHODS

A scoping review using Arkey and O'Malley methods was conducted in accordance with the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analysis. MEDLINE, CINAHL, PsycINFO, EMBASE, and SPORTDiscus were searched for studies relating to diabetes prevention, and diet/exercise interventions. Only studies delivering a diet/exercise intervention for adults identified as "at risk" for developing type 2 diabetes were included. The Template for Intervention Description and Replication (TIDieR) was used to guide data extraction, and each DPP was scored on a scale from 0 to 2 for how thoroughly it reported each of the items (0 = did not report, 2 = reported in full; total score out of 26).

RESULTS

Of the 25,110 publications screened, 351 (based on 220 programs) met the inclusion criteria and were included for data extraction. No studies comprehensively reported on all TIDieR domains (mean TIDieR score: 15.7 of 26; range 7 to 25). Reporting was particularly poor among domains related to "modifications," "tailoring," and "how well (planned/actual)." "How well (planned)" assesses the intended delivery of an intervention, detailing the initial strategies and components as per the original design, whereas "how well (actual)" evaluates the extent to which the intervention was executed as planned during the study, including any deviations or modifications made in practice.

CONCLUSIONS

Although there is evidence to suggest that DPPs are efficacious, a more thorough reporting of program content and delivery is needed to improve the ability for effective programs to be implemented or translated into different communities.

Vibrant Screens: Remote therapy and counselling through the lens of digital materiality

This article analyses the digital screen as a health technology. In particular, the article asks how screens as a part of therapy settings or counselling practices materialise - or fail to materialise - care. The empirical data comprise interviews with therapy and counselling professionals, whose experiences with technology during the COVID-19 pandemic were my original interest. Adopting a sociomaterial approach to technology use, it scrutinises not only how screens are used, but also how screens themselves act and operate. This approach foregrounds the screen as 'multiple', complicating a dichotomous understanding between in-person therapy and remote therapy. The article argues that the screen operates in a variety of ways that might either facilitate or degrade care and is an essential part of more-than-human care in digitalised societies. Acknowledging the agential capacities of all matter, the article also conceptualises screens as 'vibrant matter'.

Exploring quality of life post sudden onset hearing loss: A convergent parallel approach

BACKGROUND

 Sudden onset hearing loss (SOHL) is rare and presents differently to individuals; hence, it is complex to diagnose. The impact on the quality of life (QoL) varies for individuals and their support structure. However, the exploration of research designs is warranted.

OBJECTIVES

 This study explored the lived experiences of adults post-SOHL diagnosis and the impact on the QoL. Facilitators of emotional and social aspects of counselling provided by audiologists post-SOHL diagnosis were established.

METHOD

 This was a convergent parallel research study. Data were collected from the two primary participants and three secondary participants, face-to-face and telephonically. The Hearing Handicap Inventory for Adults (HHIA) screening tool and the semi-structured interviews were used for data collection. The data sets were analysed independently, viz. descriptive analysis and thematic analysis, to confirm the impact on the QoL post-SOHL diagnosis.

RESULTS

 The HHIA scores obtained were 84% and 50% for P1 and P2, respectively. Key themes that emerged from the interviews revealed that communication difficulties mostly impacted the QoL, which in turn influenced their mental and social well-being. Aural rehabilitation was perceived as ineffective support, thus the inability to reduce the impact on the QoL post-SOHL diagnosis.

CONCLUSION

 The integrated findings indicated the impact on the QoL post-SOHL diagnosis. Convergent parallel methods should be considered by researchers to understand rare auditory pathologies and their impact on the QoL.Contribution: Person-centred care (PCC) and family-centred care (FCC) are facilitators of counselling that audiologists can employ as QoL management strategies post-SOHL diagnosis.

Bereavement Counsellors' Experiences Supporting the Families of Deceased Children Within a German Bereavement Network- A Qualitative Interview Study

Background: The "Bereavement Network Lower Saxony" (BNLS) provides professional bereavement support to families grieving for a child. The present study aimed at exploring the experiences of BNLS bereavement counsellors in providing bereavement support to affected families. Methods: 12 semi-structured qualitative interviews were conducted with bereavement counsellors of the BNLS between June and August 2022. Interviews were recorded, transcribed and analysed using qualitative content analysis, according to Mayring (2010). Results: Bereavement counsellors perceived that grief could be experienced very differently, and thus bereavement support must always be based on the individual needs and resources of bereaved family members. Bereavement counsellors appreciated exchange within the network and supervision to cope with emotional load that arises from compassion for those affected. Conclusions: Bereavement support within a network structure may improve the accessibility of individual support and enable exchange between counsellors, thus ensuring better bereavement support. Public outreach and strategic partnerships with clinics may amplify the positive impact of this support service.

Pregnancy in antiphospholipid syndrome: what should a rheumatologist know?

This review focuses on the management of reproductive issues in women who have antiphospholipid syndrome (APS) or are carriers of antiphospholipid antibodies (aPL). The importance of aPL detection during preconception counselling relies on their pathogenic potential for placental insufficiency and related obstetric complications. The risk of adverse pregnancy outcomes can be minimized by individualized risk stratification and tailored treatment aimed at preventing placental insufficiency. Combination therapy of low-dose acetylsalicylic acid and heparin is the mainstay of prophylaxis during pregnancy; immunomodulation, especially with hydroxychloroquine, should be considered in refractory cases. Supplementary ultrasound surveillance is useful to detect fetal growth restriction and correctly tailor the time of delivery. The individual aPL profile must be considered in the stratification of thrombotic risk, such as during assisted reproduction techniques requiring hormonal ovarian stimulation or during the follow-up after pregnancy in order to prevent the first vascular event.

Exploring the smoking cessation needs of individuals with diabetes using the Information-Motivation-Behavior Skills model

INTRODUCTION

Smoking cessation is an important aspect of diabetes management. Despite the increased risk for diabetes complications when smoking, evidence suggests that people living with type 1 and type 2 diabetes are less likely to quit smoking when compared to those without diabetes. Guided by the Information-Motivation-Behavioral Skills model, this study aimed to identify the needs of individuals living with type 1 and type 2 diabetes to quit smoking.

METHODS

A qualitative descriptive design was adopted. Semi-structured telephone interviews were held between April and June 2021, with 20 former and current Maltese smokers living with type 1 or type 2 diabetes, recruited from the diabetic clinics within the two main acute public hospitals. The interview transcriptions were analyzed using applied thematic analysis.

RESULTS

Individuals with diabetes need more information on the effects of smoking on diabetes to encourage cessation. Preventing diabetic complications was reported as a motivator to quit smoking. However, having diabetes was identified as a challenge to quitting. Participants welcomed the provision of health professional support for quitting smoking, identifying the need to provide smoking cessation support within diabetic clinics. The provision of information on tobacco-associated diabetic complications, by using video messages featuring former smokers' stories was also suggested.

