Parents' Perceptions: Environments and the Contextual Strategies of Parents to Support the Participation of Children and Adolescents with Autism Spectrum Disorder-A Descriptive Population-Based Study from Switzerland

Environments have a modifying effect on the participation of children and adolescents with autism spectrum disorder (ASD) in all areas of life. This cross-sectional study investigated parental perspectives on supportive or hindering environments and the daily contextual strategies parents used to enhance their children's participation. Qualitative and quantitative data gathered from 115 parents from German-speaking Switzerland using the participation and environment measure-child and youth (PEM-CY) were analyzed. Results revealed 45 environmental supports and barriers at home, at school, and in the community. Contextual strategies were identified in combination with people, activities, time, objects, and places. Parental perspectives on participation and their contextual strategies should be considered in environmental-based interventions to support the participation of children and adolescents with ASD.

Adjusting advance care planning to older people's needs: results from focus groups and interviews

BACKGROUND

Advance care planning (ACP) is becoming increasingly important in medical care. Some suggest standardized approaches to initiate ACP with all older adults. However, the idea of patient-centered care suggests more nuanced approaches tailored to individual older adults' needs. This study investigated how older adults with different views and needs about ACP can be approached in an adequate and most beneficial way by health care professionals.

METHODS

We used questionnaires, interviews, focus groups and informal conversations with older adults, living in their own homes, who volunteered to take part in our research. The research was participatory as we collaborated closely with practice partners and we used the obtained findings immediately and continuously to inform the next steps of our research throughout the process.

RESULTS

We identified three subgroups of older adults with differential needs regarding ACP-related activities: The first group avoids talking about their needs and wishes for care towards the end of life. These older people benefit from activities, which aim at motivating them to concern themselves with ACP-related topics. The second group consists of older adults who are in principle open for ACP-conversations but do not initiate these themselves. This group either trusts their next-of-kin or their healthcare professional to act in accordance with their wishes or does not bring up the topic in order to avoid confronting relevant others with possibly unpleasant topics. This group of people benefits from information about ACP and from healthcare professionals initiating the ACP process. The third group of older people initiates the ACP process themselves, gathers information, and takes the necessary steps for ACP. With this group it remains relevant to check carefully whether they have indeed taken all relevant steps and shared the information with all relevant involved care institutions and relatives.

CONCLUSIONS

We propose a model to simplify adjustments of ACP to individuals' needs. Our suggested approach might contribute to increasing the motivation of older people to engage in ACP conversations if these are more closely related to their own needs. Further, it might also contribute to simplifying the individual shaping of the ACP process for healthcare professionals as our suggested model offers clear guidance for approaching different types of older people in different ways. The suggested approach may in future be used for training health care professionals in the conduct of ACP conversations.

Parents' perceptions: Participation patterns and desires for change for children and adolescents with autism spectrum disorder-A descriptive population-based study from Switzerland

BACKGROUND

Low participation in youth with autism spectrum disorder (ASD) has been reported, but age-related and contextual information is rare.

OBJECTIVE

This study aimed to describe, from parental perspectives, two patterns of participation and parental desires for change of children (age: 5-11) and adolescents (age: 12-17) with ASD in Switzerland.

METHOD

A cross-sectional design used the German version of the Participation and Environment Measure-Child and Youth to describe and juxtapose the participation results of 60 children and 55 adolescents with ASD in 45 activities at home, school and in the community and parental desires for change.

RESULTS

Participation patterns differed between settings and age groups. Both groups were found to participate most at home, followed by school, whereas community participation was either low or nonexistent. Children were more involved at home than adolescents, while school involvement was higher than participation frequency in both age groups. Community participation frequency was generally low but higher in children than in adolescents, while involvement was similarly low in both groups. Half the parents expressed desire for change with three tendencies: (1) widespread desire for change at home due to high support needs, (2) parents of adolescents expressed more desire for change in all settings than those of children and (3) all parents mainly desired to increase participation frequency and involvement.

CONCLUSIONS

This study informs research and social, health and community service providers to further reshape their programmes to meet parental needs and increase the participation of youth with ASD.

Clinical aspects of umbilical cord cannulation during transfer from the uterus to a liquid-based perinatal life support system for extremely premature infants a qualitative generic study

A liquid-based perinatal life support system (PLS) for extremely premature infants (born before 28 week of gestational age) envisions a connection between the infant's native umbilical cord and an artificial placenta system through cannulation. This system mimics a natural mothers' womb to achieve better organ maturations. The objective of this study is to gain insight into the clinical focus points of umbilical cord cannulation and how cannulation should be addressed in extremely premature infants during the transfer from the uterus to an in-utero simulating liquid-based PLS system. We performed an explorative qualitative study. Twelve medical specialists with knowledge of vessel cannulation participated. We collected data through twelve interviews and two focus group discussions. Data were analyzed using inductive content and constant comparison analysis via open and axial coding. Results were derived on the following topics: (1) cannulation technique, (2) cannula fixation, (3) local and systemic anticoagulation, and (4) vasospasm. A side-entry technique is preferred as this may decrease wall damage, stabilizes the vessel better and ensures continuous blood flow. Sutures, especially via an automatic microsurgery instrument, are favored above glue, stents, or balloons as these may be firmer and faster. Medication possibilities for both vasospasm and anticoagulation should function locally since there were uncertainties regarding the systemic effects. According to the findings of this research, the needed umbilical cord cannulation method should include minimal wall damage, improved vascular stability, blood flow maintenance, a strong fixation connection, and local anticoagulation effect.

Series: Public engagement with research. Part 1: The fundamentals of public engagement with research

BACKGROUND

In the first of a four-part series, we describe the fundamentals of public engagement in primary care research.

OBJECTIVES

The article's purpose is to encourage, inform and improve the researcher's awareness about public engagement in research. For a growing number of researchers, funders and patient organisations in Europe, public engagement is a moral and ethical imperative for conducting high-quality research.

DISCUSSION

Starting with an explanation of the role of public engagement in research, we highlight its diversity and benefits to research, researchers and the public members involved. We summarise principles of good practice and provide valuable resources for researchers to use in their public engagement activities. Finally, we discuss some of the issues encountered when researchers collaborate with members of the public and provide practical steps to address them. Case studies of real-life situations are used to illustrate and aid understanding.

CONCLUSION

We hope this article and the other papers in this series will encourage researchers to better consider the role and practice of public engagement and the potential added value to research that collaborating with the public could provide.

The Balancing Act of Assessment Validity in Interprofessional Healthcare Education: A Qualitative Evaluation Study

CONSTRUCT & BACKGROUND

In order to determine students' level of interprofessional competencies, there is a need for well-considered and thoroughly designed interprofessional assessments. Current literature about interprofessional assessments focuses largely on the development and validation of assessment instruments such as self-assessments or questionnaires to assess students' knowledge or attitudes. Less is known about the design and validity of integral types of assessment in interprofessional education, such as case-based assessments, or performance assessments. The aim of this study is to evaluate the evidence for and threats to the validity of the decisions about students' interprofessional performances based on such integral assessment task. We investigated whether the assessment prototype is a precursor to practice (authenticity) and whether the assessment provides valid information to determine the level of interprofessional competence (scoring).

