Why Acute Undernutrition? A Qualitative Exploration of Food Preferences, Perceptions and Factors Underlying Diet in Adolescent Girls in Rural Communities in Nigeria

BACKGROUND

Adolescent girls are nutritionally vulnerable due to their rapid growth and increased nutrient requirements. Nigeria has the sixth-largest population in the world. This study qualitatively explored the food preferences, perceptions of nutritive value and factors underlying food consumption of adolescent girls in rural communities in Nigeria.

METHODS

The data were collected via the free listing of foods and focus group sessions conducted in the Hausa language with 48 unmarried adolescent girls. The discussions were audio-recorded, transcribed, translated into English, and analyzed using a deductive thematic framework.

RESULTS

The mean age of the respondents was 13.0 ± 2.7, and almost half (48%) had a primary school education. A total of 19 and 23 foods were identified as preferred, and perceived as nourishing, respectively. The top 10 foods present on both free lists overlapped considerably in terms of cognitive salience. The focus group themes included nutrition knowledge, food preferences, autonomy, household food allocation, courtship practices, and agricultural landscapes and economic access. The participants had minimal knowledge of nutrients and food groups, and their preferred foods were limited in diversity. The key factors in food preferences were desirable health effects, sensory attributes, and the contribution of foods to a desirable body image for marriage. Household food choices depended on parents. Thus, a desire for independence was an incentive for early marriage, mostly at 13 to 17 years. Gender inequities in household food distribution (quantity) and animal protein intake were reported. The participants believed that boys need more food for strength to impregnate girls. As part of a courtship practice, the girls received gifts of animal source foods from potential suitors. The food options were limited by financial challenges and low agricultural diversity.

CONCLUSION

To interrupt the cycle of inadequate food consumption and undernutrition in these adolescent girls, policy makers need to promote nutrition education and address the underlying determinants of inequitable access to nutritious foods.

Healthcare professionals' perspectives on development of assistive technology using the comprehensive assistive technology model

The implementation of technology in healthcare shows promising results and provides new opportunities in rehabilitation. However, the adoption of technology into daily care is largely dependent on the acceptance rate of end-users. This study aims to gather information from healthcare professionals on the development of new assistive technology that match users' needs using the Comprehensive Assistive Technology model. In total 27 healthcare professionals (12 occupational therapists, 8 physiotherapists, 3 nurses, 2 allied health directors, a physician and a speech therapist) attended one of four online focus group discussions. These focus group discussions were structured using a question guide based on three predefined scenarios. Recordings were transcribed and data was analyzed using a thematic analysis (NVivo). Major themes identified in this study were safety, price and usability. Healthcare professionals focused on both functional capabilities of the user, as well as behavioral aspects of usability and attitude toward technology. Furthermore, the need for assistive technology that were catered toward the limitations in activity and user experience, was highlighted extensively. Based on information gathered from healthcare professionals a user-centered approach in development of safe, low-cost devices that maximize both functional outcomes and user acceptance, could potentially increase the adoption of new technology in rehabilitation.

Quality midwifery care during the COVID-19 pandemic in Bangladesh: A focus group study with midwives, nurses, and midwifery educators

INTRODUCTION

Bangladesh has made remarkable strides in the development of the midwifery profession. However, the COVID-19 pandemic has had profound effects on healthcare systems worldwide, including those related to reproductive, perinatal, and maternal health. Given the recent advancements in the midwifery field in Bangladesh, it is crucial to examine the pandemic's impact on existing barriers and the capacity of midwifery professionals to deliver high-quality care. The aim of this study is to describe the possibility of midwives being able to provide quality midwifery care in Bangladesh during the COVID-19 pandemic.

METHODS

To gather insights, data were collected from July to October 2020 via four qualitative focus group discussions online; 23 actively practicing midwives, nurses specializing in midwifery care, and midwifery educators, participated. The data analysis employed reflexive thematic analysis.

RESULTS

The COVID-19 crisis posed significant threats to women's safety and health, with lockdowns exacerbating gender inequalities in society. Midwives faced added challenges due to their relatively low professional status and increased workloads. Insufficient policy implementation further compromised midwives' safety. Fear of contracting the virus and working during their free time also raised concerns about the quality of care provided. Nevertheless, the pandemic provided opportunities for midwives to demonstrate their ability to deliver independent midwifery care in Bangladesh.

CONCLUSIONS

The pandemic underscored the importance of creating respectful and dignified working conditions for midwives. It revealed that professional midwives can work independently when provided with the necessary space and a supportive work environment. This opens the door for the implementation of a midwifery-led care model. Further research is recommended to investigate the medical safety and efficacy of independent midwifery care in the context of Bangladesh.

Be prepared and do the best you can: a focus group study with staff on the care environment at Swedish secure youth homes

PURPOSE

This study examined staff members' experiences of the institutional care environment within secure youth homes.

METHODS

Data were collected through three focus group discussions with 17 staff members at two secure youth homes. Subsequently, a thematic analysis was conducted.

RESULTS

The analysis indicated two main themes: risk management and damage control in a restricted environment and compensating and reconstructing ordinariness-trying to make the best of it; each theme had three subthemes. The care environment seems to be experienced by staff as characterized by conflicting demands, thus constituting a gap between needs and what is possible to achieve-a balancing act that constitutes a constant struggle.

CONCLUSIONS

The staff members' constant struggle could be interpreted as conflicting moral and instrumental demands; they know what the youths need, but the environment of the secure youth homes demands the decorous behaviour of sociomaterial control practices-rather than care practices.

The pros and cons of fertility awareness and information: a generational, Swedish perspective

Being aware of factors that affect fertility can help people make informed decisions about their reproductive futures. To some, however, fertility information leads to worry and self-blame. In this paper, we explore how people from different generations discuss fertility and reproductive decision-making, along with their perceptions of fertility information. The study was conducted in southern Sweden with 26 focus-group discussions that included a total of 110 participants aged 17-90 years. The material was analysed thematically. Our results show that fertility knowledge and openness to talking about fertility problems have increased over generations. Participants who were assigned female at birth were more often concerned about their fertility than those who were not, and fertility concerns were transferred from mothers to daughters. While age-related fertility concerns had been uncommon in older generations, participants aged 25-40 often expressed these concerns. Young adults appreciated being knowledgeable about fertility but simultaneously expressed how fertility information could lead to distress. Our conclusion is that fertility information was best received by high-school students, and efforts to improve fertility education in schools are therefore recommended.

The Vinyasa Tool for mHealth Solutions: Supporting Human-Centered Design in Nascent Digital Health Ecosystems

BACKGROUND

mHealth (mobile health) systems have been deployed widely in low- and middle-income countries (LMICs) for health system strengthening, requiring considerable resource allocation. However, most solutions have not achieved scale or sustainability. Poor usability and failure to address perceived needs are among the principal reasons mHealth systems fail to achieve acceptance and adoption by health care workers. A human-centered design approach to improving mHealth system use requires an exploration of users' perceptions of mHealth systems, including the environmental, user-related, and technological aspects of a system. At present, there is a dearth of contextually intelligent tools available to mHealth developers that can guide such exploration before full-scale development and deployment.

OBJECTIVE

To develop a tool to aid optimization of mHealth solutions in LMICs to facilitate human-centered design and, consequently, successful adoption.

METHODS

We collated findings and themes from key qualitative studies on mHealth deployment in LMICs. We then used the Informatics Stack framework by Lehmann to label, sort, and collate findings and themes into a list of questions that explore the environment, users, artifacts, information governance, and interoperability of mHealth systems deployed in LMICs.

RESULTS

We developed the Vinyasa Tool to aid qualitative research about the need and usability of mHealth solutions in LMICs. The tool is a guide for focus group discussions and key informant interviews with community-based health care workers and primary care medical personnel who use or are expected to use proposed mHealth solutions. The tool consists of 71 questions organized in 11 sections that unpack and explore multiple aspects of mHealth systems from the perspectives of their users. These include the wider world and organization in which an mHealth solution is deployed; the roles, functions, workflow, and adoption behavior of a system's users; the security, privacy, and interoperability afforded by a system; and the artifacts of an information system-the data, information, knowledge, algorithms, and technology that constitute the system. The tool can be deployed in whole or in part, depending on the context of the study.