CONCLUSIONS

To promote smoking cessation among individuals with diabetes, they need to be informed about how smoking affects their condition. Utilizing video messages featuring real-life stories of former smokers with diabetes who experienced tobacco-associated diabetic complications may be influential. Additionally, providing diabetes-specific intensive smoking cessation support is crucial to help them quit.

Impact of a post-partum family planning intervention on contraception and fertility in Tanzania: two-year follow-up of a cluster-randomised controlled trial

PURPOSE

We evaluate contraceptive use and pregnancy two years following an intervention in Tanzania, which provided antenatal post-partum family planning counselling and post-partum intrauterine device (PPIUD) services following delivery.

METHODS

We analyse data from five hospitals in Tanzania using a difference-in-difference cluster randomised design, with randomisation at the hospital level. We use women-level data collected at the index birth and a follow-up survey two years later among 6,410 women. Outcomes (overall modern contraceptive use, contraceptive type, pregnancy) are modelled with an intent-to-treat (ITT) approach using linear regression. We compare with the complier average causal effect (CACE) of the intervention among those counselled.

RESULTS

The intervention increased long-term PPIUD use by 5.8 percentage points (95% CI: 0.7-11.2%) through substitution away from other modern methods. There was no impact on overall modern contraceptive prevalence or pregnancy. Only 29% of women reported receiving PPIUD counselling. When accounting for this in the CACE analysis we saw a larger impact with 25.7% percentage point increase in PPIUD use (95% CI: 22.7-28.6%).

CONCLUSION

The intervention provided women an additional contraceptive choice, resulting in higher use of PPIUD over two years. Increase in PPIUD use was brought about by shifting methods, not creating new modern contraceptive users.

Factors associated with dietary behaviour change support in patients: A qualitative study among community nurses

AIM

To explore which factors, influencing dietary behaviour change support among patients by Dutch community nurses (CNs; nurses), are key focal points in training programmes.

BACKGROUND

Nurses have an important role in counselling patients towards healthier dietary behaviour to prevent or delay long-term complications from chronic lifestyle-related diseases. Most nurses do not incorporate dietary behaviour change support in their routines to the fullest potential.

DESIGN

A qualitative descriptive study.

METHODS

Data were collected in the Netherlands in 2018-2019 via semi-structured face-to-face interviews with 18 nurses. Interview guide themes were informed by the COM-B model, using validated descriptions in Dutch. Data were recorded, transcribed and analysed using inductive thematic analysis.

RESULTS

Factors that affected dietary behaviour change support were linked to (1) the nurse (role identity, dietary knowledge and competences such as methodical approach, behaviour change techniques and communication techniques), (2) nurse-patient encounter (building a relationship with a patient, supporting patient autonomy and tailoring the approach) and (3) cooperation and organizational context.

CONCLUSION

It is of utmost importance to pay attention to nurses' role identity regarding dietary behaviour change support, as this underlies professional behaviour. This should be accompanied by improving competences on dietary behaviour change support. Focus on competences regarding the application of behaviour change technique is crucial. Furthermore, having a relationship of trust with a patient was important for discussing sensitive topics such as diet.

IMPACT

The promotion of a healthy diet provides opportunities to contribute to patient autonomy and self-management. Well-fitted training offers for (senior) nurses will lead to improved professional practice of nurses, leading to healthier dietary behaviour of patients.

PATIENT OR PUBLIC CONTRIBUTION

A nurse provided feedback on the interview guide.

Registered nurses' perceptions of healthy lifestyle counselling for immigrants in primary healthcare: A focus group study

BACKGROUND

The use of primary healthcare and health promotion services is low among immigrants compared with native citizens. Immigrants are at risk of developing chronic diseases due to genetics, nutrition and a sedentary lifestyle. Registered nurses play an integral role in teaching, counselling for a healthy lifestyle and care coordination in primary healthcare.

AIM

We aimed to explore the perceptions of registered nurses on healthy lifestyle counselling for preventing type 2 diabetes and other chronic diseases among immigrants in the primary healthcare setting.

DESIGN

We performed a qualitative descriptive study using focus group interviews.

METHODS

Data were collected with semi-structured focus group interviews with a total of 23 registered nurses working in primary healthcare. We recruited the participants by using the purposive sampling method in the primary healthcare setting of four municipalities in Finland. Interviews were audio-recorded, transcribed verbatim and analysed with qualitative inductive content analysis.

RESULTS

The participants' perceptions were related to (1) uniform counselling practice for both immigrants and native citizens, (2) challenges in counselling immigrants, (3) understanding cultural factors influencing immigrant counselling, (4) the need to improve immigrant counselling and (5) utilizing insights from practical experience to improve the counselling service.

CONCLUSIONS

Developing a culturally sensitive health promotion service is suggested to support the health of immigrants. Moreover, both migrant communities and healthcare professionals should be involved in co-designing and implementing health promotion projects through a community-based participatory approach.

IMPACT

Our study contributes to healthcare practice and management by underscoring the need for culturally tailored health promotion services for the at-risk group of immigrants in primary healthcare. Cultural competence in nursing education needs to be reinforced. The provided recommendations inform researchers and policymakers about the health disparities and health needs of immigrants.

PUBLIC CONTRIBUTION

Healthcare professionals were consulted in the study design.

New recommendations for informing patients and gamete donors in assisted reproduction

The number of cycles of assisted reproduction using donor body parts is increasing significantly. In Europe alone, around one hundred thousand children are born each year who have some relationship to three or more parents. The European expert guarantor European Society of Human Reproduction and Embryology therefore issued a recommendation in 2022 to inform donors, recipients and children born in this way. Our article analyses developments in this area and proposes a solution for the Czech Republic. It is necessary for providers to immediately respond to the fact that the anonymity of donation can no longer be guaranteed, and to adapt the content of consultations and informed consents of potential donors and applicants accordingly. Legislation then has two possible solutions: first to adopt a system of "polyparenthoods" or second to fundamentally limit donation cycles.

A qualitative study of public health nurses' perspectives and experiences on nutritional guidance for parents of infants and toddlers

In Norway, public health nurses (PHNs) are responsible for giving parents nutritional knowledge, but limited research describes how they perceive this task. This study explores PHNs' perceptions and experiences on nutritional guidance for parents of infants and toddlers. Semistructured interviews with six PHNs were conducted and transcribed verbatim. Data were subjected to thematic analysis. Five main themes were identified: (1) Dietary guidance for parents is central to the work; (2) PHNs perceive they have parents' trust, and parents are in general open to nutrition counselling; (3) food and meals must be seen in light of the family context; (4) The dialogue must be adapted to the individual family; and (5) PHNs have expertise on nutrition; however, updating knowledge is difficult. Nutritional guidance was perceived by PHNs as a core activity. They felt that they had parents' trust, and that parents were particularly open to nutritional guidance during the first 2 years. Counselling was generally well received, but conversations on overweight were perceived as difficult. PHNs strove to tailor their guidance to individual needs. However, providing guidance on a wide range of issues in different families and cultures could be challenging. They acknowledged a need for updating knowledge but the offer of courses was sparse. Our findings suggest a discrepancy between how nutrition is prioritized in the education of PHNs and what they encounter in clinical practice. In the future, this should be given more attention given the PHNs' unique position to promote healthy eating and long-term health.

