Construct validity of the Suboptimal Health Status Questionnaire-25 in a Ghanaian population

BACKGROUND

The Suboptimal Health Status Questionnaire-25 (SHS-Q-25) developed to measure Suboptimal Health Status has been used worldwide, but its construct validity has only been tested in the Chinese population. Applying Structural Equation Modelling, we investigate aspects of the construct validity of the SHS-Q-25 to determine the interactions between SHS subscales in a Ghanaian population.

METHODS

The study involved healthy Ghanaian participants (n = 263; aged 20-80 years; 63% female), who responded to the SHSQ-25. In an exploratory factor and parallel analysis, the study extracted a new domain structure and compared to the established five-domain structure of SHSQ-25. A confirmatory factor analysis (CFA) was conducted and the fit of the model further discussed. Invariance analysis was carried out to establish the consistency of the instrument across multi-groups.

RESULTS

The extracted domains were reliable with Cronbach's [Formula: see text] of 0.846, 0.820 and 0.864 respectively, for fatigue, immune-cardiovascular and cognitive. The CFA revealed that the model fit indices were excellent [Formula: see text]. The fit indices for the three-domain model were statistically superior to the five-domain model. There were, however, issues of insufficient discriminant validity as some average variance extracts were smaller than the corresponding maximum shared variance. The three-domain model was invariant for all constrained aspects of the structural model across age, which is an important risk factor for most chronic diseases.

CONCLUSION

The validity tests suggest that the SHS-Q25 can measure SHS in a Ghanaian population. It can be recommended as a screening tool to early detect chronic diseases especially in developing countries where access to facilities is diminished.

Barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth worldwide: a systematic review

BACKGROUND

Interventions aimed at reducing risky sexual behavior are considered an important strategy for averting Human Immunodeficiency Virus (HIV) infection among youth (15-24 years) who continue to be at risk of the disease. Enhancing intervention success requires a comprehensive understanding of the barriers and facilitators to interventions targeting youth. However, there is lack of a systematic review of both quantitative and qualitative studies to comprehensively identify and synthesize barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth worldwide. This review aimed to identify and synthesize barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth globally based on original peer-reviewed studies published in the last decade.

METHODS

The Joanna Briggs Institute approach for mixed methods systematic reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used to guide this review. Nine electronic databases, Joint United Nations Programme on HIV/AIDS and World Health Organization websites, and reference lists of included studies and systematic reviews on barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth were searched for eligible articles. Studies that met the inclusion criteria underwent quality appraisal and data extraction. Findings were analyzed using thematic synthesis and underpinned by Nilsen, 2015's Determinant Framework.

RESULTS

Overall 13 studies comprising of eight qualitative studies, four quantitative studies and one mixed methods study were included in the review. Several barriers and facilitators across the five Determinant Framework domains were identified. Most of the barriers fell under the characteristics of the context domain (e.g., gender-biased norms). The next important group of barriers emerged within the characteristics of the end users domain (e.g., fear of relationship breakdown). In terms of facilitators, the majority fell under the characteristics of the strategy of facilitating implementation domain (e.g., implementation of intervention with fidelity) and characteristics of the end users domain (e.g., fear of pregnancy or sexually transmitted infections). The next common set of facilitators appeared within the characteristics of the context domain (e.g., family support).

CONCLUSION

This review identified several multi-level barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth. Multi-level and combination approaches are needed to address these factors and enhance intervention success.

The impact of final-year clinical placements on nursing students' career planning for the graduate year and beyond

AIMS

This study had three objectives: 1) to determine final-year nursing students' career preferences and long-term career plans; 2) to investigate factors influencing nursing students' specialty choices following their final-year clinical placement(s); and 3) to understand how final-year clinical placements can be used to develop the career interests of nursing students to different nursing specialties.

BACKGROUND

Clinical placement provides an insightful experience that may influence students to feel inclined to work in certain specialties. Therefore, each clinical placement should promote students' learning and enhance positive experiences that could develop their career interests and encourage them to seek employment in the specialty on graduation.

DESIGN

A cross-sectional online survey.

METHODS

The survey was structured using the Career Decision Self-Efficacy Scale - Short Form. The questionnaire was distributed to final-year nursing students (N = 222) at two public universities in Western Australia. This study specifically reports on the Goal selection and Planning domains of the Career Decision Self-Efficacy Scale - Short Form, which were explored through additional questions prompting participants to explain their career preferences and reasons for their nursing specialty choices.