CONCLUSIONS

The Vinyasa Tool is the first such comprehensive qualitative research instrument incorporating questions contextualized to the LMIC setting. We expect it to find wide application among mHealth developers, health system administrators, and researchers developing and deploying mHealth tools for use by patients, providers, and administrators. The tool is expected to guide users toward human-centered design with the goal of improving relevance, usability, and, therefore, adoption.

Perceived Roles and Barriers in Delivering Community-Based Care: A Qualitative Study of Health and Social Care Professionals

Introduction

As healthcare systems increasingly embrace population health management, the integration of health and social care to improve the health and well-being of individuals is crucial. Thus, we conducted a qualitative study in Singapore to understand health and social care professionals' (HCPs and SCPs) perception of the roles they played in delivering community-based care.

Methods

A descriptive phenomenological research design was adopted. HCPs and SCPs (n = 53) providing services in community settings were recruited purposefully and interviewed through eleven focus group discussions. Each session was recorded and transcribed. Thematic analysis was applied.

Results

Our results revealed eight themes in three main categories describing the roles played by HCPs and SCPs, including: (1) delivering needs-based care in community settings; (2) activating and empowering clients in health care, and (3) fostering community-based sustainable support networks. Six barriers encountered while performing these roles were also identified.

Discussion and Conclusion

Our results highlight that the roles of HCPs and SCPs go beyond the provision of direct medical and social care. They were involved in activating and empowering clients to take care of their health, and importantly, fostering community-based sustainable support networks to better empower individuals in coping with health challenges. The identified barriers shed light on areas for potential improvements for integrated community care.

Conducting caregiver focus groups on autism in the context of an international research collaboration: Logistical and methodological lessons learned in South Africa

LAY ABSTRACT

Most of the autism research to date has been conducted in high-income countries, with children and families typically from White, upper-middle-income backgrounds. However, we know there are significant inequalities that exist which influence how autistic individuals from diverse, underserved communities can access services they need. As many of these individuals have not been included in the majority of autism research to date, there is much we do not know about these individuals' life experiences, which are critically needed to better inform the development and implementation of care for families from historically underrepresented groups. In this article, we describe the research process we took to conduct focus group discussions with 22 caregivers of young autistic children living in Cape Town, South Africa. We specifically describe the lessons we learned in implementing these focus groups and provide recommendations aimed at how to best reduce logistical and methodological challenges moving forward to improve research conducted in similar low-resource contexts.

HIV-Related Knowledge and Practices among Asian and African Migrants Living in Australia: Results from a Cross-Sectional Survey and Qualitative Study

Australian HIV notification rates are higher for people born in Northeast Asia, Southeast Asia and sub-Saharan Africa compared to Australian-born people. The Migrant Blood-Borne Virus and Sexual Health Survey represents the first attempt to build the national evidence base regarding HIV knowledge, risk behaviors and testing among migrants in Australia. To inform survey development, preliminary qualitative research was conducted with a convenience sample of n = 23 migrants. A survey was developed with reference to the qualitative data and existing survey instruments. Non-probability sampling of adults born in Northeast Asia, Southeast Asia and sub-Saharan Africa was undertaken (n = 1489), and descriptive and bivariate analyses of data were conducted. Knowledge of pre-exposure prophylaxis was low (15.59%), and condom use at last sexual encounter was reported by 56.63% of respondents engaging in casual sex, and 51.80% of respondents reported multiple sexual partners. Less than one-third (31.33%) of respondents reported testing for any sexually transmitted infection or blood-borne virus in the previous two years and, of these, less than half (45.95%) tested for HIV. Confusion surrounding HIV testing practices was reported. These findings identify policy interventions and service improvements critically needed to reduce widening disparities regarding HIV in Australia.

Consumers' Perceptions of the Design of Front-of-Package Warning Labels-A Qualitative Study in China

The warning label is identified as a simple front-of-package labeling format that assists consumers in making healthier food choices at the point of purchase. The color and/or shape of the design elements of the packaging labels can influence the understanding and purchase intention outcomes. This study aimed to explore the perceptions of consumers regarding differently designed warning labels (WLs) to identify a possibly suitable warning label design in the Chinese context. Using a qualitative approach, we collected data through 12 focus group discussions consisting of 116 participants residing in 6 provinces. Participants were selected by purposive sampling. Data were coded following inductive thematic analysis and summarized into three themes: (1) perceived preference for the appearance of the WLs, (2) perceived benefits of the WLs, and (3) suggestions for promoting the WLs. Participants preferred the black shield label showing a high content of the nutrients of concern (e.g., sodium, added sugar, and saturated fat) in both Chinese and English. Consumers generally agreed that the WLs were easy to understand and offered a simple method for choosing healthier foods. They anticipated that WLs could encourage the food industry to reformulate their products. Our study results will support the design and facilitate the use of WLs in China.

Professional home care providers' conceptualisations of frailty in the context of home care: A focus group study

BACKGROUND

In Norway, as in many other countries, more people receive health and care services in their homes than before. Home care professionals provide care and support to people with a range of health and care needs. Older home care service users are sometimes referred to as 'frail', but the terms 'frail' and 'frailty' have different meanings in different contexts, and little is known about the meaning ascribed to the terms in the context of home care services. Home care services are crucial for many older persons who have health challenges, and how home care professionals conceptualise frailty might shape clinical encounters.

OBJECTIVES

The purpose of this study is to explore how home care professionals conceptualised frailty in the context of home care.

METHODS

We conducted four focus group discussions with 14 home care professionals who worked in municipal home care in northern Norway and analysed the data using thematic analysis.

RESULTS

Our analysis resulted in five themes: '"Frail" - a term which is too imprecise to be useful', 'Frailty as a consequence of ageing', 'Frailty as lack of engagement and possibilities for engagement', 'Frailty as a contextual phenomenon' and 'Frailty as potentially affected by care'. The home care professionals conceptualised frailty as an individual trait but also as resulting from the interplay between individual and environmental factors. Moreover, their conceptualisations of frailty represented a continuum between frailty as related to prevention and management ('cure') and frailty as related to ageing as natural decline ('care').

CONCLUSION

The home care professionals conceptualised frailty diversely, as moving along a continuum between cure and care. Diverse conceptualisations of frailty might be necessary if nurses are to meet the changing and varying care needs of older persons who live in their own homes and need health and care services.

Digital Transformation of Face-To-Face Focus Group Methodology: Engaging a Globally Dispersed Audience to Manage Institutional Change at the World Health Organization

Focus group discussions (FGDs) are widely used to obtain qualitative data from purposely selected groups of people. This paper describes how the Learning and Capacity Development (LCD) unit of the World Health Organization (WHO) Health Emergencies Programme (WHE) digitalized FGDs to engage with WHO staff from around the world, to listen, share, and collect their feedback in the development of a WHO learning framework. The impact of the COVID-19 pandemic and the introduction of local lockdowns and travel restrictions resulted in the wide use of digital platforms, such as Zoom, for employee communications and collaboration capable of reaching employees wherever they are working. The LCD/WHE team drew upon the experience of WHO colleagues from human resources, country, and regional offices to set up and hold FGDs in 6 languages with participants from all WHO regions. Building on the findings of a 2019 WHO staff survey, which was part of a comprehensive, organization-wide career development initiative, the digitalized FGDs allowed for the exchange of substantive feedback, novel ideas, and alignment, connecting across different geographies, disciplines, and levels of seniority. As a result, FGDs can be successfully conducted online, but it is essential to remove barriers to participation by adopting a multilingual and flexible approach in multinational and international organizations such as the WHO.