Genetics of infertility: a paradigm shift for medically assisted reproduction

The field of reproductive genetics has undergone significant advancements with the completion of the Human Genome Project and the development of high-throughput sequencing techniques. This has led to the identification of numerous genes involved in both male and female infertility, revolutionizing the diagnosis and management of infertility patients. Genetic investigations, including karyotyping, specific genetic tests, and high-throughput sequencing, have become essential in determining the genetic causes of infertility. Moreover, the integration of genetics into reproductive medicine has expanded the scope of care to include not only affected individuals or couples but also their family members. Genetic consultations and counselling play a crucial role in identifying potentially affected relatives and offering tailored therapy and the possibility of fertility preservation. Despite the current limited therapeutic options, an increasing understanding of genotype-phenotype correlations in infertility genes holds promise for improved treatment outcomes. The availability of genetic diagnostic tools has reduced the number of idiopathic infertility cases by providing accurate aetiological diagnoses. The transition from research to clinical practice in reproductive genetics requires the establishment of genetic consultations and data warehousing systems to provide up-to-date information on gene-disease relationships. Overall, the integration of genetics into reproductive medicine has brought about a paradigm shift, emphasizing the familial dimension of infertility and offering new possibilities for personalized care and family planning.

Effects of visual aid on state anxiety, fear and stress level in patients undergoing endoscopy: a randomized controlled trial

OBJECTIVES

The present study aimed to calculate the estimated size and confidence interval for the effects of adding visual aid to counselling on anxiety, stress and fear of patients undergoing upper gastrointestinal endoscopy. The secondary aim was to calculate confidence interval for endoscopy-related variables that predict which patients are likely to benefit from visual aids.

METHOD

In a randomized, single-blind, two arm, parallel group, superiority trial, 232 consecutive patients who were scheduled to undergo either gastroscopy or colonoscopy were randomly divided into two intervention groups; counselling with video of endoscopic procedure and counselling with no-video (n = 116 in each group). Primary outcome was anxiety and secondary outcomes were stress and fear.

RESULTS

One-way ANCOVA showed that there was significant between group differences of anxiety, stress and fear after controlling for the effect of covariates. Planned contrasts revealed that counselling along with visual aid of endoscopy procedure significantly decreased anxiety [Mean difference at post; -4.26 (-4.47, -4.05), p < .001, partial η² = 0.88], stress [-5.35 (-5.63, -5.07), p < .001, partial η² = 0.86] and fear [-2.82 (-2.97, -2.67), p < .001, partial η² = 0.86] compared to counselling alone. Linear regression showed that gender, nature of complaints and concern over seniority of endoscopist were significant negative predictors, however, satisfaction on briefing of endoscopy procedure was significant positive predictor of outcome variables in visual aid condition.

CONCLUSION

The increase in anxiety, acute stress and fear related to endoscopic procedures can be alleviated with psychological counselling coupled with visual aids before the procedure. Visual aid could lead to supplementary benefits in reducing anxiety scores.

TRIAL REGISTRATION

ClinicalTrial.gov Number: NCT05241158. Registered 16/11/2022; https://clinicaltrials.gov/ct2/show/NCT05241158KEY MESSAGESCounselling along with visual aid of endoscopy procedure significantly decreased anxiety, stress and fear as compared to counselling alone.Male patients were less stressed after visual aid intervention as compared to female patients. Patients who had chronic GI symptoms were less stressed after visual aid intervention as compared to those who had acute GI symptoms. Patients who had concern over seniority of endoscopist were less stressed after visual aid intervention as compared to those who had no concerns over seniority.Satisfaction on briefing of endoscopy procedure was significant positive predictor of stress and fear.

Breaking the silence around infertility: a scoping review of interventions addressing infertility-related gendered stigmatisation in low- and middle-income countries

Infertility is a reproductive health concern that deserves attention, as reconfirmed by the 2018 report of the Guttmacher-Lancet Commission on Sexual and Reproductive Health and Rights (SRHR). However, governments and SRHR organisations tend to neglect infertility. We conducted a scoping review of existing interventions aiming to decrease the stigmatisation of infertility in low- and middle-income countries (LMICs). The review consisted of a combination of research methods: academic database (Embase, Socological abstracts, google scholar; resulting in 15 articles), Google and social media searches, and primary data collection (18 key informant interviews and 3 focus group discussions). The results distinguish between infertility stigma interventions targeted at intrapersonal, interpersonal and structural levels of stigma. The review shows that published studies on interventions tackling infertility stigmatisation in LMICs are rare. Nevertheless, we found several interventions at intra- and interpersonal levels aiming to support women and men to cope with and mitigate infertility stigmatisation (e.g. counselling, telephone hotlines, and support groups). A limited number of interventions addressed stigmatisation at a structural level (e.g. empowering infertile women to become financially independent). The review suggests that infertility destigmatisation interventions need to be implemented across all levels. Interventions geared to individuals experiencing infertility should include women and men and also be offered beyond the clinical setting; and interventions should also aim to combat stigmatising attitudes of family or community members. At the structural level, interventions could aim to empower women, reshape masculinities and improve access to and quality of comprehensive fertility care. Interventions should be undertaken by policymakers, professionals, activists, and others working on infertility in LMICs, and accompanied with evaluation research to assess their effectiveness.

Optimising the screening for haemoglobinopathies in pregnancy planning

Haemoglobinopathies are among the most common inherited disorders around the world. In the United States the diagnosis of haemoglobinopathy or a carrier state is made by universal newborn screening. However, many individuals of childbearing age do not know they are a haemoglobinopathy carrier. Screening for common haemoglobinopathies is generally offered as a part of pregnancy planning so that prospective parents can be counselled regarding the risk of having a child with a haemoglobinopathy. Multiple tests exist to screen patients for presence of haemoglobinopathy carrier or disease state; however, it is crucial to order and interpret the results correctly to appropriately counsel couples. In this case series, we describe clinical scenarios where prospective parents were surprised to unexpectedly have a child with sickle cell disease, a haemoglobinopathy that causes severe clinical complications. Through these cases we demonstrate that deficiencies in testing can occur at different levels which may lead to incorrect estimation of the risk of having a child affected by a haemoglobinopathy. Consultation with a haematologist, laboratory medicine specialist, or genetic counsellor should be considered to select the appropriate test and interpret its results.

[The role of mental health support for medical students.]