RESULTS

Most participants, fifty-three percent, had low confidence in making career decisions. The Goal Selection and Planning questions measured the students' confidence in choosing a suitable practice destination and preparing for their professional careers. Overall, participants prefer employment in hospital settings both in the short- and long-term aspects of their nursing career. The factors influencing the students' career decisions were classified into three main categories: the clinical environment, educational factors and individual factors.

CONCLUSIONS

The nursing curriculum may encourage nursing students to work in some specialties over others. This study provides insight into factors that may promote or inhibit students' career choices and how students may be motivated to pursue the less preferred nursing specialties.

Construct Validity of the Suboptimal Health Status Questionnaire-25 in a Ghanaian Population.. [DOI: 10.21203/rs.3.rs-33104/v2]

Background: The Suboptimal Health Status Questionnaire-25 (SHS-Q-25) developed to measure suboptimal health status has been used worldwide, but its construct validity has only been tested in the Chinese population. In this article, we investigate aspects of the construct validity of the SHS-Q-25 to determine the interactions between SHS subscales in a Ghanaian population.Methods: The study involved healthy Ghanaian participants (n = 263; aged 20-80 years; 63% female), who responded to the SHSQ-25. In an exploratory factor and parallel analysis, the study extracted a new domain structure and compared to the established five-domain structure of SHSQ-25. A confirmatory factor analysis (CFA) was conducted and the fit of the model further discussed. Invariance analysis was carried out to establish the consistency of the instrument across multi-groups. Results: The extracted domains were reliable with Cronbach’s B of 0.861, 0.821 and 0.853 respectively, for fatigue, immune-cardiovascular and cognitive, confirming the construct validity of the SHSQ-25 instrument. The CFA revealed that the model fit indices were excellent a The fit indices for the three-domain model were statistically superior to the five-domain model. There were, however, issues of insufficient discriminant validity as some average variance extracts (AVE) were smaller than the corresponding maximum shared variance (MSV). The three-domain model was invariant for all constrained aspects of the structural model across age, which is an important risk factor for most chronic diseases.Conclusion: The validity tests provide evidence to endorse the credibility of the tool and suggest that the SHS-Q25 can measure SHS in a Ghanaian population. It can be recommended as a screening tool to early detect possible for chronic diseases especially in developing countries where the access to facilities is diminished.

Sub-Saharan African women's views and experiences of risk factors for obstetric fistula: a qualitative systematic review

Background

Obstetric fistula used as synonymous with VVF in this study, is an abnormal communication/hole between the urinary tract and the genital tract or the gastrointestinal tract and the genital tract, resulting from prolonged obstructed labour. VVF may cause sufferers to experience chronic urinary/faecal incontinence, and the stigma of continuing foul odour. VVF is primarily caused by prolonged obstructed labour, which is brought about by a range of causes. Recently, it has been proposed that women’s groups and fistula survivors should suggest interventions to reduce or prevent the incidence of obstetric fistula.

Objective

The objective of this review was to synthesise what is reported about women’s views and experiences of the risk factors underlying the causes of VVF.

Methods

A systematic approach outlined in the Joanna Briggs Institute Manual for Evidence synthesis was followed for this review, articles published since the last 11 years from 2011 to 2021 were selected against several criteria and critically appraised using JBI Critical Appraisal Checklist for qualitative studies.

Results

Nine studies were retained for inclusion in this review and the data were then synthesised into five themes: (1) Cultural beliefs and practices impeding safe childbirth, (2) Lack of woman’s autonomy in choices of place to birth safely, (3) Lack of accessibility and social support to safe childbirth, (4) Inexperienced birth attendants and, (5) Delayed emergency maternal care (childbirth).

Conclusions

This review highlights the complexity of risk factors predisposing women to the known causes of VVF. It also illuminates the absence of women’s voices in the identification of solutions to these risks. Women are most directly affected by VVF. Therefore, their knowledge, views, and experiences should be considered in the development and implementation of strategies to address the issue. Exploring women’s views on this issue would enable the identification of gaps in maternity care provision, which would be of interest to community and health service leaders as well as policymakers in Sub-Saharan Africa.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-05013-2.