Youths' Perceptions Of The Relation Between Alcohol Consumption And Risky Sexual Behaviour in the Western Cape, South Africa: A Qualitative Study

The purpose of this study is to explore the factors that youth identify as contributing to alcohol consumption, and more specifically its relation to risky sexual behaviour among youth. We employed an exploratory qualitative method using focus group discussions with 34 young people between the ages of 18-25-years-old in low socio-economic status communities in the Western Cape province of South Africa. Data were analyzed thematically utilizing Braun and Clarke's (2006) six-step thematic analysis process. We identified two thematic domains pertaining to alcohol consumption and risky sexual behaviour, namely individual and social factors, each comprising three themes. The individual factors thematic domain comprises intrapersonal influences, employment and educational attainment; while the social factors thematic domain includes interpersonal influences, social influences, and hope for the future. Youth living in low socio-economic status communities were thought to be at greater risk of alcohol misuse and subsequent risky behaviour, given the political and social history of marginalisation, systematic oppression, and social inequality. To address alcohol use and risky sexual behavior among youth, we recommend interventions with adolescents, parents or guardians, and the community. More specifically, interventions aimed at adolescents should focus on the transition to young adulthood. Interventions with parents should focus on their role in modelling and potentially regulating alcohol consumption. Finally, community interventions should centre on drinking behaviors, levels of drinking, what constitutes harmful drinking, and how to identify when treatment and recovery support is likely to be required.

Patients' appraisals about a multicomponent intervention for fibromyalgia syndrome in primary care: a focus group study

PURPOSE

To assess fibromyalgia patients' experiences and appraisals about a multidisciplinary intervention programme, in Catalonia's primary care, regarding its format and contents, benefits, and health impact in the short and long term.

METHOD

Qualitative interpretative research design through hermeneutic phenomenology perspective. Two focus groups discussions were conducted in February and July 2020. The purposive heterogeneous sample included 19 fibromyalgia patients who attended a multicomponent programme. In addition, thematic analysis on the verbatims was performed.

RESULTS

Findings were organized into five main domains with an explanatory theme each. Overall, the informants valued the programme as a positive experience due to its holistic approach, health benefits, suffering relief, group effect, and fibromyalgia legitimacy promotion. Detected improvable aspects focused on extending the timeframe, including family members as beneficiaries, deepening the thematic contents, and getting regular access to this healthcare service. Furthermore, the intervention was considered feasible to be incorporated into usual clinical care.

CONCLUSION

the programme fulfilled users' expectations about results and procedure and showed promise as a treatment strategy to reinforce the usual practice. Our findings suggest a broad perspective on fibromyalgia patients' suffering, which urges us to adjust the intervention programme to their real health needs.

Factors associated with child mortality among antenatal care attendees in Ado-Odo/Ota, Ogun State, Nigeria

The study examined the determinants of child mortality among attendees at a government health care facility in Ado-Odo/Ota in Ogun State, Nigeria. The study, based on a descriptive cross-sectional study, used a mixed-methods research approach and utilized an interviewer-administered structured pretested questionnaire. A total of 1350 respondents constituted the sample size. Data analysis consisted of descriptive and regression analysis with STATA Version 12. Furthermore, the study employed focus group discussions to reinforce the quantitative results of the investigation. Results showed the place of delivery (P = 0.000), distance from house to health facility (P = 0.022), immunization status (P = 0.000), duration of breastfeeding (P = 0.000), cost of treatment at the health facility (P = 0.627), household waste disposal practice (P = 0.000), and ever used oral rehydration solution (P = 0.000) as being significantly associated with child mortality. The study created awareness of behavioral practices affecting child mortality and insights on possible interventions for reducing child mortality. We conclude that community-based educational strategies and the improvement of health facilities will reduce child mortality.

Key Determinants of Health-Related Quality of Life Among Advanced Lung Cancer Patients: A Qualitative Study in Belgium and Italy

Background: The lung cancer (LC) treatment landscape has drastically expanded with the arrival of immunotherapy and targeted therapy. This new variety of treatment options, each with its own characteristics, raises uncertainty regarding the key aspects affecting patients' health-related quality of life (HRQL). The present qualitative study aimed to investigate how LC patients perceive their HRQL and the factors that they consider to be most influential in determining their HRQL. Methods: This qualitative research incorporates four focus group discussions, with six LC patients in each group. In total, 24 stage III and IV LC patients were included in the discussions, with Italian (n = 12) and Belgian (n = 12) patients, age range: 42-78, median age = 62 (IQR = 9.3 years), SD = 8.5; 62% men. Using thematic analysis, transcripts and notes from the FGDs were analyzed using NVivo software (edition 12). Results: Three main themes capturing determinants of HRQL were identified. First, patients agreed on the importance of physical aspects (symptoms and side-effects) in determining their HRQL. In particular, skin conditions, nausea, fatigue, risk of infections, sensory abnormalities, pain, and changes in physical appearance were highlighted. Second, patients worried about psychological aspects, negatively impacting their wellbeing such as uncertainties regarding their future health state, and a lower degree of autonomy and independence. Third, patients underlined the importance of social aspects, such as communication with healthcare providers and social interaction with friends, family and peers. Conclusion: This study demonstrates that physical, psychological, and social aspects are key factors driving LC patients' HRQL. Gaining a better understanding of how LC patients perceive their HRQL and how it is affected by their illness and therapy will aid patient-centric decision-making across the drug life cycle, by providing stakeholders (drug developers, regulators, reimbursement bodies, and clinicians) insights about the treatment and disease aspects of importance to LC patients as well as the unmet needs LC patients may have regarding available treatment modalities. Finally, this study underscores a need for individual treatment decision-making that is considerate of uncertainties among LC patients about their future health state, and ways for improving communication between healthcare providers and patients to do so.

Cultural Sets Shape Adult Conceptualizations and Relationships to Nature

The variability of nature and the nature construct have complicated interpretations of empirical evidence from nature-based health studies. The challenge of defining nature exposure for purposes of methodological standardization may encompass constructs beyond vegetated landcover. This study offers a new construct for defining 'nature exposure' that considers cultural sets and nature familiarity. Focus group discussions across the United States (N = 126) explored the concept of what constitutes the relationship to nature. The participant diversity included regions, cultural demographics, cumulative nature experience, and everyday nature exposure. Mixed methods of semi-structured discussion and a photo exercise that prompted nature connectedness allowed for data triangulation and the detection of contradictions between approaches. Individuals conceptualized nature in ways reflecting highly personal and differentiated experiences, which defied consensus toward a single nature construct. The group scoring of photo imagery showed consistent high and low levels of nature connectedness with respect to wildness and outdoor urban venues, respectively, but diverged in the assessment of nature within the built environment. Everyday nature exposure significantly differentiated how groups conceptualized and related to nature imagery. This result may indicate an unmet biophilic need among groups with low backgrounds of nature exposure. The contrasts between the discussion content and the observed reactions to nature imagery showed the value of using mixed methods in qualitative research.

Preconditions to parenthood: changes over time and generations

Reproductive decision-making and fertility patterns change with time and place, and are influenced by contemporary societal factors. In this paper, we have studied biosocial aspects of reproductive decision-making over time and generations in a Nordic setting. The aim was to explore intergenerational changes and influences on decision-making, especially regarding preconditions to first birth. Twenty-six focus group interviews were conducted in southern Sweden, including a total of 110 participants aged 17-90 years. The analysis of the interviews resulted in six themes: (i) 'Providing security - an intergenerational precondition'; (ii) 'A growing smorgasbord of choices and requirements'; (iii) 'Parenthood becoming a project'; (iv) 'Stretched out life stages'; (v) '(Im)possibilities to procreate'; and (vi) 'Intergenerational pronatalism'. Our findings reflect increasing expectations on what it means to be prepared for parenthood. Despite increasing awareness of the precariousness of romantic relationships, people still wish to build new families but try to be as prepared as possible for adverse events. The findings also show how increasing life expectancy and medical advancements have come to influence people's views on their reproductive timeline.

Prevalence of Rape Myths and Sexual Double Standards Among University Students in Pakistan

This study aimed to determine the prevalence of rape myths and sexual double standards among Pakistani university students. The sample size was 500 university students. The results indicated that 76.8 % students had more belief in rape myths, while 23.2 % had less belief on rape myths. In total, 71.4% had less sexual double standards, while 28.6 % had more sexual double standards. Furthermore, results showed that men believed more in rape myths as compared with women. Young adults of age ranging from 17 to 24 years had high sexual double standards as compared with adults of the age range of 25 to 32 years. Moreover, findings of focus group discussions (FGDs) highlighted that rape myths and sexual double standards are highly prevalent. The study revealed that Pakistani students are gender biased, as power and authority are associated with men. They also shared that rape victims in Pakistan do not get any support from family; rather, in most cases, the rape victims are killed in the name of so-called honor to maintain the reputation of family in society.