INTRODUCTION

The mental health of medical students is of critical importance during their medical studies, which can be a long and challenging period. Academic expectations, high workload, and emotional stress can contribute to mental burden and burnout among medical students, placing an increased burden on the healthcare system in the future. Therefore, psychological support and mental health services play a crucial role in medical education.

OBJECTIVE

The aim of this study is to present and examine the role of the Psychological Counseling Service at the University of Pécs Medical School in supporting the mental health of medical students since its establishment in 2007.

METHOD

In this study, we present the combined quantitative and qualitative results from the period between November 2021 and May 2023, as registered by the students and staff utilizing the Service as well as the counseling psychologists working at the Service. The data include the number of consultations, the patterns of the most frequently occurring problems (based on the Counseling Professional Protocol), and the mental well-being of the population receiving psychological support (GHQ-12).

RESULTS

During the examined period, a total of 1111 individuals made use of the Service in 2012 appointments. Both students and staff most commonly sought assistance from the Service in addressing relationship difficulties (37.6%) and coping with negative life events (33.1%). Based on the data collected since October 2022 (n = 113), nearly 10% of the attendees were taking medication for psychiatric treatment, a significantly higher percentage among international students. Furthermore, 38.9% had previously received professional help. The average score on the GHQ-12 questionnaire is 8 points, which is significantly above the 5-point threshold achieved by 78.6% of respondents.

CONCLUSION

The results demonstrate that the Psychological Counseling Service at the University of Pécs Medical School plays a significant role in supporting the mental health of medical students. It contributes to more effective coping with academic challenges, reducing the risk of emotional stress and burnout. Orv Hetil. 2023; 164(45): 1778-1786.

From fixer to facilitator: an interpretative phenomenological study of diabetes person-centred counselling and empowerment-based education

Background

The purpose of this study is to explore the professional and personal experiences of multidisciplinary healthcare professionals during and following diabetes counselling and empowerment-based education.

Methods

Everyone who had participated in a diabetes counselling and empowerment course between 2008-2016 was invited to respond to an online survey and follow-up telephone interview if willing. Interviews were recorded and transcribed verbatim. The research team used interpretative phenomenology to identify core themes from both the survey and telephone interviews and which captured the impact of empowerment-based education.

Results

22 doctors, nurses, dieticians, and psychologists completed an online questionnaire. 10 subsequently took part in telephone interviews. Empowerment-based education changed them from fixers to facilitators. Their transformation included a sense of becoming authentic, 'being the way I want to be' in clinical practice and becoming more self-reflective. This affected them personally as well as reinvigorating them professionally.

Conclusions

The participants described a personal and professional journey of transformation that included discovering their person-centred philosophy. They adopted a consultation structure that empowered people with diabetes to care for themselves. It can be speculated that participants' experience of transformation may also guard against professional burnout.

Behavioural interventions for tobacco cessation in India: A systematic review and meta-analysis

Tobacco consumption is an area of public health concern in India. One of the unmet needs of many low-resource countries is to provide cost-effective tobacco cessation interventions for reducing tobacco-related mortality. This article reviews studies on non-pharmacological interventions for tobacco cessation in India. A systematic review by PICO (population, intervention, comparison, outcome) of behavioural intervention-based tobacco cessation studies that met the inclusion criteria, with a minimum 1-month follow-up, reporting outcomes in terms of frequencies or percentages published between 2010 and 2020 was performed. Following the review stages, 16 studies comprising 9,613 participants were included in the review. A pooled estimate was derived using both fixed-effects and random-effects models. The intervention showed good overall efficacy for any tobacco user (relative risk [RR] = 1.73 [95% confidence interval [CI]: 1.58-1.90) (fixed-effect model)] and (RR = 2.02 [95% CI: 1.64-2.48] [random-effects model]). Behavioural intervention studies targeted towards only smokers (RR of 1.81 [95% CI: 1.55-2.11] and 1.96 [95% CI: 1.52-2.53]) and combined smoking and smokeless tobacco users (RR of 1.69 [95% CI: 1.50-1.90] and 2.12 [95% CI: 1.49-3.01]) were equally efficacious. The review provides the effectiveness of behavioural interventions in quitting tobacco among users of both smoking and smokeless forms of tobacco. The review findings are of particular significance to inform health policy decisions on the integration of cost-effective brief behavioural intervention into existing health care services in resource-constrained countries.

Intensive care professionals' perceptions of the quality of counselling provided in the ICU: A cross-sectional study

BACKGROUND

Intensive care professionals (ICPs) have a key role in counselling adult intensive care unit (ICU) patients and their family members. The counselling provided to ICU patients and their family members can be described based on the content, implementation, benefits, and resources.

AIMS

The study had two specific aims: first, to assess ICPs' perceptions of the quality of counselling provided to ICU patients and their family members; and second, to explore which factors ICPs feel is associated with the quality of counselling.

STUDY DESIGN

A cross-sectional survey of ICPs working in adult ICUs in Finnish university hospitals. Data were collected using the Counselling Quality Instrument. The data were analysed by descriptive statistics and chi-square and t-test statistical methods.

RESULTS

A total of 182 ICPs returned the questionnaire, reflecting a response rate of 18.6%. Most of the respondents were nurses (97%) and the mean age was 42 years. The ICPs reported having adequate time for patient- (77%) and family-centered (73%) counselling, but only 47% felt that their units had the appropriate facilities. There were statistically significant differences between patient- and family-centered counselling and the ICP's self-assessed competence (p < .001), goal-oriented counselling (p < .001), and atmosphere during counselling (p < .001). ICPs' attitudes towards counselling impacted how these professionals assessed patients' and family members' confidence, along with patient recovery (p < .001).

CONCLUSIONS

This study confirms that the provision of high-quality counselling has beneficial effects; however, it also indicates that there is a need for training that considers each ICP's professional experience and patient- and family-centered factors, which may differ from one another.

RELEVANCE TO CLINICAL PRACTICE

According to ICPs, the quality of counselling can be enhanced by empowering ICPs to improve counselling and providing appropriate ICU facilities for counselling, such as a private room for family members.

Review: Recommendations for male-friendly counselling with adolescent males: A qualitative systematic literature review

BACKGROUND

There are growing calls to tailor counselling practices for adolescent males, a population reluctant to engage in psychological treatment despite concerning rates of mental illness. The objective of this systematic review (PROSPERO: CRD4202125547) was to collate and synthesise recommendations for individual counselling with adolescent males (12-18 years).

METHOD

The databases Psychology and Behavioural Science Collection, PsycArticles, PsycINFO, Academic Search Complete, EBSCO eBook Collection, Wiley Science Collection, Taylor and Francis Collection and ProQuest One Academic were searched for articles published between 1995 and November 2021. The quality of evidence was assessed using the JBI critical appraisal checklists, and thematic analysis was employed to synthesise findings across the literature.