APPROACH

We used a design-based qualitative research design in which we conducted three group interviews with teachers, students, and interprofessional assessment experts. In semi-structured group interviews, participants evaluated the evidence for and threats to the validity of an interprofessional assessment task, which were analyzed using deductive and inductive content analysis.

FINDINGS

Although both evidence for and threats to validity were mentioned, the threats refuting the assessment's validity prevailed. Evidence for the authenticity aspect was that the assessment task, conducting a team meeting, is common in practice. However, its validity was questioned because the assessment task appeared more structured as compared to practice. The most frequently mentioned threat to the scoring aspect was that the process of interprofessional collaboration between the students could not be evaluated sufficiently by means of this assessment task.

CONCLUSIONS

This study showed that establishing interprofessional assessment validity requires three major balancing acts. The first is the balance between authenticity and complexity. As interprofessional practice and competencies are complex, interprofessional tasks require build-up or guidance toward this complexity and chaotic practice. The second is that between authenticity and scoring, in which optimal authenticity might lead to threats to scoring and vice versa. Simultaneous optimal authenticity and scoring seems impossible, requiring ongoing evaluation and monitoring of interprofessional assessment validity to ensure authentic yet fair assessments for all participating professions. The third balancing act is between team scoring and individual scoring. As interprofessional practice requires collaboration and synthesis of diverse professions, the team process is at the heart of solving interprofessional tasks. However, to stimulate individual accountability, the individual performance should not be neglected.

Series: Practical guidance to qualitative research. Part 7: Qualitative evidence synthesis for emerging themes in primary care research: Scoping review, meta-ethnography and rapid realist review

This article, the seventh in a series aiming to provide practical guidance for qualitative research in primary care, introduces qualitative synthesis research for addressing health themes in primary care research. Qualitative synthesis combines rigorous processes and authorial judgement to present the collective meaning of research outputs; the findings of qualitative studies - and sometimes mixed-methods and quantitative research - are pooled. We describe three exemplary designs: the scoping review, the meta-ethnography and the rapid realist review. Scoping reviews aim to provide an overview of the evidence/knowledge or to answer questions regarding the nature and diversity of the evidence/knowledge available. Meta-ethnographies intend to systematically compare data from primary qualitative studies to identify and develop new overarching concepts, theories, and models. Rapid realist reviews aim to provide a knowledge synthesis by looking at complex questions while responding to time-sensitive and emerging issues. It addresses the question, 'what works, for whom, in what circumstances, and how?'We discuss these three designs' context, what, why, when and how. We provide examples of published studies and sources for further reading, including manuals and guidelines for conducting and reporting these studies. Finally, we discuss attention points for the research team concerning the involvement of necessary experts and stakeholders and choices to be made during the research process.

Rationale and development of an e-health application to deliver patient-centered care during treatment for recently diagnosed multiple myeloma patients: pilot study of the MM E-coach

BACKGROUND

Patients with multiple myeloma (MM) increasingly face complicated treatment regimens. E-health may support patients and healthcare providers in enhancing a patient-centered healthcare approach. Therefore, we aimed to develop a patient-centered multi-modality e-health application, to assess the application for usability and end-user experiences.

METHODS

The application was developed following an iterative "action-based" methodology using the design thinking approach. Key end users participated, and relevant stakeholders were consulted in the development process. First, the care pathway was evaluated, the focus of development was determined, and a solution ideated during recurring multidisciplinary meetings. Second, a prototype was tested and improved. Third, a subsequent prototype was evaluated during a pilot study with patients and healthcare professionals on usability, usage, and experiences.

RESULTS

The multi-modality application, named the "MM E-coach," consisted of a newly developed medication module, patient-reported outcome (PRO) questionnaire assessments, a messaging service, alerts, information provision, and a personal care plan. The median system usability score was 60 on a scale of 0-100. Patients appreciated the medication overview, healthcare professionals appreciated the outpatient clinic preparation module, and both appreciated the messaging service. Additional recommendations for improvement mostly revolved around the flexibility of functionalities and look and feel of the application.

CONCLUSIONS

The MM E-coach has the potential to provide patient-centered care by supporting patients and caregivers during MM treatment and is a promising application to be implemented in the MM care pathway. A randomized clinical trial was initiated to study its clinical effectiveness.

Design guidelines for assessing students' interprofessional competencies in healthcare education: a consensus study

INTRODUCTION

Healthcare systems require healthcare professionals and students educated in an interprofessional (IP) context. Well-designed assessments are needed to evaluate whether students have developed IP competencies, but we currently lack evidence-informed guidelines to create them. This study aims to provide guidelines for the assessment of IP competencies in healthcare education.

METHODS

A qualitative consensus study was conducted to establish guidelines for the design of IP assessments using the nominal group technique. First, five expert groups (IP experts, patients, educational scientists, teachers, and students) were asked to discuss design guidelines for IP assessment and reach intra-group consensus. Second, one heterogeneous inter-group meeting was organized to reach a consensus among the expert groups on IP assessment guidelines.

RESULTS

This study yielded a comprehensive set of 26 guidelines to help design performance assessments for IP education: ten guidelines for both the IP assessment tasks and the IP assessors and six guidelines for the IP assessment procedures.

DISCUSSION

The results showed that IP assessment is complex and, compared to mono-professional assessment, high-quality IP assessments require additional elements such as multiple IP products and processes to be assessed, an IP pool of assessors, and assessment procedures in which standards are included for the IP collaboration process as well as individual contributions. The guidelines are based on expert knowledge and experience, but an important next step is to test these design guidelines in educational practice.

Series: Practical guidance to qualitative research. Part 5: Co-creative qualitative approaches for emerging themes in primary care research: Experience-based co-design, user-centred design and community-based participatory research

This article, the fifth in a series aiming to provide practical guidance for qualitative research in primary care, introduces three qualitative approaches with co-creative characteristics for addressing emerging themes in primary care research: experience-based co-design, user-centred design and community-based participatory research. Co-creation aims to define the (research) problem, develop and implement interventions and evaluate and define (research and practice) outcomes in partnership with patients, family carers, researchers, care professionals and other relevant stakeholders. Experience-based co-design seeks to understand how people experience a health care process or service. User-centred design is an approach to assess, design and develop technological and organisational systems, for example, eHealth, involving end-users in the design and decision-making processes. Community-based participatory research is a collaborative approach addressing a locally relevant health issue. It is often directed at hard-to-reach and vulnerable people. We address the context, what, why, when and how of these co-creative approaches, and their main practical and methodological challenges. We provide examples of empirical studies using these approaches and sources for further reading.

Implementation of a patient-reported experience measure in a Dutch disability care organization: A process evaluation of cocreated tailored strategies

INTRODUCTION

In 24/7 disability care facilities, patient-reported experience measures (PREMs) are important to help healthcare professionals understand what matters to care users and to improve the quality of care. However, the successful implementation of a PREM is complex. In a Dutch disability care organization, stakeholders cocreated tailored implementation strategies aimed at improving the use and integration of a qualitative PREM. This study gives insights into the uptake and experiences with these cocreated implementation strategies and the perceived impact of the set of strategies.

METHODS

We performed a prospective process evaluation between February 2020 and February 2021. We collected data in three disability care facilities from 35 care users, 11 professionals, 3 facility managers and 4 organization representatives. Data collection included observations during kick-offs and learning goal meetings and several attendance checklists. We collected 133 questionnaires (Time 0 and Time 1). We conducted 35 individual semistructured interviews and an online focus group interview. Quantitative data were analysed using descriptive statistics and qualitative data using directed content analysis.