Psycho-social and behavioral impact of COVID-19 on middle-aged and elderly individuals: A qualitative study

BACKGROUND

COVID-19 may seem to have an impact on middle-aged and elderly people. However, not much is known about the lived experiences of middle-aged and elderly people during this pandemic. The study aims to explore psychosocial and behavioral impact of COVID-19 on the lives of these individuals.

MATERIALS AND METHODS

Three focus group discussions and seven in-depth interviews were conducted. A format to guide discussions and interviews was made to bring uniformity across groups and participants. Participants were recruited through purposive and snowball sampling techniques. Discussions were recorded and transcribed verbatim. Thematic analysis method was used to extract key conceptual themes.

RESULTS

There were 12 male and 10 female participants included, with a mean age of 62.2 years. Five subcategories identified were: Fear and anxiety, household confinement, lifestyle modification, preventive practices, and coping strategies. These sub-categories formed three major categories-psychological, social, and behavioral which ultimately led to the emergence of the main theme that is, COVID-19 effects on the life of middle-aged and older individuals.

CONCLUSION

Middle-aged and elderly people are affected in many ways due to COVID-19. Addressing the psycho-social and behavioral problems can help in the better adjustment to tide over the pandemic.

School-Based Nutrition Programs for Adolescents in Dodoma, Tanzania: A Situation Analysis

BACKGROUND

Tanzania has a double burden of malnutrition, including a high prevalence of undernutrition and an increasing prevalence of overweight and obesity among adolescents. Schools present a valuable opportunity to reach a large section of the country's adolescent population with nutrition-oriented interventions.

OBJECTIVE

The objective of this study was to assess the current state of adolescent school nutrition interventions in Dodoma, Tanzania, with emphasis on 3 potential school-based nutrition interventions, school vegetable gardens, school meals, and education (on nutrition, agriculture, and water, sanitation, and hygiene).

METHODS

Focus group discussions were conducted with several regional and district-level governmental stakeholders, including health, education, and agricultural officers. Ten public secondary schools were visited, and interviews with school administrators, teachers, students, and parents were conducted.

RESULTS

All stakeholders interviewed supported interventions to improve school-based nutrition, including school gardens, school feeding, and nutrition education. All 10 schools visited had some experience providing school meals, but parents' contributions were essential for the program's sustainability. Most schools visited had land available for a school garden program, but water availability could be challenging during certain times of the year. The teachers interviewed expressed that the curriculum on nutrition education was highly theoretical and did not allow students to practice the knowledge and skills they learned in the classroom.

CONCLUSIONS

The current school-based approach to tackling the double burden of adolescent malnutrition in Dodoma is localized and ad hoc. To leverage the potential of schools as a platform for nutrition interventions, integrated and policy-mandated interventions are needed.

Perceptions of pastoralist problems: A participatory study on animal management, disease spectrum and animal health priorities of small ruminant pastoralists in Georgia

Small ruminants support the livelihoods of millions of poor pastoralist and sedentary households around the world. While pastoralists are generally not amongst the poorest in terms of assets, they are frequently marginalised in terms of their access to political power, health and education. This study was undertaken among pastoralist households keeping small ruminants in four regions of the country of Georgia. Small ruminants are an important cultural, social and economic asset in Georgia and are mainly managed in a transhumant pastoralist system. Georgia suffered its first, and so far only outbreak of peste des petits ruminants (PPR) in 2016. This qualitative interview study was designed to acquire contextual understanding of local small ruminant husbandry and the livelihood situations of the participating pastoralists, and to detect historical, unreported PPR outbreaks. Focus group discussions comprising participatory epidemiology tools and other forms of interviews were used to explore small ruminant management, disease spectrum and management, and animal health priorities. The participants had experienced a wide variety of animal health constraints, with intestinal worms, braxy, piroplasmosis, pasture-related problems, predators and lameness emerging as priorities. No historic, unreported PPR outbreak was detected in this study, and PPR was not a priority for participants. Instead, the day-to-day reality of animal health for the pastoralists was characterised by co-infections of mainly endemic pathogens, and problems related to other challenges such as access to land, feed and genetic resources. The rationale behind the participants' prioritisation of animal health problems was supported by the need to pay extra attention to animals in order to avoid risk factors, keep animals healthy and minimise the negative impact of diseases or management problems; the various epidemiological and clinical parameters of the prioritised diseases; the economic impact of the specific problems and the zoonotic potential of diseases and predation. Even within regions, and within seemingly socially and culturally homogenous groups, there were important local differences in the problems faced by pastoralists that affect their livestock management. This study underlines the importance of a contextualised understanding of the local disease panorama and complexities in the livelihood situations of rural people when designing actions to improve animal health in general or, more specifically, passive surveillance as well as prevention or control measures. Finally, it is concluded that to achieve such an understanding, there is a need for participatory, scoping-style studies that specifically acknowledge diversity and power relations.

Using Panel Community Surveys to Track the Impact of Crop Pests Over Time and Space - The Case of Maize Lethal Necrosis (MLN) Disease in Kenya from 2013 to 2018

Maize lethal necrosis (MLN) disease appeared in Kenya in 2011, causing major damage. In a first survey of 121 communities in 2013, participants estimated the proportion of households affected and the yield loss in affected areas; from this survey, the overall loss was estimated at 22%, concentrated in western Kenya (94%). Efforts to combat the disease included planting resistant varieties, creating awareness of MLN management, and producing pathogen-free seed. In 2018, the same communities were revisited and asked the same questions, establishing a panel community survey. The results showed that incidents of MLN had greatly decreased, and the number of communities that had observed it had reduced from 76% in 2013 to 26% by the long rains of 2018; while still common in western Kenya (60%), MLN had greatly reduced elsewhere (to 10%). In 2013, 40% of farmers were affected, yield loss among affected farmers was estimated at 44%, and total yield loss was estimated at 22% (a production loss of 0.5 million metric tons/year), valued at US$187 million. By the long rains of 2018, 23% of farmers were affected, with a loss among affected farmers of 36%; overall annual loss was estimated at 8.5% or 0.37 million metric tons, valued at US$109 million, concentrated in western Kenya (79%). Of the recommended control measures, only the removal of diseased plants was commonly used (by 62% of affected communities), but not the use of agronomic practices (11%) or resistant varieties (9.5%). The reasons for the reduction in MLN are not well understood; external factors such as spraying insecticide against fall armyworm and unfavorable weather likely played a role, as did using disease-free seed, but not the use of resistant varieties or appropriate management practices. Still, as the pathogen remains in the fields, it is important to keep disseminating these control methods, particularly resistant varieties.[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY 4.0 International license.

Consumer Perceptions of Precision Livestock Farming-A Qualitative Study in Three European Countries

Scholars in the fields of animal science and technology have investigated how precision livestock farming (PLF) can contribute to the quality and efficiency of animal husbandry and to the health and welfare of farm animals. Although the results of such studies provide promising avenues for the development of PLF technologies and their potential for the application in animal husbandry, the perspectives of consumers with regard to PLF technologies have yet to be the subject of much investigation. To address this research gap, the current study explores consumer perceptions of PLF technologies within the pork and dairy value chains. The investigation is based on results from six focus group discussions conducted in three European countries, each reflecting a different market environment: Finland, the Netherlands and Spain. The results indicate that consumers expect the implementation of different PLF technologies to enhance the health and welfare of farm animals, while generating environmental improvements and increasing the transparency of value-chain processes. The analysis further reveals three over-arching consumer concerns: (1) the fear that the integration of PLF technologies will introduce more industrialisation into livestock farming production; (2) the concern that PLF technologies and data are vulnerable to misuse and cyber-crime; and (3) the concern that PLF information is not communicated adequately to allow informed purchase decisions. The research findings provide directions for members of the animal-based food value chain to make informed decisions to improve their sustainability, social responsibility and credibility by endorsing the acceptance of PLF (technologies) amongst European consumers.