RESULTS

A total of 1625 texts were identified, of which 16 met the inclusion criteria. Generated themes included (a) therapist knowledge of masculinity, gender socialisation, and male-relational styles; (b) necessity of therapists to address masculinity in the therapeutic space; and (c) customising engagement and treatment practices to appeal to adolescent males.

CONCLUSIONS

The themes highlighted the unique developmental, and sociocultural considerations practitioners should be aware of when working with young men. Through a multicultural counselling competency framework, masculinity and adolescent male identity are expressions of diverse sociocultural identities that psychological assessment and intervention should ideally be tailored to suit. The findings of the review suggest that empirical research focusing on the experiences of adolescent males receiving psychological treatment is sparse. Further research is needed to inform the development of practicable, gender-sensitive adaptions to counselling practice for young men.

Preconception and Pregnancy Nutrition Support for Women with a History of Bariatric Surgery: A Mixed-Methods Survey of Healthcare Professionals in the UK

Preconception bariatric surgery improves obesity-related maternal pregnancy complications but may reduce the absorption of nutrients required for healthy fetal growth and development. Women who receive preconception nutritional support after bariatric surgery are less likely to have adverse pregnancy outcomes. This study aimed to investigate the provision of preconception and pregnancy-specific nutritional support for women having bariatric surgery in the UK. A mixed-methods survey was distributed to healthcare professionals working in obesity or maternity services between December 2018 and October 2019. We collected both quantitative and qualitative data which were analysed using a mixed-methods approach. We received 135 responses from online (n = 99) and postal (n = 36) questionnaires. Only 45% of participants reported being 'very familiar' with the preconception/pregnancy nutritional needs of this population. Barriers to providing nutritional support included: a lack of resources and time; poor communication both across services and with women; not having contact with women preconception; and a lack of information and guidance. Respondents felt that dietitians have the expertise in nutrition necessary to provide support; however, GPs and midwives have the most frequent patient access post-surgery, both before and during pregnancy. Optimal preconception and pregnancy-related nutritional support requires multidisciplinary care pre- and post-surgery, and healthcare professionals require training and guidance to inform practice.

[Pilot study of Experience Focused Counselling by nurses with people who hear voices: Evaluation of the implementation of the study protocol]

Pilot study of Experience Focused Counselling by nurses with people who hear voices: Evaluation of the implementation of the study protocol Abstract: Background: Hearing voices and the treatment and support of people who hear voices and are distressed by the experience are defined differently in psychiatry. In contrast to the medical approach to define and treat voices as symptoms of a disease, the EFC counselling approach developed with voice-hearers focuses on non-pathologizing acceptance and a constructive relationship to voices. Mental health nurses with their focus on everyday life are predestined for the dissemination and application of alternative therapeutic approaches in practice. Aim: The aim was to evaluate the study protocol as part of a pilot study regarding its suitability for a larger trial. Method: The multi centre pilot study had a single-blind randomised controlled design. The intervention consisted of EFC counselling by nurses with people who hear voices. The control group received Treatment As Usual (TAU). The suitability of the study design was evaluated in terms of recruitment, burden on study participants, suitability of assessment tools, the application of EFC counselling and the use of study nurses. Results: As planned 21 participants could be included in the study within fifteen months across the two study sites. Overall, the participants rated the study as not very burdensome and the intervention as helpful. The application of EFC by the nurses as well as the use of study nurses was assessed as good and suitable respectively. Discussion: The evaluation of the study protocol shows that with minor adjustments it is suitable for conducting a larger study.

Kangaroo mother care utilization at stepdown ward of a tertiary care teaching hospital: a quality improvement study

PURPOSE

India has the highest burden of preterm/low birth weight newborns. To tackle this, Kangaroo Mother Care (KMC) needs to be scaled up. We did a quality improvement (QI) study to increase KMC coverage to 80% and its utilization to at least 4 h/infant/day.

METHODS

This study was conducted at a stepdown ward (KMC ward) of a tertiary care teaching institute over a period of four months. All babies with birth weight <2.5 kg were eligible. The QI team included faculty in-charge, one senior resident and three senior staff nurses. Potential barriers were listed using fish-bone analysis. Four possible interventions were identified (daily documentation of total KMC hours by doctor, providing KMC during all the nursing duty shifts, counseling and education to mothers and family members), introduced, and then subsequently tested by four Plan-Do-Study-Act (PDSA) cycles and sustenance was assessed over three months.

RESULTS

A total of 93 infants were included in this QI study. During baseline phase, the KMC coverage was 50% which increased to 100% by the end of fourth PDSA cycle and remained 100% during the sustenance phase. During baseline period, KMC was given for ≥ 4 h in 18.8% (28 of 149) patient days which increased to 88.96% (137 of 154) during the sustenance phase. The mean KMC utilization increased from 1.97 (1.57) h/infant/day to 5.65 (1.20) h/infant/day in the sustenance phase.

CONCLUSION

QI study incorporating PDSA cycles helped improve coverage and utilization of KMC.

Survival in very preterm infants with congenital diaphragmatic hernia and association with prenatal imaging markers: A retrospective cohort study

OBJECTIVES

To describe the outcomes of preterm born infants with congenital diaphragmatic hernia (CDH; ≤32.0 weeks of gestation) and the associations between prenatal imaging markers and survival.

DESIGN

Retrospective cohort study.

SETTING

Multicentre study in large referral centres.

POPULATION

Infants with an isolated unilateral CDH, live born at 32.0 weeks or less of gestation, between January 2009 and January 2020.

METHODS

Neonatal outcomes were evaluated for infants that were expectantly managed during pregnancy and infants that underwent fetoscopic endoluminal tracheal occlusion (FETO) therapy, separately. We evaluated the association between prenatal imaging markers and survival to discharge. Prenatal imaging markers included observed to expected lung-to-head ratio (o/e LHR), side of the defect, liver position, stomach position grade, and observed to expected total fetal lung volume (o/e TFLV).

MAIN OUTCOME MEASURE

Survival to discharge.

RESULTS

We included 53 infants born at 30+4 (interquartile range 29+1 -31+2 ) weeks. Survival in fetuses expectantly managed during pregnancy was 48% (13/27) in left-sided CDH and 33% (2/6) in right-sided CDH. Survival in fetuses that underwent FETO therapy was 50% (6/12) in left-sided CDH and 25% (2/8) in right-sided CDH. The o/e LHR at baseline was positively associated with survival in cases expectantly managed during pregnancy (odds ratio [OR] 1.20, 95% CI 1.07-1.42, p < 0.01), but not in cases that received FETO therapy (OR 1.01, 95% CI 0.88-1.15, p = 0.87). Stomach position grade (p = 0.03) and o/e TFLV were associated with survival (p = 0.02); liver position was not (p = 0.13).

CONCLUSIONS

In infants with CDH born at or before 32 weeks of gestation, prenatal imaging markers of disease severity were associated with postnatal survival.