RESULTS

The exposure to and adoption of strategies was between 76% and 100%. Participants were positive about tailoring the strategies to each facility. Implementation was hindered by challenges in care users' communication and COVID-19. The perceived impact referred to an improved understanding of the goal and added value of the PREM and better preparation and execution of the PREM. The impact of the set of strategies was mainly experienced on the micro level.

CONCLUSION

The uptake of the cocreated implementation strategies was acceptable. The participants valued the tailored approach, which enabled them to focus on facility-specific learning goals. Stakeholder engagement and co-created strategies may have strengthened the adoption of and experiences with the implementation.

PATIENT OR PUBLIC CONTRIBUTION

In this article, we present the process evaluation of implementation strategies for the integrated use of a PREM in disability care. A development group consisting of communication vulnerable care users, trainers and professionals developed the implementation strategies. The disability care organization was responsible for the planning and organization of the implementation process. During the process evaluation the end users, trainers, professionals and managers tailored the implementation strategies to their own settings and needs. Researchers observed this implementation process and interviewed the stakeholders about their experiences and the perceived impact.

Clients and professionals elicit long-term care preferences by using 'What matters to me': A process evaluation in the Netherlands

BACKGROUND

'What matters to me' is a five-category preference elicitation tool to assist clients and professionals in choosing long-term care. This study aimed to evaluate the use of and experiences with this tool.

METHODS

A mixed-method process evaluation was applied. Participants were 71 clients or relatives, and 12 professionals. They were all involved in decision-making on long-term care. Data collection comprised online user activity logs (N = 71), questionnaires (N = 38) and interviews (N = 20). Descriptive statistics was used for quantitative data, and a thematic analysis for qualitative data.

RESULTS

Sixty-nine per cent of participants completed one or more categories in an average time of 6.9 (±0.03) minutes. The tool was rated 6.63 (±0.88) of 7 in the Post-Study System Usability Questionnaire (PSSUQ). Ninety-five per cent experienced the tool as useful in practice. Suggestions for improvement included a separate version for relatives and a non-digital version. Although professionals thought the potentially extended consultation time could be problematic, all participants would recommend the tool to others.

CONCLUSION

'What matters to me' seems useful to assist clients and professionals with preference elicitation in long-term care. Evaluation of the impact on consultations between clients and professionals by using 'What matters to me' is needed.

Series: Practical guidance to qualitative research. Part 6: Longitudinal qualitative and mixed-methods approaches for longitudinal and complex health themes in primary care research

This article, the sixth in a series aiming to provide practical guidance for qualitative research in primary care, introduces two approaches for addressing longitudinal and complex health themes in primary care research. The first approach – longitudinal qualitative research – supports the study of change during the life course. The second approach – mixed-methods research – integrates quantitative and qualitative research to gain new insights to address the complex and multifaceted themes in primary care.

We discuss the context, what, why, when and how of these approaches and their main practical and methodological challenges. We provide examples of empirical studies using these approaches and sources for further reading.

Interprofessional collaboration in palliative dementia care through the eyes of informal caregivers

A qualitative study was conducted to examine the experiences of informal caregivers of persons with dementia pertaining interprofessional collaboration with and among healthcare professionals in home care (HC), nursing homes and during home to nursing home transitions in palliative care. Semi-structured interviews were performed with bereaved informal caregivers. Data were analysed using a critical realist approach. The two main themes that emerged were: (1) Informal caregivers' roles in interprofessional collaboration with healthcare professionals and (2) Informal caregivers' perception of interprofessional collaboration among healthcare professionals. Informal caregivers' roles were identified in three collaboration processes: information exchange, care process and shared decision-making. Interprofessional collaboration among healthcare professionals was more perceptible on the collaboration outcome level (e.g. being up to date with the health status of the person with dementia; acting proactive, being adequate and consistent in the care process; and giving a warm welcome) than on the collaboration processes level (e.g. communicating and being involved in team processes). Our study revealed that intrinsic and extrinsic factors and interprofessional collaboration among healthcare professionals affected informal caregivers' collaborative roles. In summary, our study showed that informal caregivers have important roles as team members in the continuity and quality of palliative care for persons with dementia.

How to foster successful implementation of a patient reported experience measurement in the disability sector: an example of developing strategies in co-creation

BACKGROUND

The integrated uptake of patient-reported experience measures, using outcomes for the micro, meso and macro level, calls for a successful implementation process which depends on how stakeholders are involved in this process. Currently, the impact of stakeholders on strategies to improve the integrated use is rarely reported, and information about how stakeholders can be engaged, including care-users who are communication vulnerable, is limited. This study illustrates the impact of all stakeholders on developing tailored implementation strategies and provides insights into supportive conditions to involve care-users who are communication vulnerable.

METHODS

With the use of participatory action research, implementation strategies were co-created by care-users who are communication vulnerable (n = 8), professionals (n = 12), management (n = 6) and researchers (n = 5) over 9 months. Data collection consisted of audiotapes, reports, and researchers' notes. Conventional content analysis was performed.

RESULTS

The impact of care-users concerned the strategies' look and feel, understandability and relevance. Professionals influenced impact on how to use strategies and terminology. The impact of management was on showing the gap between policy and practice, and learning from previous improvement failures. Researchers showed impact on analysis, direction of strategy changes and translating academic and development experience into practice. The engagement of care-users who are communication vulnerable was supported, taking into account organisational issues and the presentation of information.

CONCLUSIONS

The impact of all engaged stakeholders was identified over the different levels strategies focused on. Care-users who are communication vulnerable were valuable engaged in co-creation implementation strategies by equipping them to their needs and routines, which requires adaptation in communication, delimited meetings and a safe group environment.

TRIAL REGISTRATION

Reviewed by the Medical Ethics Committee of Zuyderland-Zuyd (METCZ20190006). NL7594 registred at https://www.trialregister.nl/ .

The Next Step Toward Patient-Centeredness in Multidisciplinary Cancer Team Meetings: An Interview Study with Professionals

Background

Patient-centeredness is essential in complex oncological multidisciplinary team decision-making. Improvement seems to be needed, while there is a lack of knowledge about health care providers’ needs for improvement.

Objective

To explore multidisciplinary team members’ perspectives on the need to improve patient-centeredness in complex decision-making, and subsequently the strategies to enhance it.

Methods

This was a qualitative descriptive interview study. The participants were twenty-four professionals who attended multidisciplinary cancer team meetings weekly. The setting was five multidisciplinary teams (gastrointestinal, gynecological, urological, head and neck, and hematological cancer) in a Dutch academic hospital. Data were collected by semi-structured interviews and were analyzed with a combination of inductive and deductive content analysis.

Results

The participants voiced the need for additional information (patient-centered information, patients’s needs and preferences, individualized medical information) during the multidisciplinary team meeting, to be more patient-centered in the decision-making conversation with the patient following the meeting, and for more information following the meeting to support patient-centeredness. The strategies, which mostly originated from the needs, were categorized as organization, decision-making, and communication. The most prominent strategies were those aimed at collecting and using patient-centered information, and to facilitate the decision-making conversation with the patient following the multidisciplinary team meeting.