Perceived Nexus Between Non-Invigilated Summative Assessment and Mental Health Difficulties: A Cross Sectional Studies

The COVID-19 pandemic rapidly led to changes in the mode of teaching, learning and assessments in most tertiary institutions worldwide. Notably, non-invigilated summative assessments became predominant. These changes heightened anxiety and depression, especially among individuals with less resilient coping mechanism. We explored the perceptions and experiences of mental health difficulties of students in tertiary education regarding non-invigilated alternative assessments in comparison to invigilated assessments. A pragmatic, mixed method cross sectional design was conducted online via Qualtrics. Thematic analysis of text was carried out using NVivo 12. In the quantitative analysis, univariable and multivariable ordinal logistic models were used to examine the potential factors for preference among students in higher education. A total of 380 Nursing and Social Science students responded to the survey. Approximately 77% of students perceived non-invigilated assessments to be less stressful compared to invigilated exams. Age, course of study, stage of studies, and number of units enrolled per semester were identified as significant drivers for students' perceived preference for non-invigilated assessments. There was an inverse relationship between the perception of stress associated with invigilated exams and the age of students. For instance, students aged between 18-24 were 5 times more likely to prefer non-invigilated exams compared to those aged 55 or more. Comparatively, students in early stages of studies had higher preference for non-invigilated assessments. However, there was a preference reversal for students enrolled in 2 or less units per semester. Social sciences students were two times more likely to prefer non-invigilated examinations to invigilated examinations compared to nursing students. The findings reinforce the use of alternative assessments in higher education as a mitigating agency to lessen the mental health burden of tertiary students in post COVID-19 era.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10805-023-09472-w.

Construct Validity of the Suboptimal Health Status Questionnaire-25 in a Ghanaian Population.. [DOI: 10.21203/rs.3.rs-33104/v3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background: The Suboptimal Health Status Questionnaire-25 (SHS-Q-25) developed to measure suboptimal health status has been used worldwide, but its construct validity has only been tested in the Chinese population. In this article, we investigate aspects of the construct validity of the SHS-Q-25 to determine the interactions between SHS subscales in a Ghanaian population. Methods: The study involved healthy Ghanaian participants (n = 263; aged 20-80 years; 63% female), who responded to the SHSQ-25. In an exploratory factor and parallel analysis, the study extracted a new domain structure and compared to the established five-domain structure of SHSQ-25. A confirmatory factor analysis (CFA) was conducted and the fit of the model further discussed. Invariance analysis was carried out to establish the consistency of the instrument across multi-groups. Results: The extracted domains were reliable with Cronbach’s of 0.861, 0.821 and 0.853 respectively, for fatigue, immune-cardiovascular and cognitive, confirming the construct validity of the SHSQ-25 instrument. The CFA revealed that the model fit indices were excellent but the fit indices for the three-domain model were statistically superior to the five-domain model. There were, however, issues of insufficient discriminant validity as some average variance extracts (AVE) were smaller than the corresponding maximum shared variance (MSV). The three-domain model was invariant for all constrained aspects of the structural model across age, which is an important risk factor for most chronic diseases. Conclusion: The validity tests provide evidence to endorse the credibility of the tool and suggest that the SHS-Q25 can measure SHS in a Ghanaian population. It can be recommended as a screening tool to early detect possible for chronic diseases especially in developing countries where the access to facilities is diminished.

Light acupuncture and five-element music therapy for nurses' mental health and well-being during and post-COVID-19: protocol for a randomised cross-over feasibility study

INTRODUCTION

Australian nurses have experienced higher levels of anxiety during the COVID-19 pandemic compared with the prepandemic. This may have affected their long-term mental health and intention to stay in the profession resulting in a workforce shortage, which further impacts the health of the public. Management is urgently required to improve nurses' well-being. However, there is limited evidence available. The proposed clinical trial aims to evaluate the feasibility and therapeutic effects of using a combination of light acupuncture and five-element music therapy to improve nurses' mental health and well-being during and post-COVID-19.

METHODS AND ANALYSIS

This randomised, single blinding, two-arm cross-over feasibility study involves a 1-week run-in period, 2-week intervention and 1-week run-in period in between interventions. Thirty-six eligible nurses will be recruited from the community and randomised into either a combination of light acupuncture treatment and five-element music therapy group or no treatment group for 2 weeks. After a 1-week run in period, they will be swapped to the different group. The primary outcome of this study is to evaluate the feasibility of a combination of light acupuncture treatment and five-element music therapy to improve nurses' mental health and well-being. The secondary outcomes will include anxiety and depression, work productivity and activity, and quality of life assessments. Participants will be asked to complete a set of online questionnaires throughout the trial period. All analyses will be performed in R Studio V.1.1.463.