Trajectories of depression and anxiety symptom severity during psychological therapy for common mental health problems

BACKGROUND

There is substantial variation in patient symptoms following psychological therapy for depression and anxiety. However, reliance on endpoint outcomes ignores additional interindividual variation during therapy. Knowing a patient's likely symptom trajectories could guide clinical decisions. We aimed to identify latent classes of patients with similar symptom trajectories over the course of psychological therapy and explore associations between baseline variables and trajectory class.

METHODS

Patients received high-intensity psychological treatment for common mental health problems at National Health Service Improving Access to Psychological Therapies services in South London (N = 16 258). To identify trajectories, we performed growth mixture modelling of depression and anxiety symptoms over 11 sessions. We then ran multinomial regressions to identify baseline variables associated with trajectory class membership.

RESULTS

Trajectories of depression and anxiety symptoms were highly similar and best modelled by four classes. Three classes started with moderate-severe symptoms and showed (1) no change, (2) gradual improvement, and (3) fast improvement. A final class (4) showed initially mild symptoms and minimal improvement. Within the moderate-severe baseline symptom classes, patients in the two showing improvement as opposed to no change tended not to be prescribed psychotropic medication or report a disability and were in employment. Patients showing fast improvement additionally reported lower baseline functional impairment on average.

CONCLUSIONS

Multiple trajectory classes of depression and anxiety symptoms were associated with baseline characteristics. Identifying the most likely trajectory for a patient at the start of treatment could inform decisions about the suitability and continuation of therapy, ultimately improving patient outcomes.

Examining the impact of a Volunteer-Delivered counselling service for people experiencing sight loss: a mixed methods evaluation

PURPOSE

This article describes a mixed methods evaluation of a volunteer-delivered counselling service for people experiencing sight loss, to identify the outcomes, benefits, and challenges of this model of service provision within rehabilitation services.

MATERIALS AND METHOD

A mixed methods approach was used, with both outcome and process evaluation components. Outcomes for 817 service users were assessed pre-and-post service use, using standardised (CORE10) measures. Semi-structured interviews and surveys with 22 volunteer counsellors and 4 senior counsellors were conducted, to understand their experiences of the format, content, and delivery of the service.

RESULTS

Clients presenting for counselling experienced significant levels of self-reported depression, anxiety, and feelings of bereavement. Analysis showed a significant positive change in clinical outcomes for service users who received volunteer-delivered counselling services. Volunteer counsellors saw the unique and specialist nature of the service as critical for its impact on clients, and reported benefits of volunteering for this service, including developing their skills with this client group.

CONCLUSIONS

Volunteer-delivered counselling can be effective for people affected by sight loss, providing accessible and much-needed psychological support, which is relevant given current pressures on health and social care services. There are key lessons for future models of this type.Implications for RehabilitationVision loss can have a profound negative impact on people's emotional and mental well-being, with many advocating for counselling and emotional support (CESS) to be included in low vision rehabilitative services.Despite this, access to psychological support is often overlooked in low vision rehabilitation, and access to CESS services is often poor.This study evaluated a volunteer-delivered CESS service, demonstrating that this model of service delivery is effective for this group.There are clear advantages to a volunteer-delivered model for those with sight loss, in terms of widening access, supporting integrated rehabilitative care, and reducing health inequalities.

Establishment of cross-cradle hold technique combined with intensive breastfeeding counselling positively impacts the weight gain rate in early infancy

A quasiexperimental field study was undertaken in 576 exclusively breastfed (EBF) infants from 0 to 14 weeks in Gujarat, India to assess the effect of the use of appropriate breastfeeding techniques on daily weight gain rate and on reducing the underweight rate in early infancy. The interventions were delivered through the existing health system and focused primarily on counselling pregnant women during antenatal and post-natal sessions for ensuring 'effective breastfeeding' by adoption of the technique of 'cross cradle hold', appropriate breast attachment, emptying of one breast before shifting to the other along with conducting regular monitoring of infant's weight. The intervention care group (ICG) of 300 EBF infants were compared with 276 EBF infants in the control standard care group (SCG). The findings revealed that median weight gain per day between 0 and 14 weeks was significantly higher (p = 0.000) in ICG (32.7 g) as compared with SCG (28.05 g). The median weight-for-age Z at 14 weeks of age was also significantly higher in ICG compared with SCG (p = 0.000). Underweight prevalence was three times lower in ICG (5.3%) compared with SCG (16.7%) at 14 weeks of age. Infants in the ICG were noted to be 2.65-fold more likely to achieve a weight gain of 30 g or more per day compared with infants in SCG. Nutrition interventions, therefore, must aim not only on mere promotion of EBF for up to 6 months but stress on ensuring EBF is 'effective' for optimum transfer of breastmilk through adoption of appropriate techniques, including cross-cradle hold, by mothers.

Interest in prenatal stress management training: association with medical risk and mental health

OBJECTIVE

The objective of this study was to document levels of interest in stress management training (SMT) during pregnancy, including differences in interest in SMT across levels of medical risk in pregnancy. We also sought to assess differences in pregnancy-specific stress, prenatal worry and depressed mood across levels of medical risk in pregnancy and investigate predictors of interest in SMT.

METHODS

We surveyed 379 English-speaking, pregnant people living in Vancouver, Canada, between November 2007 and November 2010. Questionnaires were administered during the third trimester and assessed interest and preferred format of SMT, pregnancy-specific stress, prenatal worry, depressed mood and medical risk in pregnancy.

RESULTS

Interest in stress management training programmes during pregnancy was common, with 32% of participants being quite-to-very interested. Preference was split between self-guided study (41%), group counselling (38%) and one-on-one counselling (34%). Higher pregnancy-specific stress and depressed mood, but not medical risk in pregnancy, were associated with higher interest in SMT. Participants experiencing higher stress levels or lower medical risk were more interested in one-on-one counselling.

CONCLUSION

Findings indicate that subjective distress rather than objective circumstances is a better predictor of interest in SMT. Care providers should inquire early-on about interest in SMT during pregnancy and ensure awareness of SMT options.

A quasi-experimental study of group counselling effectiveness for patient functional ability and quality of counselling among patients with hip arthroplasty

AIM

The aim of this study was to investigate effectiveness of group counselling for the patients with hip arthroplasty, self-assessed functional ability, and quality of counselling.

DESIGN

A quasi-experimental study.

METHOD

The questionnaire included the Counselling Quality Instrument (CQI), Harris hip score and Oldwellactive self-rated wellness profile. A Mann-Whitney U- and chi-squared and t-tests were used. A Wilcoxon singed rank test were used to evaluate changes in functional ability.

NO PATIENT OR PUBLIC CONTRIBUTION

Patients and the public were not involved in the design, recruitment and implementation of this study.