Conclusion

Our findings highlighted the need to improve patient-centeredness in oncological multidisciplinary teams and provided a comprehensive overview of strategies for improvement, supported by multidisciplinary team members. These strategies emphasize involvement of patients throughout the continuous process of decision-making for patients with cancer. These strategies may be implemented in other oncological multidisciplinary teams, taking in mind the local needs. Future research may help to prioritize the strategies and to determine and evaluate the effect on endpoints, like patient or professional satisfaction, shared decision-making, and on the decision that was made.

Improving the experience of older people with colorectal and breast cancer in patient-centred cancer care pathways using experience-based co-design

BACKGROUND

Patient and public involvement (PPI) in quality improvement of oncological care pathways for older patients are rare.

OBJECTIVES

Improve the care pathway experience of older cancer patients and explore lessons learned regarding how to engage this vulnerable group.

DESIGN

Experience-Based Co-Design.

SETTING AND PARTICIPANTS

Older cancer patients, their caregivers and healthcare professionals within colorectal and breast cancer care pathways.

INTERVENTIONS

Co-design quality improvement teams.

MAIN OUTCOME MEASURES

Colorectal cancer care pathway touchpoints were (a) availability of a contact person during diagnostic, treatment and aftercare phases; (b) collaboration between physicians and different hospital departments; (c) continuous relationship with same physician; (d) respectful treatment; (e) and information transfer with primary care. Breast cancer care pathway touchpoints were (a) comprehensive information package and information provision, (b) care planning based on patient preferences, (c) continuity of patient-professional relationship and (d) specialized care in case of vulnerability. Challenges related to PPI included (a) ability of older cancer patients to be reflective, critical and think at a collective level; (b) gaining support and commitment of professionals; (d) overcoming cultural differences and power inequalities; and (e) involving researchers and facilitators with appropriate expertise and position.

CONCLUSION

This multidisciplinary quality improvement project revealed several challenges of PPI with older cancer patients and their caregivers. Research teams themselves need to assume the role of facilitator to enable meaningful PPI of older cancer patients.

PATIENT OR PUBLIC CONTRIBUTION

Patient and caregiver representatives and advocates were involved in the design, conduct, analysis, interpretation of the data and preparation of this manuscript.

Patient and public involvement cultures and the perceived impact in the vulnerable context of palliative care: A qualitative study

Background

Cultural values are crucial to the practice and impact of patient and public involvement (PPI) in research.

Objective

To understand different PPI cultures among research teams and the impacts of PPI associated with each culture type.

Design

A participatory action research design.

Setting and participants

The setting was 10 palliative care research projects. Seventeen patients and members of the public and 31 researchers participated.

Intervention

A programme consisting of four components: (1) training and coaching of patients and the public to prepare them for participation in research, (2) tailored coaching of the 10 research teams over 12‐18 months, (3) a community of practice, and (4) a qualitative evaluation.

Results

We identified three cultures types: relationship cultures, task cultures, and control cultures. We identified four areas of impact: the project aim became more relevant to the target audience, methodological reliability increased, the research products were better able to reach the public, and the awareness increased, associated with behavioural changes, among researchers regarding PPI.

Discussion

A relationship culture appears to be long‐lasting due to impacting the behaviours of the researchers during future projects. Different cultural types require different types of patients and researcher participants, assigned to different tasks.

Conclusions

Further research remains necessary to investigate the support required by researchers to enable relationship‐ and task‐oriented PPI cultures.

Patient or public contribution

Patient advocates and representatives contributed to our research team throughout the entire research process, as well as within the 10 implementation projects.

Stakeholder engagement from problem analysis to implementation strategies for a patient-reported experience measure in disability care: A qualitative study on the process and experiences

Background

In implementation science, vast gaps exist between theoretical and practical knowledge. These gaps prevail in the process of getting from problem analysis to selecting implementation strategies while engaging stakeholders including care users.

Objective

To describe a process of how to get from problem analysis to strategy selection, how to engage stakeholders, and to provide insights into stakeholders’ experiences.

Design

A qualitative descriptive design.

Setting and participants

The setting was a care organization providing long‐term care to people with acquired brain injuries who are communication vulnerable. Fourteen stakeholders (care users, professionals and researchers) participated. Data were collected by a document review, five interviews and one focus group. Inductive content analysis and deductive framework analysis were applied.

Intervention

Stakeholder engagement.

Main outcome measures

A three‐step process model and stakeholders experiences.

Results and conclusion

We formulated a three‐step process: (a) reaching consensus and prioritizing barriers; (b) categorizing the prioritized barriers and idealization; and (c) composing strategies. Two subthemes continuously played a role in how stakeholders were engaged during the process: communication supportive strategies and continuous contact. The experiences of stakeholder participation resulted in the following themes: stakeholders and their roles, use of co‐creation methods and communication supportive strategies, building relationships, stimulus of stakeholders to engage, sharing power, empowerment of stakeholders, feeling a shared responsibility and learning from one another. We conclude that the inclusion of communication‐vulnerable care users is possible if meetings are prepared, communication‐friendly presentations and reports are used, and relationship building is prioritized.

Cross-cultural adaptation of the Participation and Environment Measure for Children and Youth (PEM-CY) into German: a qualitative study in three countries

BACKGROUND

Concepts such as participation and environment may differ across cultures. Consequently, to use a measure like the Participation and Environment Measure for Children and Youth (PEM-CY) in other than the original English-speaking contexts, cultural adaptation needs to be assured. The aim of this study was to cross-culturally translate and adapt the PEM-CY into German as it is used in Germany, Austria and Switzerland.

METHODS

Fifteen parents of children and adolescents with disabilities from three German speaking countries participated in three rounds of think-aloud interviews. We followed the procedure of cultural equivalence guidelines including two additional steps. Data was analyzed by content analysis using semantic, idiomatic, experiential and conceptual equivalence.

RESULTS

Results show adaptations mainly focused on experiential and conceptual equivalence, with conceptual equivalence being the most challenging to reach. Examples of experiential equivalence included adapting the examples of activities in the PEM-CY to reflect those typical in German speaking countries. Conceptual equivalence mainly addressed aspects of "involvement" and "environment" of children and adolescents and was reached through adaptations such as enhanced instructions and structures, and additional definitions.

CONCLUSIONS

This study presents a cross-cultural translation and adaptation process to develop a German version of the PEM-CY that is suitable for Germany, Austria and Switzerland. Using a modified cultural adaptation process, a culturally adapted version of PEM-CY (German) is now available for research, practice and further validation.

Circadian regulation of hedonic appetite in mice by clocks in dopaminergic neurons of the VTA

Unlimited access to calorie-dense, palatable food is a hallmark of Western societies and substantially contributes to the worldwide rise of metabolic disorders. In addition to promoting overconsumption, palatable diets dampen daily intake patterns, further augmenting metabolic disruption. We developed a paradigm to reveal differential timing in the regulation of food intake behavior in mice. While homeostatic intake peaks in the active phase, conditioned place preference and choice experiments show an increased sensitivity to overeating on palatable food during the rest phase. This hedonic appetite rhythm is driven by endogenous circadian clocks in dopaminergic neurons of the ventral tegmental area (VTA). Mice with disrupted clock function in the VTA lose their hedonic overconsumption rhythms without affecting homeostatic intake. These findings assign a functional role of VTA clocks in modulating palatable feeding behaviors and identify a potential therapeutic route to counteract hyperphagy in an obesogenic environment.