From Learning on Mannequins to Practicing on Patients: Nursing Students' First-Time Experience of Clinical Placement in Jordan

Introduction

Although clinical nursing placement is an indispensable component of student nurses' education, data on students' first clinical experiences is scarce in developing countries.

Objectives

The study aim is to uncover nursing students' first-time clinical placement experience and identify related influencing factors in Jordan.

Methods: Focus group discussions (n=4) were used.

Results

The results showed that the transition from learning with mannequins to practicing on real patients in the clinical placement involved both effective learnings through hands-on practice to dealing with clinical challenges. Students perception of nursing ranged from positive comments such as “humanistic” and “nursing almost medicine” to negative images such as “nursing is all about bedside care” and “nursing has poor social status.”

Conclusion

Students' experience in their first clinical placement is multifaceted, and incorporation of student's perspective in the first clinical placement is a crucial component of educational planning.

What Matters Most to Lung Cancer Patients? A Qualitative Study in Italy and Belgium to Investigate Patient Preferences

Background: The potential value of patient preference studies has been recognized in clinical individual treatment decision-making between clinicians and patients, as well as in upstream drug decision-making. Drug developers, regulators, reimbursement and Health Technology Assessment (HTA) bodies are exploring how the use of patient preference studies could inform drug development, regulatory benefit risk-assessment and reimbursement decisions respectively. Understanding patient preferences may be especially valuable in decisions regarding Non-Small Cell Lung Cancer (NSCLC) treatment options, where a variety of treatment options with different characteristics raise uncertainty about which features are most important to NSCLC patients. As part of the Innovative Medicines Initiative PREFER project, this qualitative study aimed to identify patient-relevant lung cancer treatment characteristics.

Methods: This study consisted of a scoping literature review and four focus group discussions, 2 in Italy and 2 in Belgium, with a total of 24 NSCLC patients (Stages III-IV). The focus group discussions sought to identify which treatment characteristics patients find most relevant. The discussions were analyzed thematically using a thematic inductive analysis.

Results: Patients highlighted themes reflecting: 1) positive effects or expected gains from treatment such as greater life expectancy and maintenance of daily functioning, 2) negative effects or adverse events related to therapy that negatively impact patients’ daily functioning such as fatigue and 3) uncertainty regarding the duration and type of treatment effects. These overarching themes were consistent among patients from Belgium and Italy, suggesting that treatment aspects related to efficacy and safety as well as the psychological impact of lung cancer treatment are common areas of concern for patients, regardless of cultural background or country.

Discussion: Our findings illustrate the value of using qualitative methods with patients to identify preferred treatment characteristics for advanced lung cancer. These could inform a subsequent quantitative preference survey that assesses patient trade-offs regarding treatment options.

Analysis of consumer-oriented quality characteristics of raw and boiled plantains in Cameroon: implication for breeding

This study aimed at understanding users' demand for raw and boiled plantains in rural and urban areas in West and Littoral regions of Cameroon. Surveys conducted in eight rural localities consisted of key informant interviews, gender-disaggregated focus group discussions, market and individual interviews. Processing and cooking diagnoses were done with restaurant cooks in urban areas, to know the details of plantain processing and boiling and to understand the quality characteristics of raw plantain that give a most-liked boiled plantain. Local favourite landraces, most cultivated landraces in Cameroon (Batard and Big ebanga) and a new CARBAP/CIRAD hybrid (CARBAP K74) were used. The preference for plantain cultivars was both gender and region-dependent. High-quality plantain should be mature, with big fingers and having a dark green peel colour. The fruit length and girth, pulp pH, dry matter content and firmness were found to be relevant postharvest quality characteristics for plantain breeding improvement.

Development and pilot testing of an oral hygiene self-care photonovel for Punjabi immigrants: a qualitative study

INTRODUCTION

The purpose of this research study was to develop and pilot test a culturally and linguistically appropriate oral hygiene self-care photonovel for Punjabi immigrants.

METHODS

Purposeful sampling technique was used to recruit 5 members of a Punjabi community organization (the Sikh Women's Association of Montreal) for participation in 3 focus group sessions in August 2015. A thematic content analysis approach was used to sort the data, enabling identification of the storyline and photonovel contents from the themes that emerged. Comic Life 3 version 3.1.1 software was used to create a "Safeguard Your Smile" (SYS) photonovel, which was printed for pilot testing. Ten additional participants were recruited for this pilot testing, enabling further revision of the photonovel based on their suggestions.

RESULTS

Four major themes emerged from the focus group discussions: 1) lack of understanding of oral hygiene self-care and risk factors; 2) lack of oral hygiene self-care-related awareness and routine; 3) lack of emphasis on prevention by oral health care providers; and 4) perceived barriers to accessing dental health care. Thematic content analysis revealed a lack of knowledge of oral hygiene self-care skills and routine. Guided by these overarching themes, a final version of the photonovel script was created including photographs of key characters. The photonovel was subsequently printed for pilot testing. Pilot test results revealed close to 80% of participants agreed that the SYS photonovel was culturally and linguistically appropriate and easy to understand.

CONCLUSIONS

A culturally and linguistically appropriate photonovel may be a useful tool for enhancing oral hygiene self-care knowledge among ethnic communities. Further studies are required to test the effectiveness of such a tool.

Concerned and Conscious, but DefenselessThe intersection of gender and generation in child malnutrition in Indonesia: a qualitative grounded theory study

Background: Several studies in Indonesia have shown the protective effect of women-headed households on the double burden of malnutrition (coexistence of undernutrition and overnutrition in a household). Many other studies have presented a positive impact on children’s health and conditions when women are educated, have higher social capital and have control of income and its intra-household allocation. However, how women’s status affects the nutritional status of a household and, in particular, of children still remains understudied.

Objective: In this study, our aim was to explore the role of gender relations and contextual factors for overnutrition and undernutrition among children within a household.

Method: We conducted a qualitative study in two provinces of Indonesia: Central Java (urban and rural) and Jakarta (central and suburban) among 123 community members (59 men and 64 women). We utilised principles of constructivist grounded theory in conducting this study, and focus group discussions were chosen as a tool to collect data.

Results: Three categories were constructed, capturing the significance of: (i) the man is dominant within the family (gendered power relations), (ii) the environment that makes the unhealthy choice the easy choice (the emerging obesogenic environment) and (iii) parents’ being concerned but unable to control their children’s eating habits (intersection of gender and generational relations) in child malnutrition.

Conclusion: Community health and nutrition programmes should help both women and men within the context of households to acknowledge and respect women’s status. More importantly, these programmes should involve men when it comes to children’s nutritional habits and consider them as an important factor in the realisation of gender equality and empowerment. Furthermore, it is increasingly important to recognise the implication of the availability and accessibility of junk food among children.

'Violence exists to show manhood': Nepali men's views on domestic violence - a qualitative study

Background

There is significant evidence of the prevalence and factors associated with domestic violence in high and low-income country settings. However, men’s views on domestic violence are still understudied and have never been reported in Nepali society.

Objective

The aim of the study was to explore Nepali men’s perceptions regarding domestic violence in their communities.

Method

The authors undertook a qualitative study using focus group discussions.

Results

Sixty-six married men, considered they were responsible for upholding family discipline and physically demonstrating their masculinity, and they suggested that violence was a mean for achieving this. Men’s frustration when unable to fulfil their family’s expectations or material needs, and cultural attitudes that precluded interference in other families’ lives, were perceived as factors contributing to domestic violence. The men held the opinion that women also perpetrated domestic violence. Some men were reluctant to accept domestic violence as a norm in Nepali families and were aware of recent changes in societal expectations regarding gender roles.

Conclusion

Overall, the Nepali men who participated in the study held different and sometimes opposing views on domestic violence, ranging from violence justified as a necessity for family discipline, uneasy acceptance that violence was commonplace in families, to definite opposition to the use of domestic violence. The study’s findings provide information for identifying points of intervention for violence-prevention efforts and strategies to alter the social and cultural norms that lead to acceptance of domestic violence.