RESULTS

Fifty patients participated. Patients reported better results for limping (p = 0.000), walking distance (p = 0.000) and use of a walking aid (p = 0.001) in the follow-up time point and they pain decreased. Patients were satisfied with interactions during counselling; gender (p = 0.000) and use of a walking aid (p = 0.044) were found to significantly affect. A lack of goal-oriented counselling was in depressive symptoms (p = 0.016), worries (p = 0.010) and loneliness (p = 0.026).

Nurses' and medical doctors' attitudes towards exercise for people with chronic kidney disease in Denmark

BACKGROUND

Implementation of exercise training in people with kidney failure may be affected by clinicians' attitudes.

OBJECTIVES

To investigate Danish nephrology nurses' and medical doctors' attitudes towards: exercise for people undergoing dialysis; use of physical activity interventions in chronic kidney disease; and to compare Danish and previously reported Australian nurse attitudes.

DESIGN

Cross-sectional survey.

PARTICIPANTS

Nurses and medical doctors from the nephrology field in Denmark.

MEASUREMENTS

The questionnaire attitudes towards exercise in dialysis, and questions about exercise advice, counselling and interventions.

RESULTS

Nephrology nurses (n = 167) and 17 medical doctors (women 92%, age 47 ± 11 years) from 19 dialysis units participated. There were no differences between nurses' and medical doctors attitudes about training. Ninety-five % and 88% of nurses and medical doctors, respectively, agreed that most people undergoing dialysis could benefit from exercise. Exercise training was offered to people undergoing haemodialyses in 88% of 17 departments. Danish nurses reported more positive attitudes than Australian towards exercise (p < 0.05). Ninety-five % and 86% of the Danish and Australian nurses, respectively, agreed/strongly agreed that most people undergoing dialysis could benefit from exercise. Six % and 35% of the Danish and Australian nurses, respectively, agreed/strongly agreed that most people with dialysis were too sick to exercise.

CONCLUSION

Danish nephrology nurses and medical doctors had mostly positive attitudes to exercise training to people undergoing dialysis, and exercise to people with dialysis was offered frequently. Danish and Australian nurses had positive attitudes to exercise to people undergoing dialysis, it was however more positive in Danish nurses.

Acute and intensive care nurses' perspectives on suicide prevention with medically hospitalized patients: Exploring barriers, facilitators, interests, and training opportunities

AIMS

To explore opportunities for acute and intensive care nurses to engage in suicide prevention activities with patients hospitalized for medical, surgical or traumatic injury reasons.

DESIGN

A qualitative descriptive study.

METHODS

We conducted two studies consisting of 1-h focus groups with nurses. Study 1 occurred prior to the onset of the COVID-19 pandemic during January and February of 2020 and identified barriers and facilitators of engaging in an eLearning training in suicide safety planning and engaging patients on their units in suicide safety planning. Study 2 occurred in December of 2020 and explored nurses' perspectives on their role in suicide prevention with patients on their units and training needs related to this. The research took place at an urban level 1 trauma center and safety net hospital where nurses universally screen all admitted patients for suicide risk. We conducted a rapid analysis of the focus group transcripts using a top-down, framework-driven approach to identify barriers, facilitators, strategies around barriers, and training interests mentioned.

RESULTS

Twenty-seven registered nurses participated. Nurses indicated they serve a population in need of suicide prevention and that the nursing role is an important part of suicide care. A primary barrier was having adequate uninterrupted time for suicide prevention activities and training; however, nurses identified various strategies around barriers and offered suggestions to make training successful.

CONCLUSION

Findings suggest training in suicide prevention is important for nurses in this context and there are opportunities for nurses to engage patients in interventions beyond initial screening; however, implementation will require tailoring interventions and training to accommodate nurses' workload in the hospital context.

IMPACT

Acute and intensive care nurses play a key role in the public health approach to suicide prevention. Understanding perspectives of bedside nurses is critical for guiding development and deployment of effective brief interventions.

NO PUBLIC OR PATIENT INVOLVEMENT

This study is focused on eliciting and exploring perspectives of acute and intensive care nurses.

Mapping parents' journey following prenatal diagnosis of CHD: a qualitative study

OBJECTIVE

To better understand parents' accounts of their prenatal and postnatal experience after prenatal diagnosis of CHD - particularly emotional processing and coping mechanisms - to identify strategies to improve support.

METHODS

This single-centre, longitudinal qualitative study included pregnant mothers and their support persons seen in Fetal Cardiology Clinic at Vanderbilt Children's Hospital from May through August 2019 for probable complex CHD. Twenty-seven individuals from 17 families participated in 62 phone interviews during pregnancy and postpartum: 27 conducted after the initial prenatal cardiology consultation, 15 after a follow-up prenatal visit, and 20 after birth. Applied thematic analysis approach was used to code and analyse transcribed interviews. Coding and codebook revisions occurred iteratively; intercoder reliability was >80%.

RESULTS

Patients included mothers (16 [59%]), fathers (8 [30%]), and other support persons (3 [11%]). Initial fetal diagnoses included a range of moderate to severe CHD. Prenatally, parents sought to maintain hope while understanding the diagnosis; planning for the future rather than focusing on day-to-day was more common if prognoses were better. Postnatally, with confirmation of prenatal diagnoses, parents' sense of control expanded, and they desired more active engagement in clinical decision making.

CONCLUSIONS

To enhance effective communication and support, understanding how parents conceptualise hope in relation to diagnosis and how that may evolve over time is critical. Expectant parents whose child has a significant risk of mortality may demonstrate hope by focusing on positivity. As prognostic uncertainty diminishes postpartum, the parental role on the team may shift, requiring clinicians to provide different support.

The quality of long-term counselling for percutaneous coronary intervention patients: A cross-sectional study

AIM

To compare the long-term counselling quality among the patients visited and not visited at cardiac nurse after percutaneous coronary intervention (PCI) and related factors one to two years after PCI.

DESIGN

An explorative, register-based cross-sectional study.

METHODOLOGY METHODS

A sample was drawn from the one university hospital's procedure register consisted of the patients undergone a PCI (n = 977). The data was collected by Counselling Quality Instrument (CQI) questionnaire by mail, and analysed by basic and multivariate methods.

FINDINGS RESULTS

Of the respondents (n = 459), less than half the patients (48.4%) visited at cardiac nurse one to two years after PCI as instructed in the national current care guidelines. Patients, who visited the nurse (n = 194) had higher satisfaction for counselling than the ones not visited (n = 70). Nevertheless, patients, especially those who had no dyslipidemia, had Unstable Angina Pectoris or Non-ST-elevated myocardial infarction or were out of the workforce, were unsatisfied with counselling, and needed more social support, patient-centred counselling and goal orientating implementation from the cardiac nurse. A half of the PCI patients (51.6%) did not visit the cardiac nurse at the primary health care.

PATIENT OR PUBLIC CONTRIBUTION

Cardiac nurses assisted the members of research group by assessing the questionnaire prior sending it to the patients and patients contributed by completing the questionnaires. We thank both parties for their contribution.