In addition to promoting overconsumption, palatable diets dampen daily intake patterns, which further augments metabolic dysfunction. Here, the authors find that in mice, circadian clocks in dopaminergic neurons in the ventral tegmental area drive hedonic appetite rhythms.

Environmental pre-requisites and social interchange: the participation experience of adolescents with autism spectrum disorder in Zurich

Aim: Participation of adolescents with autism spectrum disorder hardly occurs in settings outside of home and school. Little is known about how their participation is influenced by environmental factors. This study explored how and why adolescents with autism spectrum disorder perceive aspects of their environment as facilitators or barriers to their participation outside of home and school.Method: This explanatory case study explored the participation experiences of adolescents with autism spectrum disorder (15-21 years) from Zurich and surroundings with in-depth interviews and photo-elicitation, using photos made by the participants during activities outside of home and school. Data was analysed with a 7-step procedure.Result: The presence of two main themes seemed necessary to facilitate participation outside of home and school: "environmental prerequisites to attend activities", which consists of five subthemes, such as "the company of trusted persons" and "the provision of knowledge and information", and "social interchange and engagement", which consists of three subthemes and describes how actual involvement can be supported.Conclusion: Our findings highlight the influence of trusted persons on adolescents with autism spectrum disorder, and the need to extend the support network for these adolescents to other individuals, services and society so that their participation in activities can be encouraged.IMPLICATIONS FOR REHABILITATIONAdolescents with autism spectrum disorder perceive every kind of participation outside of home and school as social.We recommend using the company of trusted persons to encourage adolescents with autism spectrum disorder to actively participate outside of home and school.Rehabilitation professionals should promote environment-based approaches to achieve participation of adolescents with autism spectrum disorder.Rehabilitation professionals should actively approach, acknowledge and gently guide adolescents with autism spectrum disorder to support engagement in participation.

What matters to me - a web-based preference elicitation tool for clients in long-term care: a user-centred design

Background

During the process of decision-making for long-term care, clients are often dependent on informal support and available information about quality ratings of care services. However, clients do not take ratings into account when considering preferred care, and need assistance to understand their preferences. A tool to elicit preferences for long-term care could be beneficial. Therefore, the aim of this qualitative descriptive study is to understand the user requirements and develop a web-based preference elicitation tool for clients in need of long-term care.

Methods

We applied a user-centred design in which end-users influence the development of the tool. The included end-users were clients, relatives, and healthcare professionals. Data collection took place between November 2017 and March 2018 by means of meetings with the development team consisting of four users, walkthrough interviews with 21 individual users, video-audio recordings, field notes, and observations during the use of the tool. Data were collected during three phases of iteration: Look and feel, Navigation, and Content. A deductive and inductive content analysis approach was used for data analysis.

Results

The layout was considered accessible and easy during the Look and feel phase, and users asked for neutral images. Users found navigation easy, and expressed the need for concise and shorter text blocks. Users reached consensus about the categories of preferences, wished to adjust the content with propositions about well-being, and discussed linguistic difficulties.

Conclusion

By incorporating the requirements of end-users, the user-centred design proved to be useful in progressing from the prototype to the finalized tool ‘What matters to me’. This tool may assist the elicitation of client’s preferences in their search for long-term care.

Implementation of a Patient Reported Experience Measure in a Dutch disability care organisation: a qualitative study

BACKGROUND

Patient Reported Experience Measures are promoted to be used as an integrated measurement approach in which outcomes are used to improve individual care (micro level), organisational quality (meso level) and external justification (macro level). However, a deeper understanding of implementation issues of these measures is necessary. The narrative Patient Reported Experience Measure "Dit vind ik ervan!" (English "How I feel about it!") is used in the Dutch disability care sector, but insight into its' current use is lacking. We aimed to provide insight into experiences with the implementation and current ways of working with "Dit vind ik ervan!" as an integrated measurement strategy. A descriptive qualitative study was done at a disability care organisation. Data were collected by nine documentations, seven observations, 11 interviews and three focus groups. We applied deductive content analysis using the Consolidated Framework for Implementation Research as a framework.

RESULTS

Our analysis revealed facilitators and barriers for the implementation of "Dit vind ik ervan!". We found most barriers at the micro level. Professionals and clients appreciated the measure's narrative approach, but struggled to perform it with communication vulnerable clients. Some clients, professionals and team leaders were unfamiliar with the measure's aim and benefit. On the meso level, implementation was done top-down, and the management's vision using the measure as an integrated measurement approach was insufficiently shared throughout the organisation.

CONCLUSIONS

Our study shows that Patient Reported Experience Measures have the potential to be used as an integrated measurement strategy. Yet, we found barriers at the micro level, which might have influenced using the measurement outcomes at the meso and macro level. Tailored implementation strategies, mostly focusing on designing and preparing the implementation on the micro level, need to be developed in co-creation with all stakeholders.

Effects of Health Risk Assessment and Counselling on Fruit and Vegetable Intake in Older People: A Pragmatic Randomised Controlled Trial

OBJECTIVES

Interventions to increase fruit and vegetable intake among community-dwelling older people have shown mixed effects. We investigated whether an intervention based on an initial multidimensional health risk assessment and subsequent physician-lead nutrition counselling has favourable effects on dietary intake among community-dwelling older people.

DESIGN

Randomised controlled trial comparing the intervention versus usual care.

SETTING AND PARTICIPANTS

Non-disabled persons aged 65 years or older at an ambulatory geriatric clinic in Bucharest, Romania, allocated to intervention (n=100) and control (n=100) groups.

INTERVENTION

Participants received a computer-generated health profile report based on answers to a health risk assessment questionnaire, followed by monthly individual counselling sessions with a geriatrician on topics related to health promotion and disease prevention, with a special focus on adequate fruit and vegetable consumption.

MEASUREMENTS

Fruit and vegetable intake at baseline and at 6-month follow-up.

RESULTS

At baseline, fruit and vegetable intake was below the recommended five portions per day in most study participants (85% in the intervention group, and 86% among controls, respectively). At six months, intake increased in the intervention group from a median of 3.8 to 4.6 portions per day, and decreased in the control group due to a seasonal effect from a median of 3.8 to 3.1 portions per day. At six months, fruit and vegetable consumption was significantly higher among persons in the intervention group as compared to controls (median difference 1.4 portions per day, 95% confidence interval 1.1-1.7, p<0.001).

CONCLUSION

Personalised food-based dietary guidance, delivered as part of multidimensional preventive health counselling during geriatric clinic visits, results in relevant improvement of fruit and vegetable intake in community-dwelling older adults.

Proposal for a Framework to Enable Elicitation of Preferences for Clients in Need of Long-Term Care

PURPOSE

Collaborative deliberation comprises personal engagement, recognition of alternative actions, comparative learning, preference elicitation, and preference integration. Collaborative deliberation may be improved by assisting preference elicitation during shared decision-making. This study proposes a framework for preference elicitation to facilitate collaborative deliberation in long-term care consultations.

METHODS

First, a literature overview was conducted comprising current models for the elicitation of preferences in health and social care settings. The models were reviewed and compared. Second, qualitative research was applied to explore those issues that matter most to clients in long-term care. Data were collected from clients in long-term care, comprising 16 interviews, 3 focus groups, 79 client records, and 200 online client reports. The qualitative analysis followed a deductive approach. The results of the literature overview and qualitative research were combined.