ETHICS AND DISSEMINATION

Ethical approval was attained from Edith Cowan University's Human Research Ethics Committee (No. 2021-02728-WANG). Research findings will be shared with hospitals and in various forms to engage broader audiences, including national and international conferences, presentations, open-access peer-reviewed journal publications, and local community workshop dissemination with healthcare professionals.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry: ACTRN12621000957897p https://www.anzctr.org.au/ACTRN12621000957897p.aspx.

North-central Nigerian women's experiences of obstetric fistula risk factors and their perceived treatment services: An Interpretive Description

BACKGROUND

An obstetric fistula also known as vesico vaginal fistula (VVF), or recto-vaginal fistula (RVF) is an abnormal opening between the urogenital tract and intestinal tract caused by prolonged obstructed labour; when the head of the baby presses on the soft tissues in the pelvis leading to loss of blood flow to the women's bladder, vagina, and rectum. This can cause necrosis of the soft tissues resulting in debilitating fistula formations.

AIM

This study aimed to uncover North-central Nigerian women's experiences of obstetric fistula and their perceived treatment services.

DESIGN

Qualitative, interpretive descriptive methodology underpinned by symbolic interactionism involving face-to-face semi-structured interviews was used to explore North-central Nigerian women's experiences of obstetric fistula and their perceived treatment services.

SAMPLE

A purposive sample of 15 women who had experienced obstetric fistula at a repair Centre in North-central Nigeria were eligible.

RESULTS

Four themes emerged from North-central Nigerian women's experiences of obstetric fistula and their perceived treatment services i) I was left alone in the room ii) Waiting for the one vehicle in the village iii) I never knew about labour until that very day iv) and We kept following the native doctors and sorcerers.

CONCLUSION

The findings from this study highlighted the depth of women's experiences from the devastating complication of childbirth injury in North-central Nigeria. Analysis of insights from women's voices directly affected by obstetric fistula demonstrated that in their views and experiences the themes identified were majorly responsible for their fistula status. Thus women need to raise their collective voices to resist oppressive harmful traditions and demand empowerment opportunities that will improve their social status. Government should improve primary healthcare facilities, train more midwives and subsidise maternal care for antenatal education and birth services spending for childbirth women may result in improved childbirth experiences for women in rural and urban communities.

TWEETABLE ABSTRACT

Reproductive women call for increased accessibility to healthcare services and the provision of more midwives to mitigate obstetric fistula in North-central Nigerian communities.

Women's views on obstetric fistula risk factors and prevention in north-central Nigeria: an interpretive descriptive study

OBJECTIVE

Obstetric fistula, also known as vesicovaginal fistula or rectovaginal fistula, is an abnormal opening between the vagina and rectum caused by prolonged obstructed labour that causes substantial long-term harm to women. It is most prevalent in low resource settings and although preventative measures have been proposed, they have not, to date, taken women's own views into account. The objective of this study was to explore the views of North Nigerian women on obstetric fistula risk factors and prevention.

DESIGN

This study was conducted using Interpretive Description methodology, which is a qualitative approach underpinned by Symbolic Interactionism. A semistructured questionnaire was used to explore the views of 15 women living with obstetric fistula about risk factors and prevention of the condition. Data were collected in one-to-one in-depth interviews conducted between December 2020 and May 2021. All interviews were audio-recorded and transcribed verbatim, and a thematic approach to data analysis was employed.

SAMPLING AND SETTING

The setting for this study was a fistula repair centre in north-central Nigeria. The sample was formed of a purposively selected 15 women who had experienced obstetric fistula at a repair Centre in north-central Nigeria.

RESULTS

Four core themes emerged from women's views on obstetric fistula risk factors and prevention: (1) Women's autonomy, (2) Economic empowerment, (3) Infrastructure/transportation and (4) Provision of skilled healthcare services.

CONCLUSION

The findings from this study highlight previously unknown women's views on obstetric fistula risk factors and prevention in north-central Nigeria. Analysis of insights from women's voices directly affected by obstetric fistula demonstrated that in their views and experiences, giving women autonomy (decision-making power) to choose where to birth safely, economic empowerment, enhancement of transportation/infrastructure and provision of skilled healthcare services may mitigate obstetric fistula in Nigeria.