Perception, Attitudes, and Experiences Regarding Mental Health Problems and Web Based Mental Health Information Amongst Young People with and without Migration Background in Germany. A Qualitative Study

Mental illnesses in adolescence and young adulthood are steadily increasing. Thus, mental disorders represent an individual and societal challenge and an enormous health economic burden, creating an urgent need for research and action. Mental health problems are omnipresent in the life of young people and the internet is the first resource, which helps them to understand their situation. Young people with migration background often have more difficulties accessing health care services. Digital technologies offer an ideal opportunity for a low-threshold platform that addresses the needs of young people. The current project "GeKo:mental" aims to design a multilingual website for Cologne-based adolescents and young adults that will enable them to obtain comprehensive information about mental illness and health, treatment options and first contact points. To design this website, this study aims to find out what kind of health information is needed and how it should best be presented. Nine focus group discussions with adolescents and young adults with and without migration background (N = 68) were conducted; the focus group discussions took place at schools, in an association for social youth work and in an cultural association, which is linked to a mosque in Cologne, Germany. A qualitative content analysis was conducted on the gathered material. The participants reported concrete challenges and needs. The results will form the basis for the development and design of a website.

Public engagement by researchers of different disciplines in Singapore: A qualitative comparison of macro- and meso-level concerns

Guided by neo-institutional theory, this study compares how researchers from science, technology, engineering, and math disciplines differ from researchers from the arts, humanities, and social sciences fields in terms of how macro- and meso-level concerns shaped their willingness to conduct public engagement. Focus group discussions conducted among researchers based in Singapore revealed that science, technology, engineering, and math and arts, humanities, and social sciences researchers held different macro-level concerns. Particularly, science, technology, engineering, and math researchers raised more concerns about media misrepresentation, while arts, humanities, and social sciences researchers were more concerned about receiving political repercussions and public backlash. With regard to meso-level considerations, researchers from all disciplines cited similar institutional constraints for public engagement; however they possessed varying public engagement competencies and held differing perceptions of their social duty to engage the public. Hence, researchers of different disciplines desired different kinds of media training. Policy and managerial implications as well as directions for future research were provided.

"If you do not birget [manage] then you don't belong here": a qualitative focus group study on the cultural meanings of suicide among Indigenous Sámi in arctic Norway

Suicide is a major public health issue across the Arctic, especially among Indigenous Peoples. The aim of this study was to explore and describe cultural meanings of suicide among Sámi in Norway. Five open-ended focus group discussions (FGDs) were conducted with 22 Sámi (20) and non-Sámi (2) participants in South, Lule, Marka, coastal and North Sámi communities in Norway. FGDs were recorded, transcribed verbatim and analysed employing thematic analysis. Six themes were developed from the analysis: “Sámi are treated negatively by the majority society”, “Some Sámi face negative treatment from other Sámi”, “The historic losses of the Sámi have turned into a void”, “Sámi are not provided with equal mental health care”, “The strong Sámi networks have both positive and negative impacts” and “‘Birgetkultuvvra’ might be a problem”. The findings indicate that the participants understand suicide among Sámi in relation to increased problem load for Sámi (difficulties in life not encountered by non-Sámi) and inadequate problem-solving mechanisms on different levels, including lack of equal mental health care for Sámi and cultural values of managing by oneself (“ieš birget”). The findings are important when designing suicide prevention initiatives specifically targeting Sámi.

In the hands of nurses: A focus group study of how nurses perceive and promote inpatients' needs for physical activity

Aims

To describe how nurses perceive and promote inpatients' needs for physical activity during their stay at the ward.

Design

A qualitative descriptive design was employed providing an exploration of how nurses perceive and promote inpatients' need for physical activity.

Methods

Seven semi-structured focus group discussions were held between November 2016 and February 2017 with 29 nurses in three hospitals in Sweden. Both interaction analysis and content analysis of the data were conducted.

Results

Patients are dependent on nurses' prioritizations and promotions to be sufficiently physically active during their stay at the ward. The external environment and the integration of physical activity affected the promotion of physical activity. The nurses perceived that understanding the patient's expectations was important and that promotion of physical activity was a joint responsibility of patient, relatives and healthcare professionals. The interaction analysis revealed no clear hierarchical pattern as all members in each focus group took initiative to open the discussions. The Registered Nurses contributed with more new ideas.

"You must first save her life": community perceptions towards induced abortion and post-abortion care in North and South Kivu, Democratic Republic of the Congo

Structural barriers such as a restrictive legal environment, limited medical resources, and high-costs inhibit access to safe abortion in the Democratic Republic of the Congo (DRC); these barriers are exacerbated by two decades of conflict. Socio-normative barriers further complicate access to safe abortion and post-abortion care (PAC) in DRC, where fear of abortion-related stigma may lead women to avoid PAC services. Programme partners support the Ministry of Health to provide good quality contraceptive and PAC services in North and South Kivu, DRC. This paper presents results from focus group discussions that explored community members' attitudes towards women who induce abortion and their care-seeking behaviour in programme areas. Results indicate that while abortion stigma was widespread, community members' attitudes towards women who induced abortions were not one-dimensional. Although they initially expressed negative opinions regarding women who induced abortion, beliefs became more nuanced as discussion shifted to the specific situations that could motivate a woman to do so. For example, many considered it understandable that a woman would induce abortion after rape: perhaps unsurprising, given the prevalence of conflict-related sexual violence in this area. While community members believed that fear of stigma or associated negative social consequences dissuaded women from seeking PAC, a majority believed that all women should have access to life-saving PAC. This commitment to ensuring that women who induced abortion have access to PAC, in addition to the professed acceptability of induced abortion in certain situations, indicates that there could be an opening to destigmatise abortion access in this context.

Chronic pelvic pain in women: an embedded qualitative study to evaluate the perceived benefits of the meridian balance method electro-acupuncture treatment, health consultation and National Health Service standard care

Introduction

Chronic pelvic pain (CPP) - defined as intermittent or constant pain in the lower abdomen or pelvis of at least 6 months' duration, not occurring exclusively with menstruation or intercourse and not associated with pregnancy - is estimated to affect 6-27% of women worldwide. In the United Kingdom, over 1 million women suffer from CPP, which has been highlighted as a key area of unmet need. Current medical treatments for CPP are often associated with unacceptable side effects. A specific style of acupuncture, the meridian balance method electro-acupuncture (BMEA) and traditional Chinese medicine health consultation (TCM HC (BMEA + TCM HC = BMEA treatment)), may be effective for CPP in women.

Aim

Three focus group discussions and semi-structured telephone interviews were embedded in a randomised controlled feasibility trial to gain in-depth description of the perceived benefits of the participants' respective interventions.

Methods

Women with CPP were randomised into the BMEA treatment, TCM HC or National Health Service standard care (NHS SC). Focus group discussions were recorded, transcribed and analysed thematically. Semi-structured telephone interviews were conducted post focus group discussions.

Findings

A total of 30 women were randomised into BMEA treatment, TCM HC or NHS SC. A total of 11 participants attended the three focus group discussions. Thematic analysis of focus group discussions showed: a perceived pain reduction, enhanced sleep, energy level and sense of well-being in the BMEA treatment and TCM HC groups; a dislike for the adverse effects of medications, frustration at the lack of effective treatment, heavy reliance on medications and services that are helpful, in the NHS SC group. Semi-structured telephone interviews showed that the methodology was acceptable to the participants.

Conclusion

The embedded focus group discussions captured the rich and complex narratives of the participants and provided insights into the perceived benefits of the BMEA treatment, TCM HC and NHS SC interventions.

What Influences Saturation? Estimating Sample Sizes in Focus Group Research

Saturation is commonly used to determine sample sizes in qualitative research, yet there is little guidance on what influences saturation. We aimed to assess saturation and identify parameters to estimate sample sizes for focus group studies in advance of data collection. We used two approaches to assess saturation in data from 10 focus group discussions. Four focus groups were sufficient to identify a range of new issues (code saturation), but more groups were needed to fully understand these issues (meaning saturation). Group stratification influenced meaning saturation, whereby one focus group per stratum was needed to identify issues; two groups per stratum provided a more comprehensive understanding of issues, but more groups per stratum provided little additional benefit. We identify six parameters influencing saturation in focus group data: study purpose, type of codes, group stratification, number of groups per stratum, and type and degree of saturation.