RESULTS

Based on the literature overview, five overarching domains of preferences were described: "Health", "Daily life", "Family and friends", "Living conditions", and "Finances". The credibility of these domains was confirmed by qualitative data analysis. During interviews, clients addressed issues that matter in their lives, including a "click" with their care professional, safety, contact with loved ones, and assistance with daily structure and activities. These data were used to determine the content of the domains.

CONCLUSION

A framework for preference elicitation in long-term care is proposed. This framework could be useful for clients and professionals in preference elicitation during collaborative deliberation.

Jointly discussing care plans for real-life patients: The potential of a student-led interprofessional team meeting in undergraduate health professions education

BACKGROUND

Interprofessional education is promoted as a means of enhancing future collaborative practice in healthcare. We developed a learning activity in which undergraduate medical, nursing and allied healthcare students practice interprofessional collaboration during a student-led interprofessional team meeting.

DESIGN AND DELIVERY

During their clinical rotation at a family physician's practice, each medical student visits a frail elderly patient and prepares a care plan for the patient. At a student-led interprofessional team meeting, medical, nursing and allied healthcare students jointly review these care plans. Subsequently, participating students reflect on their interprofessional collaboration during the team meeting, both collectively and individually. Every 4 weeks, six interprofessional team meetings take place. Each team comprises 9-10 students from various healthcare professions, and meets once. To date an average of 360 medical and 360 nursing and allied healthcare students have participated in this course annually.

EVALUATION

Students mostly reported positive experiences, including the opportunity to learn with, from and about other healthcare professions in the course of jointly reviewing care plans, and feeling collectively responsible for the care of the patients involved. Additionally, students reported a better understanding of the contextual factors at hand. The variety of patient cases, diversity of participating health professions, and the course material need improvement.

CONCLUSION

Students from participating institutions confirmed that attending a student-led interprofessional team meeting had enabled them to learn with, from and about other health professions in an active role. The use of real-life cases and the educational design contributed to the positive outcome of this interprofessional learning activity.

Improving End-of-Life Care and Advance Care Planning for Frail Older Adults in Canad

We present five Key Concepts that describe priorities for improving end-of-life care for frail older adults in Canada, and recommendations based on each Key Concept. Key Concept #1: Our end-of-life care system is focused on cancer, not frailty. Key Concept #2: We need better strategies to systematically identify frail older adults who would benefit from a palliative approach. Key Concept #3: The majority of palliative and end-of-life care will be, and should be, provided by clinicians who are not palliative care specialists. Key Concept #4: Organizational change and innovative funding models could deliver far better end-of-life care to frail individuals for less than we are currently spending. Key Concept #5: Improving the quality and quantity of advance care planning for frail older adults could reduce unwanted intensive care and costs at the end of life, and improve the experience for individuals and family members alike.

Getting to grips with the process of decision-making in long-term care. Descriptive cases illustrate the chaotic reality of the construction of preferences

Background

Clients facing decision-making for long-term care are in need of support and accessible information. Construction of preferences, including context and calculations, for clients in long-term care is challenging because of the variability in supply and demand. This study considers clients in four different sectors of long-term care: the nursing and care of the elderly, mental health care, care of people with disabilities, and social care. The aim is to understand the construction of preferences in real-life situations.

Method

Client choices were investigated by qualitative descriptive research. Data were collected from 16 in-depth interviews and 79 client records. Interviews were conducted with clients and relatives or informal caregivers from different care sectors. The original client records were explored, containing texts, letters, and comments of clients and caregivers. All data were analyzed using thematic analysis.

Results

Four cases showed how preferences were constructed during the decision-making process. Clients discussed a wide range of challenging aspects that have an impact on the construction of preferences, e.g. previous experiences, current treatment or family situation. This study describes two main characteristics of the construction of preferences: context and calculation.

Conclusion

Clients face diverse challenges during the decision-making process on long-term care and their construction of preferences is variable. A well-designed tool to support the elicitation of preferences seems beneficial.

Involving "authentic" cancer patients, their caregivers, and multidisciplinary professionals in a quality improvement trajectory in a hospital cancer pathway: a study protocol

Introduction

The implementation of oncology care pathways that standardize organizational procedures has improved cancer care in recent years. However, the involvement of "authentic" patients and caregivers in quality improvement of these predetermined pathways is in its infancy, especially the scholarly reflection on this process. We, therefore, aim to explore the multidisciplinary challenges both in practice, when cancer patients, their caregivers, and a multidisciplinary team of professionals work together on quality improvement, as well as in our research team, in which a social scientist, health care professionals, health care researchers, and experience experts design a research project together.

Methods and design

Experience-based co-design will be used to involve cancer patients and their caregivers in a qualitative research design. In-depth open discovery interviews with 12 colorectal cancer patients, 12 breast cancer patients, and seven patients with cancer-associated thrombosis and their caregivers, and focus group discussions with professionals from various disciplines will be conducted. During the subsequent prioritization events and various co-design quality improvement meetings, observational field notes will be made on the multidisciplinary challenges these participants face in the process of co-design, and evaluation interviews will be done afterwards. Similar data will be collected during the monthly meetings of our multidisciplinary research team. The data will be analyzed according to the constant comparative method.

Discussion

This study may facilitate quality improvement programs in oncologic care pathways, by increasing our real-world knowledge about the challenges of involving "experience experts" together with a team of multidisciplinary professionals in the implementation process of quality improvement. Such co-creation might be challenging due to the traditional paternalistic relationship, actual disease-/treatment-related constraints, and a lack of shared language and culture between patients, caregivers, and professionals and between professionals from various disciplines. These challenges have to be met in order to establish equality, respect, team spirit, and eventual meaningful participation.

Supporting and hindering environments for participation of adolescents diagnosed with autism spectrum disorder: A scoping review

The influence of a person's environment and its modifying potential on participation is well recognized for most childhood disabilities, but scarcely studied for adolescents with autism spectrum disorder (ASD). A scoping review was conducted, the aim of which was to map the existing literature about supporting and hindering environments for the participation of adolescents with ASD. Sources of scientific evidence were searched for in four databases. Inclusion criteria were the perspectives of adolescents between 12 and 21, families, peers, or significant others; ecologic validity; and a clear connection between environment and participation. The publication dates ranged from 2001 to 2014 and partly up to 2018. The International Classification of Functioning, Disability and Health (ICF) served as the guiding framework for inclusion/exclusion during the selection process. Thematic analysis was performed by five independent reviewers. Results were additionally validated by stakeholders. This scoping review identified 5528 articles, and finally included 31 studies. Two main themes were found: "providing security" indicates how the environment, and specifically the parental, physical, and informational environments, have a securing or intimidating effect. The second theme, "helping to connect", indicates which environments support or hinder social relationships or social activities, and hence participation. An additional third main theme, "tension in participation", relates to ambiguities that seem essential to understand participation or isolation of adolescents with ASD. Results show that participation is a value-laden concept. This research widens the field of dealing with adolescents with ASD, as it directs attention towards the responsibility of the environment regarding participation.