The influence of individual factors on the career preferences and specialty choices of final-year nursing students

BACKGROUND

Statistical evidence shows that nursing students prefer a professional career in hospital settings, leading to a lack of career interest in non-hospital settings such as community and residential aged care facilities. The lack of preference for non-hospital settings has persisted over several decades and presents a need for different approaches that may reveal new information to better understand the individual factors that influence specialty choices and preferences from the students' viewpoints.

PURPOSE

The aims of this study were to (1) explore individual factors that impact the nursing specialty choices of final-year nursing students and (2) explore how these factors influence the final-year nursing students' career decision-making process.

METHOD

A narrative inquiry approach using semi-structured interviews was carried out with purposively sampled nursing students (n = 12) who had undertaken a final-year clinical placement(s). Data was analysed using two main steps. First, the interviews were restoried and then analysed using the three-dimensional framework. Subsequently, thematic analysis was applied to generate themes.

RESULTS

Data analysis generated three main themes: demographic factors, social factors, and career goals. Participants' characteristics and interactions with other individuals and systems influenced their nursing specialty preferences and professional career plans.

CONCLUSION

Nursing students' career interests are influenced by individual factors external to their nursing education, such as their age, gender, and life experiences. These student characteristics and experiences facilitated or inhibited a career in some nursing specialties, with the students gauging their ability to practice in a specialty during their CPs. Nursing education should expose and inform students about the core skills, career opportunities, and how to advance their careers in the different nursing specialties. Most importantly, final-year students may need formal career guidance to encourage nursing students' positive attitudes and career interests in different nursing specialties and make realistic career decisions.

Construct Validity of the Suboptimal Health Status Questionnaire-25 in a Ghanaian Population.. [DOI: 10.21203/rs.3.rs-33104/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

BackgroundThe Suboptimal Health Status Questionnaire-25 (SHS-Q-25) developed to measure suboptimal health status has been used worldwide, but its construct validity has only been tested in the Chinese population. In this article, we investigate aspects of the construct validity of the SHS-Q-25 to determine the interactions between SHS subscales in a Ghanaian population.MethodsThe study involved healthy Ghanaian participants (n = 263; aged 20-80 years; 63% female), who responded to the SHSQ-25. In an exploratory factor and parallel analysis, the study extracted a new domain structure and compared to the established five-domain structure of SHSQ-25. A confirmatory factor analysis (CFA) was conducted and the fit of the model further discussed. Invariance analysis was carried out to establish the consistency of the instrument across multi-groups.ResultsThe extracted domains were reliable with Cronbach’s B of 0.861, 0.821 and 0.853 respectively, for fatigue, immune-cardiovascular and cognitive, confirming the construct validity of the SHSQ-25 instrument. The CFA revealed that the model fit indices were excellent a The fit indices for the three-domain model were statistically superior to the five-domain model. There were, however, issues of insufficient discriminant validity as some average variance extracts (AVE) were smaller than the corresponding maximum shared variance (MSV). The three-domain model was invariant for all constrained aspects of the structural model across age, which is an important risk factor for most chronic diseases.ConclusionThe validity tests provide evidence to endorse the credibility of the tool and suggest that the SHS-Q25 is robust tool for measuring SHS in a different population.

"A spade was called a spade … ": Youth and intervention implementers' perceptions of a resilience-based HIV-prevention intervention for youth in South Africa

The youth (15-24 years old) in South Africa remain at high risk of HIV infection despite varied efforts to control the disease. An understanding of the perspectives of relevant stakeholders of HIV-prevention interventions targeting the youth is important to guide research, policy and practice aimed at improving these interventions. This study explores youth and intervention implementers' perceptions of a resilience-based HIV-prevention intervention (You Only Live Once) aimed at reducing risky sexual behaviours among the youth in South Africa. Semi-structured interviews were conducted with 10 young people who participated in the intervention, and four intervention implementers at a not-for-profit organisation in Maluti-a-Phofung Local Municipality, South Africa. Data were analysed using thematic analysis. Three main themes emerged from the data: (1) Acceptability and impact of the intervention; (2) Factors influencing intervention implementation; and (3) Recommendations to improve intervention implementation. These findings provide insights into the acceptability, impact, barriers and facilitators of resilience-based HIV-prevention interventions for the youth in South Africa and similar contexts, and how implementation of these interventions could be enhanced. The findings can help researchers, policy makers and health care practitioners in the field of HIV prevention to improve interventions targeting young people.