Information as a crucial factor for toilet training by parents

BACKGROUND

Toilet training (TT) is a milestone in a child's development. Nowadays, children complete TT later than previous generations. This can have detrimental consequences for the child, the parents, and the environment. TT is experienced as difficult and time-consuming; parents could benefit from guidelines to assist in this process.

METHODS

Focus group discussions (FGDs) were used to explore parents' experiences in an inductive approach applying purposive sampling. The FGDs aimed to explore the type of information parents wanted to receive on TT, from whom and how.

RESULTS

After six FGDs, including 37 participants with personal experience in TT, data saturation was achieved. The findings of this qualitative study show that reputable agencies, family, friends, day-care workers, and nursery school teachers were considered very helpful and trustworthy sources. TT information should be easily understandable and not contain scientific terms or much text. A colourful and illustrated brochure sent by regular mail is preferred.

CONCLUSION

Our study allows to develop a source of correct and wanted information about TT that parents can and want to use, which helps them completing this training more easily and timely.

Physical Activity Among Adolescents in India: A Qualitative Study of Barriers and Enablers

Inadequate physical activity (PA) levels are reported in Indian youth, with lowest levels among adolescents, particularly girls. We aimed to identify barriers to and enablers of PA among school children in New Delhi and examine potential differences by gender and school type (government vs. private). A total of 174 students (private school students = 88, 47% girls; government school students = 86, 48% girls) aged 12 to 16 years from two Delhi schools participated in 16 focus group discussions (FGDs) conducted by bilingual moderators. We conducted FGDs separately for girls and boys, for students in Grades VIII and IX, and for private and government schools. We conducted FGDs among government school students in Hindi and translated the transcriptions to English for analysis. We coded transcriptions using a combination of inductive and deductive approaches, guided by the "youth physical activity promotion model." We identified various personal, social, and environmental barriers and enablers. Personal barriers: Private school girls cited body image-related negative consequences of PA participation. Social barriers: Girls from both schools faced more social censure for participating in PA. Environmental barriers: Reduced opportunity for PA in schools was commonly reported across all participants. Personal enablers: All participants reported perceived health benefits of PA. Social enablers: Several participants mentioned active parents and sports role models as motivators for increasing PA. Few environmental enablers were identified. This study highlights the need for further investment in physical activity within schools and for gender-sensitive policies for encouraging PA participation among adolescents in India.

Patient and Provider Perspectives on a Decision Aid for Familial Hypercholesterolemia

Familial Hypercholesterolemia (FH) is an inherited disorder associated with increased cardiovascular risk that requires patients to make multiple impactful decisions regarding the management of their condition. Patient decision aids (PDAs) can facilitate shared decision-making (SDM) and enable patients to make choices that are concordant with their goals and values. To inform the development of a PDA for patients with FH, we employed a qualitative inductive approach and focus group discussions with patients, physicians, and genetic counselors. We explored and analyzed the perceptions and understanding of these stakeholders related to a PDA for FH and identified important concepts to include in the PDA. Categories emerging from focus group discussions included: (a) perceptions of a PDA related to FH; (b) discussion about the content of a PDA related to FH; and (c) SDM. In general, stakeholders were in favor of developing tools which can inform and individualize discussion about genetic testing and treatment options for FH. Physicians valued a tool that facilitates knowledge transfer to FH patients. Patients desired a tool to help them understand the genetic aspects of and treatment options related to FH. Genetic counselors emphasized the inclusion of visual aids to support discussion with patients. Potential barriers to and facilitators of PDA implementation were identified. The input of various stakeholders will inform the development of a prototype tool that will be iteratively tested before implementation in the clinical setting.

European University Students' Experiences and Attitudes toward Campus Alcohol Policy: A Qualitative Study

BACKGROUND

Many studies indicate that a substantial part of the student population drinks excessively, yet most European universities do not have an alcohol policy. In the absence of an alcohol guideline at universities and the easy access to alcohol sold at the student cafeteria, for instance, this has the potential to place students at risk of overconsumption, which has adverse health consequences.

OBJECTIVES

Therefore, our study objectives were to explore and compare university students' experiences and attitudes toward alcohol policy on their campus using a qualitative approach.

METHODS

29 focus group discussions (FGDs) were conducted among students from universities in five European countries: Belgium (4 FGDs), Denmark (6 FGDs), France (5 FGDs), Hungary (6 FGDs), and the Slovak Republic (8 FGDs), with a total number of 189 participants.

RESULTS

Across the five European countries, students recognized that alcohol was a big problem on their campuses yet they knew very little, if any, about the rules concerning alcohol on their campus.

CONCLUSIONS

Students will not support an on campus alcohol restriction and a policy should therefore focus on prevention initiatives.

"There Is Zero Regulation on the Selling of Alcohol": The Voice of the Youth on the Context and Determinants of Alcohol Drinking in Lebanon

Alcohol-related research from the Arab world has rarely touched on the experiences or views of Arab adolescents. In this article, we present an in-depth analysis of youth alcohol drinking patterns and determinants derived from focus group discussions completed with more than 100 Lebanese high school/vocational students (15-19 years). The social ecology of alcohol use framework guided our research and analysis. Findings reveal that alcohol drinking is perceived as a pervasive and serious public health problem, triggered by a complex web of social relations, and facilitated by lax policies. Recommendations to curb heavy/harmful alcohol drinking among adolescents include regulating the role of alcohol industry, providing alternative recreational spaces/pass-times, educating about alcohol-related harms, and promoting more research on alcohol and its harms. Findings confirm the social ecology of alcohol use framework, and suggest the addition of the macro level of influence to this model, namely, a comprehensive alcohol harm reduction policy.

Conceptions of Contraceptive Use in Rural KwaZulu-Natal, South Africa: Lessons for Programming

Community family planning programmes in South Africa arose from the controversial apartheid history of controlling the African population while encouraging the growth of European migrant population. Post-apartheid population policies shifted away from population control to aligning policies to the global agenda that placed emphasis on the link between population and development. The focus on population and development polices in post-apartheid South Africa is on social equality, justice and peace rather than controlling sections of the population. Given the shift, this paper interrogates the conceptions of contraceptive use among rural communities in KwaZulu-Natal. Our primary objective is to understand the dynamics surrounding access to and use of family planning services in peri-urban and rural areas of KwaZulu-Natal. Using focus group data, the findings of the study suggest that different social categories interact with the family planning programmes differently. How teenagers and married women perceive the value of family planning differs. Gender differences regarding the use of condoms are also evident. The paper attempts to grapple with the non-use of condoms despite the knowledge that these prevent pregnancy and provide protection from sexually-transmitted diseases. The contribution of this paper lies in its identification of socio-cultural factors and the political economy underlying the different attitudes towards contraceptive use in rural KwaZulu-Natal.

'It's good enough': Swedish general dental practitioners on reasons for accepting substandard root filling quality

AIM

The concept of 'good enough' is central and necessary in the assessment of root filling quality. The aim was to explore the concept by analysing reasons and arguments for the acceptance or rejection of substandard root filling quality as reported by general dental practitioners (GDPs) in Sweden.

METHODOLOGY

The study was designed as a qualitative and exploratory study based on seven videotaped focus group interviews analysed by means of qualitative content analysis. Thirty-three GDPs employed in the Public Dental Health Service in Gothenburg, Sweden, participated (4-6 GDPs/interview). In all, nine predetermined questions were followed. Before each focus group, the participants received radiographs of 37 root fillings and were asked to assess the root filling quality. The three cases representing the most divergent assessments served as a basis for the discussion. The cases were presented without clinical information; the dentists would relate to the cases as being just root filled by themselves.

RESULTS

The radiographs did not provide a sufficient basis for decisions on whether or not to accept the root filling. This study emphasized that dentists did not primarily look for these arguments in the technical details of the root filling per se, but instead, they considered selected features of the contextual situation. The GDPs constantly introduced relevant 'ad hoc considerations' to account for the decisions they made. These contextual considerations were related to aspects of pulpal and periapical disease, risks (e.g. technical complications) or to consumed resources (personal and/or economic).

CONCLUSIONS

It was obvious that the concept of 'good enough' does not exist as a general formula ready to be applied in particular situations. Instead, it is necessarily and irremediably tied to contextual properties that emerge from case to case.