Series: Practical guidance to qualitative research. Part 2: Context, research questions and designs

In the course of our supervisory work over the years, we have noticed that qualitative research tends to evoke a lot of questions and worries, so-called frequently asked questions (FAQs). This series of four articles intends to provide novice researchers with practical guidance for conducting high-quality qualitative research in primary care. By ‘novice’ we mean Master’s students and junior researchers, as well as experienced quantitative researchers who are engaging in qualitative research for the first time. This series addresses their questions and provides researchers, readers, reviewers and editors with references to criteria and tools for judging the quality of qualitative research papers. This second article addresses FAQs about context, research questions and designs. Qualitative research takes into account the natural contexts in which individuals or groups function to provide an in-depth understanding of real-world problems. The research questions are generally broad and open to unexpected findings. The choice of a qualitative design primarily depends on the nature of the research problem, the research question(s) and the scientific knowledge one seeks. Ethnography, phenomenology and grounded theory are considered to represent the ‘big three’ qualitative approaches. Theory guides the researcher through the research process by providing a ‘lens’ to look at the phenomenon under study. Since qualitative researchers and the participants of their studies interact in a social process, researchers influence the research process. The first article described the key features of qualitative research, the third article will focus on sampling, data collection and analysis, while the last article focuses on trustworthiness and publishing.

Preparing researchers for patient and public involvement in scientific research: Development of a hands-on learning approach through action research

Background

Acquiring the theoretical and practical knowhow of conducting patient and public involvement (PPI) in research is not part of the traditional curriculum of researchers. Zuyd University of Applied Sciences and Huis voor de Zorg, a regional umbrella patient organization, therefore started a 1.5‐year coaching programme.

Objective

To establish a community of practice by developing a PPI coaching programme for senior and junior health services researchers of Zuyd University. The context consisted of research projects conducted by the participants.

Methods

A participatory action research methodology. Data were collected from reports of thematic group meetings and individual sessions with participants, field notes and regular reflection meetings with the project team. Data were analysed by reflexive deliberation.

Findings

The programme comprised a kick‐off meeting (52 attendees), followed by 7 group meetings with 11 junior and 9 senior researchers. The project team constructed a serious game based on the concept of the participation ladder. Questions and concerns differed for junior and senior researchers, and separate tailored meetings were organized for both groups. Between group meetings, participants received individual assignments. Group meetings were accompanied by individual coaching sessions to provide tailor‐made feedback. The programme concluded with a combined meeting with all stakeholders.

Conclusion

Building a community of PPI practice through action research facilitates the development of a coaching programme that fosters social learning, empowerment and the development of a shared identity concerning PPI. The role and responsibilities of senior researchers should be distinguished from those of junior researchers.

Series: Practical guidance to qualitative research. Part 4: Trustworthiness and publishing

In the course of our supervisory work over the years we have noticed that qualitative research tends to evoke a lot of questions and worries, so-called frequently asked questions (FAQs). This series of four articles intends to provide novice researchers with practical guidance for conducting high-quality qualitative research in primary care. By ‘novice’ we mean Master’s students and junior researchers, as well as experienced quantitative researchers who are engaging in qualitative research for the first time. This series addresses their questions and provides researchers, readers, reviewers and editors with references to criteria and tools for judging the quality of qualitative research papers. The first article provides an introduction to this series. The second article focused on context, research questions and designs. The third article focused on sampling, data collection and analysis. This fourth article addresses FAQs about trustworthiness and publishing. Quality criteria for all qualitative research are credibility, transferability, dependability, and confirmability. Reflexivity is an integral part of ensuring the transparency and quality of qualitative research. Writing a qualitative research article reflects the iterative nature of the qualitative research process: data analysis continues while writing. A qualitative research article is mostly narrative and tends to be longer than a quantitative paper, and sometimes requires a different structure. Editors essentially use the criteria: is it new, is it true, is it relevant? An effective cover letter enhances confidence in the newness, trueness and relevance, and explains why your study required a qualitative design. It provides information about the way you applied quality criteria or a checklist, and you can attach the checklist to the manuscript.

Series: Practical guidance to qualitative research. Part 3: Sampling, data collection and analysis

In the course of our supervisory work over the years, we have noticed that qualitative research tends to evoke a lot of questions and worries, so-called frequently asked questions (FAQs). This series of four articles intends to provide novice researchers with practical guidance for conducting high-quality qualitative research in primary care. By 'novice' we mean Master's students and junior researchers, as well as experienced quantitative researchers who are engaging in qualitative research for the first time. This series addresses their questions and provides researchers, readers, reviewers and editors with references to criteria and tools for judging the quality of qualitative research papers. The second article focused on context, research questions and designs, and referred to publications for further reading. This third article addresses FAQs about sampling, data collection and analysis. The data collection plan needs to be broadly defined and open at first, and become flexible during data collection. Sampling strategies should be chosen in such a way that they yield rich information and are consistent with the methodological approach used. Data saturation determines sample size and will be different for each study. The most commonly used data collection methods are participant observation, face-to-face in-depth interviews and focus group discussions. Analyses in ethnographic, phenomenological, grounded theory, and content analysis studies yield different narrative findings: a detailed description of a culture, the essence of the lived experience, a theory, and a descriptive summary, respectively. The fourth and final article will focus on trustworthiness and publishing qualitative research.

Factors associated with sustainability of 2 quality improvement programs after achieving early implementation success. A qualitative case study

RATIONALE, AIMS, AND OBJECTIVES

Sustainability of innovations is a relatively new concept in health care research and has become an issue of growing interest. The current study explored factors related to the sustainability of 2 multidisciplinary hospital-based programs 3 to 6 years after achieving early implementation success.

METHOD

An exploratory qualitative study was conducted into 2 implementation cases, an Enhanced Recovery After Surgery program for colorectal surgery and a short-stay program for breast cancer surgery. Semistructured interviews were held with key persons involved in the care process in 14 hospitals from both cases minimally 3 years after the implementation, between March 2012 and May 2013. The Consolidated Framework for Implementation Research was used to direct the development of the interview guide, during data collection and during analysis. A directed content analysis was performed.

RESULTS

A total of 21 interviews with 26 individuals were held, 18 regarding the Enhanced Recovery After Surgery case and 8 regarding the short-stay program case. Respondents mentioned the following factors associated with sustainability of the programs: modification and adaptability of the program, cost-effectiveness, institutionalization into existing systems, short communication lines within the multidisciplinary team, an innovative culture, benefits for patients, cosmopolitanism, the existence of external policies and incentives, trust and belief in the program, and spread of the program to other settings. Two factors are not covered by the Consolidated Framework for Implementation Research, ie, modification of the program over the years and spread of the program to other contexts.

CONCLUSIONS

The factors associated with sustainability put forward in both cases were largely the same. Leadership and the implementation project were not mentioned as having influenced the long-term sustainability of the benefits achieved. Sustainability of the innovations is influenced by determinants stemming from all ecological levels of the health care system and demands continuous effort in the postimplementation phase.

Series: Practical guidance to qualitative research. Part 1: Introduction

In the course of our supervisory work over the years, we have noticed that qualitative research tends to evoke a lot of questions and worries, so-called Frequently Asked Questions. This journal series of four articles intends to provide novice researchers with practical guidance for conducting high-quality qualitative research in primary care. By ‘novice’ we mean Master’s students and junior researchers, as well as experienced quantitative researchers who are engaging in qualitative research for the first time. This series addresses their questions and provides researchers, readers, reviewers and editors with references to criteria and tools for judging the quality of papers reporting on qualitative research. This first article describes the key features of qualitative research, provides publications for further learning and reading, and gives an outline of the series.