Parents' experiences of children with a rare disease attending a mainstream school: Australia

PURPOSE

To explore the perceptions of parents who had a child or adolescent (6-18 years) diagnosed with a rare disease who attended a mainstream school in Western Australia.

DESIGN AND METHODS

A cross-sectional online survey was conducted with 41 parents of children with a rare disease. Here we report the findings of 14 open-ended questions on their experience of illness-related factors and impact on school-related social activities, such as sports, school camps and leadership roles whilst their child with a rare disease attended a mainstream school in Australia. Responses were analysed using an inductive thematic content approach.

RESULTS

We identified three themes (resources, experiences and needs), seven categories (illness, support, knowledge, acceptance, isolation, activities of daily living and adjunctive therapy) and 24 codes from the parents' responses describing the experiences of their child at school. Parents want the government and educational systems to provide the necessary funding and resources to reflect an inclusive curricula and supportive environment that can meet the learning needs of children with a rare disease at a mainstream school.

CONCLUSIONS

Further research, policy development and interventions are needed to explore how schools can meet the diverse psychosocial physical and emotional needs of children diagnosed with a rare disease who attend a mainstream school in Australia.

PRACTICE IMPLICATIONS

A child needs to be viewed from a holistic ecological viewpoint; future research with larger representative samples to explore rare disease experiences and a critical review of existing legislation, interventions and initiatives is required.

An examination of the career decision-making self-efficacy of final-year nursing students

BACKGROUND

One in four newly graduated registered nurses leave their employment positions within the first year. To reduce this attrition, nursing stakeholders could focus on the final year of nursing education because students at this stage make professional career plans, including their practice destination for the graduate year and their commitment to the profession. Previous studies provide evidence of nursing students' career preferences and specialty choices. However, there is a dearth of data that focuses on the students' career decision-making process.

AIM

This study examined the self-efficacy or confidence of final-year nursing students in making career decisions and the factors that influence their career decision-making process.

SETTING AND PARTICIPANTS

Final year pre-registration nursing students (N = 222) at two public universities in Western Australia.

METHODS

An online survey was used to collect cross-sectional data. The Career Decision Self-Efficacy Scale - Short Form was used to investigate nursing students' confidence in making career decisions. Career decision-making self-efficacy refers to the confidence to successfully complete career decision-making tasks. Descriptive statistics were used to describe the participants' characteristics. The chi-square test was used to assess the significance of the difference between categorical data, and binary logistic regression was used to determine the odds of the factors that predict career decision self-efficacy.

RESULTS

Forty-seven percent of participants who answered all Career Decision Self-Efficacy Scale - Short Form questions had good confidence in making career decisions. Factors such as the setting of the final clinical placement, the intention to be employed in the specialisation or organisation of their final placement and the students' assessment of their clinical experience were associated with career decision-making confidence.

CONCLUSIONS

Most participants had low confidence in making career decisions. This study provides ideas for nursing stakeholders to implement measures to improve students' confidence to make informed career decisions.

Australian fathers' experiences of caring for their preterm infants

Fathers and/or non-birthing partners are now actively involved in child-rearing globally; however some experience emotional difficulties during the perinatal period. With the birth of a preterm infant, parents experience additional stress beyond that normally engendered by having a baby, which can impact on parent-infant relationship and infant development. In Australia, there is limited evidence on fathers' experiences of preterm birth. Thus, this study aimed to explore the experiences of Australian fathers of preterm infants including their emotional and physical wellbeing when they have a preterm infant. Narrative inquiry guided the study; 13 fathers whose preterm infant was admitted to Australian neonatal units participated in in-depth interviews lasting 22-72 min. Data analysis generated four themes: (i) emotional response, (ii) fathers' wellbeing, (iii) fathering in neonatal unit and during transition home (iv) fathers' needs in the neonatal unit. The findings revealed that fathers felt emotionally overwhelmed, had specific needs but their role in the neonatal unit was not well defined and they felt mothers were given more attention. Despite feeling excluded, many continued to support their partner and infant. Health professionals must be aware of their unconscious biases toward gender roles in the neonatal unit and utilize strategies to actively include fathers and non-birthing partners.