Urine diversion dry toilets in eThekwini Municipality, South Africa: acceptance, use and maintenance through users' eyes

This study was part of the VUNA project aimed to develop an affordable sanitation system that produces a valuable fertiliser, reduces pollution of water resources and promotes health. Urine diversion dry toilets (UDDTs) simplify the on-site hygienisation of faeces and allow for nutrient recovery from urine. Social acceptance is vital for the implementation of the UDDT, because sanitation is only effective if the system not only provides a well-designed toilet and effective waste management, but also offers users a facility that caters to their needs and is sensitive to their cultural lifestyle. This study used qualitative and quantitative methods to investigate acceptance, use and maintenance of UDDTs. Key findings indicate lower levels of acceptance of UDDTs among the elderly, who are accustomed to traditional pit toilets. The users aspire to own a flush toilet, perceived to be indicative of household wealth. A dominant concern was emptying the pit and the quality of the building material. Community interventions are required that will promote acceptance, understanding and encourage proper use and maintenance of the UDDT, and may need some technology modification. There is an urgent need for increased community participation to address users' perceptions, attitudes and behaviour concerning the UDDT.

Listening to the consumer voice: developing multilingual cancer information resources for people affected by liver cancer

Background

In Australia, liver cancer incidence is rising, particularly among people born in hepatitis B‐endemic countries. We sought to build an understanding of the information needs of people affected by liver cancer, to inform the design of in‐language consumer information resources.

Methods

We searched the World Wide Web for available in‐language consumer information and conducted a literature search on consumers’ information needs and their preferred means of accessing it. Qualitative data collection involved bilingual researchers conducting focus group discussions (26 participants) and in‐depth interviews (22 participants) with people affected by liver cancer in English, Vietnamese, Cantonese and Mandarin. Sessions were audio‐recorded, transcribed, translated and thematically analysed. The key themes and salient findings informed the development of in‐language multimedia information resources.

Results

Many consumer resources did not cater for people with low literacy levels. The participants wanted more information on cancer diagnostic and treatment options, nutrition and Chinese Medicine and experienced communication challenges speaking to health professionals. While Vietnamese speakers relied entirely on information provided by their doctors, other participants actively searched for additional treatment information and commonly used the Internet to source it. We developed multilingual, multimedia consumer information resources addressing identified consumer information needs through an iterative process, in collaboration with our multilingual consumer panel. These resources are available in four languages, as separate modules accessible online and in DVD format.

Conclusion

This process enabled the development of user‐friendly patient resources, which complement health‐care provider information and supports informed patient decision making.

General practitioners' perceptions of working with the certification of sickness absences following changes in the Swedish social security system: a qualitative focus-group study

BACKGROUND

Many physicians in Sweden, as well as in other countries, find the matter of certification of sickness absence (COSA) particularly burdensome. The issuing of COSAs has also been perceived as a work-environment problem among physicians. Among general practitioners (GPs) are the highest proportion of physicians in Sweden who experience difficulties with COSA. Swedish authorities have created several initiatives, by changing the social security system, to improve the rehabilitation of people who are ill and decrease the number of days of sick leave used. The aim of this study was to describe how GPs in Sweden perceive their work with COSA after these changes.

METHODS

A descriptive design with a qualitative, inductive focus-group discussion (FGD) approach was used.

RESULTS

Four categories emerged from the analysis of FGDs with GPs in Sweden: 1) Physicians' difficulties in their professional role; 2) Collaboration with other professionals facilitates the COSA; 3) Physicians' approach in relation to the patient; 4) An easier COSA process.

CONCLUSIONS

Swedish GPs still perceived COSA to be a burdensome task. However, system changes in recent years have facilitated work related to COSA. Cooperation with other professionals on COSA was perceived positively.

Motivational factors for participation in biomedical research: evidence from a qualitative study of biomedical research participation in Blantyre District, Malawi

Obtaining effective informed consent from research participants is a prerequisite to the conduct of an ethically sound research. Yet it is believed that obtaining quality informed consent is generally difficult in settings with low socioeconomic status. This is so because of the alleged undue inducements and therapeutic misconception among participants. However, there is a dearth of data on factors that motivate research participants to take part in research. Hence, this study was aimed at filling this gap in the Malawian context. We conducted 18 focus group discussions with community members in urban and rural communities of Blantyre in Malawi. Most participants reported that they accepted the invitation to participate in research because of better quality treatment during study also known as ancillary care, monetary and material incentives given to participants, and thorough medical diagnosis.

'Will I be able to have a baby?' Results from online focus group discussions with childhood cancer survivors in Sweden

STUDY QUESTION

What do adolescent and young adult survivors of childhood cancer think about the risk of being infertile?

SUMMARY ANSWER

The potential infertility, as well as the experience of having had cancer, affects well-being, intimate relationships and the desire to have children in the future.

WHAT IS KNOWN ALREADY

Many childhood cancer survivors want to have children and worry about possible infertility.

STUDY DESIGN, SIZE, DURATION

For this qualitative study with a cross-sectional design, data were collected through 39 online focus group discussions during 2013.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Cancer survivors previously treated for selected diagnoses were identified from The Swedish Childhood Cancer Register (16–24 years old at inclusion, ≥5 years after diagnosis) and approached regarding study participation. Online focus group discussions of mixed sex (n = 133) were performed on a chat platform in real time. Texts from the group discussions were analysed using qualitative content analysis.

MAIN RESULTS AND THE ROLE OF CHANCE

The analysis resulted in the main category Is it possible to have a baby? including five generic categories: Risk of infertility affects well-being, Dealing with possible infertility, Disclosure of possible infertility is a challenge, Issues related to heredity and Parenthood may be affected. The risk of infertility was described as having a negative impact on well-being and intimate relationships. Furthermore, the participants described hesitation about becoming a parent due to perceived or anticipated physical and psychological consequences of having had cancer.

LIMITATIONS, REASONS FOR CAUTION

Given the sensitive topic of the study, the response rate (36%) is considered acceptable. The sample included participants who varied with regard to received fertility-related information, current fertility status and concerns related to the risk of being infertile.

WIDER IMPLICATIONS OF THE FINDINGS

The results may be transferred to similar contexts with other groups of patients of childbearing age and a risk of impaired fertility due to disease. The findings imply that achieving parenthood, whether or not with biological children, is an area that needs to be addressed by health care services.

STUDY FUNDING/COMPETING INTEREST(S)

The study was financially supported by The Cancer Research Foundations of Radiumhemmet, The Swedish Childhood Cancer Foundation and the Doctoral School in Health Care Science, Karolinska Institutet. The authors report no conflicts of interest.

Community perceptions of rape and child sexual abuse: a qualitative study in rural Tanzania

BACKGROUND

Rape of women and children is recognized as a health and human rights issue in Tanzania and internationally. Exploration of the prevailing perceptions in rural areas is needed in order to expand the understanding of sexual violence in the diversity of Tanzania's contexts. The aim of this study therefore was to explore and understand perceptions of rape of women and children at the community level in a rural district in Tanzania with the added objective of exploring those perceptions that may contribute to perpetuating and/or hindering the disclosure of rape incidences.

METHODS

A qualitative design was employed using focus group discussions with male and female community members including religious leaders, professionals, and other community members. The discussions centered on causes of rape, survivors of rape, help-seeking and reporting, and gathered suggestions on measures for improvement. Six focus group discussions (four of single gender and two of mixed gender) were conducted. The focus group discussions were recorded, transcribed verbatim, and analyzed using manifest qualitative content analysis.

RESULTS

The participants perceived rape of women and children to be a frequent and hidden phenomenon. A number of factors were singled out as contributing to rape, such as erosion of social norms, globalization, poverty, vulnerability of children, alcohol/drug abuse and poor parental care. Participants perceived the need for educating the community to raise their knowledge of sexual violence and its consequences, and their roles as preventive agents.

CONCLUSIONS

In this rural context, social norms reinforce sexual violence against women and children, and hinder them from seeking help from support services. Addressing the identified challenges may promote help-seeking behavior and improve care of survivors of sexual violence, while changes in social and cultural norms are needed for the prevention of sexual violence.