Validity, reliability and feasibility of commercially available activity trackers in physical therapy for people with a chronic disease: a study protocol of a mixed methods research

BACKGROUND

For older people and people with a chronic disease, physical activity provides health benefits. Patients and healthcare professionals can use commercially available activity trackers to objectively monitor (alterations in) activity levels and patterns and to support physical activity. However, insight in the validity, reliability, and feasibility of these trackers in people with a chronic disease is needed. In this article, a study protocol is described in which the validity, reliability (part A), and feasibility from a patient and therapist's point of view (part B) of commercially available activity trackers in daily life and health care is investigated.

METHODS

In part A, a quantitative cross-sectional study, an activity protocol that simulates everyday life activities will be used to determine the validity and reliability of nine commercially available activity trackers. Video recordings will act as the gold standard. In part B, a qualitative participatory action research study will be performed to gain insight in the use of activity trackers in peoples' daily life and therapy settings. Objective feasibility of the activity trackers will be measured with questionnaires, and subjective feasibility (experiences) will be explored in a community of practice. Physical therapists (n = 8) will regularly meet during 6 months to learn from each other regarding the actual use of activity trackers in therapy. Therapists and patients (n = 48) will decide together which tracker will be used in therapy and for which purpose (e.g., monitoring, goal setting). Data from the therapist' and patients' experiences will be collected by interviews (individual and focus groups) and analyzed by a directed content analysis. At the time of submission, selection of activity trackers, development of the activity protocol, and the ethical approval process are finished. Data collection and data processing are ongoing.

DISCUSSION

The relevance of the study as well as the advantages and disadvantages of several aspects of the chosen design are discussed. The results acquired from both study parts can be used to create decision aids that may assist therapists and people with a chronic disease in choosing a suitable activity tracker, and to facilitate use of these activity trackers in health care settings.

TRIAL REGISTRATION

Ethical approval has been obtained from two medical-ethical committees (nr. 15-N-109, 15-N-48 and MEC-15-07).

Developing a patient decision aid for the treatment of women with early stage breast cancer: the struggle between simplicity and complexity

Background

A patient decision aid (PtDA) can support shared decision making (SDM) in preference-sensitive care, with more than one clinically applicable treatment option. The development of a PtDA is a complex process, involving several steps, such as designing, developing and testing the draft with all the stakeholders, known as alpha testing. This is followed by testing in ‘real life’ situations, known as beta testing, and then finalising the definite version.

Our aim was developing and alpha testing a PtDA for primary treatment of early stage breast cancer, ensuring that the tool is considered relevant, valid and feasible by patients and professionals.

Methods

Our qualitative descriptive study applied various methods including face-to-face think-aloud interviews, a focus group and semi-structured telephone interviews. The study population consisted of breast cancer patients facing the choice between breast-conserving therapy with or without preceding neo-adjuvant chemotherapy and mastectomy, and professionals involved in breast cancer care in dedicated multidisciplinary breast cancer teams.

Results

A PtDA was developed in four iterative test rounds, taking nearly 2 years, involving 26 patients and 26 professionals. While the research group initially opted for simplicity for the sake of implementation, the clinicians objected that the complexity of the decision could not be ignored. Other topics of concern were the conflicting views of professionals and patients regarding side effects, the amount of information and how to present it.

Conclusion

The development was an extensive process, because the professionals rejected the simplifications proposed by the research group. This resulted in the development of a completely new draft PtDA, which took double the expected time and resources. The final version of the PtDA appeared to be well-appreciated by professionals and patients, although its acceptability will only be proven in actual practice (beta testing).

Trial registration

NTR TC 5721.

Electronic supplementary material

The online version of this article (doi:10.1186/s12911-017-0505-6) contains supplementary material, which is available to authorized users.

Abstract P5-10-09: Prospective cross-sectional-study on participation in mammography screening according to immigration background and education status

Introduction

Although the health of immigrants is an important issue in national health care policy there is a serious shortage of data in many countries. Most studies lack information on educational status which is a major limitation. In this prospective cross-sectional-study we analyzed the influence of immigration background and educational status on the participation in mammography screening programs in Lower-Saxony, Germany.

Material and methods

Data collection was conducted from 2012-2016 in six certified breast cancer centers using a personal questionnaire and data from the patients' medical records. Stratification into subgroups was carried out according to first and second generation immigrants and country of origin.

Results

1547/2129 primary breast cancer cases were analyzed. The percentage of patients with a history of immigration in our study cohort was 17.7%. The majority of them were citizens of EU27 Member states. First generation immigrants (n= 146), second generation immigrants (n=129), natives (n= 1272). No significant difference was seen in sex, age, tumor stage, histology, grading, Ki-67, Her2/neu-status, and hormone receptor status. A 100% participation rate in the mammography screening program was seen in patients with no school graduation. The lowest participation rate (85.5%) was seen in the group of native Germans with a college graduation and in first generation immigrants with a high school graduation (86.7%). Detailed statistical analysis will be presented on the poster.

Conclusion

No difference was seen between immigrants and native Germans with regard to tumor biology. In first-generation immigrants mammography screening was well accepted despite cultural and linguistic differences. Participation rate decreased with higher education level in all groups. High school graduates with immigrant background participated more frequently in breast cancer screening than native high school graduates. These findings mainly relate to immigrants from EU27 Member states rather than immigrants from non EU countries.

Citation Format: Kuehnle E, Oeztuerk T, Siggelkow W, Luebbe K, Moser A, Noeding S, John J, Noesselt T, Busch C, Arfsten M, Lemster S, Hillemans P, Doerk T, Park-Simon T-W. Prospective cross-sectional-study on participation in mammography screening according to immigration background and education status [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-10-09.

Photo-responsive thiol–ene networks for the design of switchable polymer patterns

Photo-patternable thiol–ene networks are prepared by combining versatile o-NBE chemistry with the distinctive advantages of a typical “click” reaction.

Content Validity of the Credibility and Expectancy Questionnaire in a Pain Rehabilitation Setting

BACKGROUND

Content validity, the proper reflection of the concept to be measured, is yet unknown for the Credibility and Expectancy Questionnaire (CEQ). It is frequently used in pain rehabilitation because treatment expectancy is influential on the outcome.

OBJECTIVE

To test and improve the content validity of the CEQ in a sample of patients with chronic pain in different phases of their treatment.

METHODS

A qualitative observational study design using the Three-Step Test-Interview method was used. Therein, data collection, analyses, and adaptations occur iteratively.

RESULTS

Seventeen patients with chronic pain in different stages of treatment participated through convenience sampling from the mother sample of a randomized controlled trial. The main study parameter is content validity, which is defined as (1) interpretations and responses of the participants and (2) the identification of response problems operationalized, and resulting in changes in the CEQ. For patients waiting for treatment, the written instruction of the CEQ allowed different interpretations. After changing the instructions, the CEQ became an easy-to-understand and content-valid questionnaire. For patients who had already undergone treatment, changes regarding time frame and recall period were necessary to overcome interpretation and response problems to the CEQ.

DISCUSSION

After small changes, the CEQ appeared to be a content-valid measurement instrument for patients waiting for treatment. However, for patients who had already undergone treatment, the content validity of the CEQ was less, and considerable changes were necessary.