IMPLICATION FOR PROFESSION AND PATIENT CARE

This study demonstrated, that patients out of the workforce and having emergency PCI are in need for better quality counselling, concentrating on social support, patient-centred counselling and goal orientating implementation from the cardiac nurse. Those patients, who did not visit the cardiac nurse, should be offered easier access to cardiac nurse for example, by novel digital solutions.

Impact of Physical Activity Counselling on Children with Medical Conditions and Disabilities and Their Families

Physical activity counselling can target cognitive-affective participation barriers, but counselling benefits for children with medical conditions/disabilities were unknown. This study investigated successes, challenges, and the impact of physical activity counselling on children and their families. One-on-one semi-structured interviews were completed with 7 patients (2 male/5 female, aged 13-17) and 4 parents who participated in 2-8 weekly counselling sessions (2015-2020). Interviews were recorded and transcribed verbatim for inductive thematic analyses. Counselling encouraged positive mindset changes (viewing physical activity more holistically, making it "more fun and manageable", helping them to "learn how to love moving and doing sports"). Participants felt strong support (feeling heard, validated, and provided with "hope… that we can still achieve things… even though it may seem like there's limitations"). Counselling was viewed positively. The intent to improve active lifestyle attitudes and confidence was reflected in positive, primarily cognitive-affective (motivation for activity, "more general skills of having a positive attitude towards physical activity and the willingness to try new things") outcomes. More sessions, additional resources to keep, and follow-up after counselling completion were recommended to support behaviour change. Future research should evaluate enhanced counselling services and comparing children who have and have not received such counselling.

Community-based counselling programme for pregnant women with alcohol problems in Cape Town, South Africa: a qualitative study of the views of pregnant women and healthcare professionals

Introduction

South Africa lacks services to detect and address alcohol use during pregnancy, particularly outside of health-care facilities. This study aimed to explore pregnant women and healthcare providers' perceptions of the acceptability, feasibility and appeal of a community-based counselling programme for pregnant women with alcohol problems.

Methods

Twenty-eight in-depth interviews with pregnant women who drink, Community Health Workers (CHWs) and antenatal service providers were conducted. Transcribed interviews were analyzed thematically using a combined deductive and inductive approach.

Results

Women reported feeling uncomfortable seeking help for their alcohol use at antenatal clinics, limiting usefulness of current support services. All stakeholders perceived a community-based intervention to be acceptable and feasible as it could be integrated with other CHW-delivered services. Participants thought an intervention should facilitate early linkage to antenatal services and should include partners or family members. The feasibility of an intervention may depend on the relationship between CHWs and clinic-based antenatal staff, and their relationships with pregnant women. Clinic and community challenges to implementation were raised. Clinic-level challenges included shortage of space, staff capacity, high number of pregnant women, long waiting times, financial burden of having to travel to a clinic, lack of comfort and privacy and staff attitudes. Community-level challenges included crime, lack of privacy, lack of attention given competing interests in the home, fear due to abuse, and stigma and discrimination from other community members. Suggestions for overcoming these challenges were provided.

Conclusion

Findings provide essential information to facilitate the adaptation of a community-based alcohol counselling programme for greater acceptability, feasibility and cultural appropriateness for the South African context. Intensive training, supervision and support is required to ensure the programme is delivered as planned.

Determinants of Quit Attempts and Short-Term Abstinence among Smokers in India: Global Adult Tobacco Survey, 2016-17

OBJECTIVE

The objective was to study the determinants of quit attempts and abstinence among smokers in India using nationally representative data from the Global Adult Tobacco Survey (GATS-2).

METHODS

Data from GATS-India, (2016-17) was analysed. Key outcome variables included quitting attempts in the previous 12 months among smokers and duration of abstinence among those who attempted quitting. The receipt of messages through mass media, warning labels and quit advice by doctors or healthcare providers were key exposure variables for both outcomes. The use of cessation methods was an exposure variable for abstinence. Logistic regression analyses were employed to identify determinants of quit attempt and survival analysis for the duration of abstinence.

RESULT

The adjusted analyses showed that those who received quit advice from doctors or healthcare providers had higher odds (2.11; CI 1.88-2.37) of quit attempts. Exposure to anti-smoking messages through media and warning labels was associated with higher quit attempt odds of 1.53 (1.33-1.77) and 1.63 (1.38-1.92), respectively, when the anti-smoking messages made the smokers think about quitting. The use of counselling as a cessation method had a lower risk (Hazard Ratio 0.80; 0.69-0.93) of relapse compared to the non-use of cessation aids. The use of counselling and modern pharmacotherapy also had a lower risk of relapse (Hazard Ratio 0.77; 0.59-0.99). However, only 6.0% had used counselling, and another 2.0% had used a combination of modern pharmacotherapy and counselling as cessation aids. Addiction to tobacco and higher consumption of smoked sticks were negatively associated with both outcomes.

CONCLUSION

Quit advice by healthcare providers is associated with a higher likelihood of quit attempts. Counselling can help increase the period of abstinence in pragmatic settings, and there is a need to improve the access of smokers to counselling services.

Ethical principles, challenges and opportunities when conducting genetic counselling for schizophrenia

Ethical challenges of genetic counselling for schizophrenia include effective communication of critical scientific information in an easily understood manner by patients and relatives, and the ability to ensure communication is unencumbered by medical jargon. Levels of literacy in the target population may limit this process, making it difficult for patients to attain the desired levels of informed consent to make crucial decisions during genetic counselling. Multilingualism in target communities may further complicate such communication. This paper outlines the ethical principles, challenges and opportunities facing clinicians when conducting genetic counselling for schizophrenia and how these might be met, drawing on lessons from South African studies. The paper draws on reflections of clinician and researcher experiences gained from clinical practice or research on the genetics of schizophrenia and psychotic disorders in South Africa. The context of genetic studies in schizophrenia is used to illustrate the ethical challenges in genetic counselling for schizophrenia, both in clinical and research settings. Attention is also drawn to multicultural and multilingual populations, particularly where the preferred language lacks a well-developed scientific language of communication for some of the genetic concepts that have to be presented during the genetic counselling process. The authors describe the ethical challenges and how to address these to empower patients and relatives to make well-informed decisions despite these obstacles. Principles applied by clinicians and researchers during the genetic counselling are described. Potential solutions, including the establishment of community advisory boards to address potential ethical challenges inherent to the genetic counselling process, are also shared. Genetic counselling for schizophrenia still faces ethical challenges which require a balance of principles of beneficence, autonomy, informed consent, confidentiality and distributive justice, while striving to present accuracy in the science that guides the process. Evolution in language and cultural competency therefore needs to occur alongside scientific advances in genetic research. Key stakeholders need to partner and build capacity and expertise in genetic counselling through the provision of funding and resources. The goal of partnerships is to empower patients, relatives, clinicians and researchers to share scientific information in a manner guided by empathy while retaining scientific accuracy.