"This is real", "this is hard" and "I'm not making it up": Experience of diagnosis and living with non-epileptic attack disorder

PURPOSE

To use a qualitative research approach to explore adults' experience of living with non-epileptic attack disorder.

OBJECTIVE

The objective was to explore the experience of adults (18 years+) with a confirmed diagnosis of non-epileptic attack disorder (NEAD) across the trajectory of the disorder. The topics investigated included the onset of symptoms, the experience of non-epileptic attacks, the diagnostic process and living with NEAD.

METHOD

Twelve people diagnosed with NEAD who attended a tertiary hospital neurology department took part in semi-structured interviews. The data generated were analysed using reflexive thematic analysis.

RESULTS

Eleven women and one man with median age of 25 years took part. Three themes were developed: mind-body (dis)connect, a stigmatised diagnosis and a role for containment. Adults spoke about their experience of nonepileptic attacks, the diagnostic and management process and the impact of both nonepileptic attacks and the NEAD diagnosis on their lives.

CONCLUSIONS

Adults' experience's within the healthcare system across the trajectory of NEAD influenced their own understanding and trust in their NEAD experience, how they shared this with others in their social and work lives and how they managed their NEAD symptoms on a daily basis. The research suggests the need for a consistent, timely implementation of a rule-in diagnostic approach and multi-disciplinary management of NEAD. It is recommended that lessons be taken from theoretical models including the common-sense model and a modified version of the reattribution model to support the de-stigmatisation of this diagnosis to inform psychoeducation and professionally facilitated peer-support groups.

Perceived barriers and facilitators to healthy eating among Pakistani women participating in the PakCat program in Catalonia: A qualitative approach

Immigrant women of Pakistani origin are among the most at-risk groups for type 2 diabetes, obesity, and heart failure in Catalonia. As the incidence of these diseases is associated with lifestyle factors, we approached this community with participatory research and conducted six focus groups (N = 36) among Pakistani women participating in the PakCat Program. The research process of this paper adhered to the COREQ checklist. Through the thematic analysis, we identified six main themes: social beliefs and attitudes, family environment, personal factors, dietary acculturation, traditional dietary patterns, and economic factors. We discovered both facilitators and barriers associated with each theme, but the findings indicated that Pakistani women encounter more inhibitors than enablers to following a healthy diet. The determination of these factors can facilitate the reinforcement of the aspects that help Pakistani women to follow a healthy diet and provide adequate tools to overcome the barriers.

Interprofessional collaboration in the cardiovascular management of Marfan syndrome: A qualitative study based on interviews with professionals

BACKGROUND AND AIM

Patients with Marfan syndrome, who present with a variety of symptoms and complex psychosocial problems, require interprofessional collaboration in their care. However, it is unclear how health care providers contribute to interprofessional collaboration for these patients. The purpose of this study was to determine the characteristics of interprofessional collaboration for patients with Marfan syndrome in the cardiovascular field.

METHODS

Semi-structured interviews were conducted with health care specialists (5 physicians, 2 nurses, and 3 certified genetic counselors) were analyzed qualitatively.

RESULTS

Based on the medical collaboration for the management of cardiovascular complications in patients and their relatives, interprofessional collaboration was identified, such as collaboration and cooperation between physicians and certified genetic counselors, and nursing practice to facilitate interprofessional collaboration. In addition, issues such as difficulties in dealing with and coordinating medical care for noncardiovascular complications, lack of specialist physicians, and lack of opportunities to collaborate with nurses were identified.

CONCLUSIONS

Effective interprofessional collaboration requires the acquisition of Marfan syndrome and genetic knowledge by healthcare providers and the development of a healthcare delivery system based on departments that can provide leadership. In addition, the assignment of nurses to work across organizational boundaries and effective collaboration between genetic counselors and nurses should be considered.

Vibrational circular dichroism study and gas chromatographic analysis of chiral epichlorohydrin

In recent years, there have been numerous incidents of serious accidents related to impurities of optical isomers, particularly in pharmaceutical treatment, environmental problems, and pesticide application. Among these impurities, chiral epichlorohydrin (ECH) is an important C3 synthon and a potentially genotoxic impurity. The enantiopure forms of S-ECH and R-ECH are key raw materials for synthesizing many drugs, which make it important to accurately quantify the specific conformation of chiral epichlorohydrin in pharmaceuticals. In this paper, we achieved the separation of chiral ECH by gas chromatography (GC) and based on the combination of vibrational circular dichroism (VCD) experiments and theoretical calculations, the qualitative method of chiral ECH was achieved without relying on a single enantiomeric standard.

"It doesn't exist, only other people have it, or it's bad luck": perceptions of HIV as barriers to its prevention in Bata

BACKGROUND

Currently, Africa is the region of the world where the highest number of new cases of HIV infection are registered. In 2022, Equatorial Guinea was the Central African country with the highest HIV prevalence (6.9%) and incidence (3.80 per 1,000 amongst the population of all ages). The main objective of this study was to determine the perceptions of HIV and the meanings given to it among the population of Equatorial Guinea in order to assess to what extent they represent a barrier to the prevention strategies implemented hitherto.

METHODS

A total of 30 semi-structured interviews and nine focal groups were carried out.

FINDINGS

The interviewees' testimonies revealed a combination of differing perceptions and meanings around HIV. In some cases, HIV was perceived as "a non-existent illness", and in others as "a disease of others", or as "a disease of bad luck". Other majority perceptions of HIV classed it as "a deadly disease" or "a sexual illness".

CONCLUSIONS

All these perceptions of HIV and the social representations constructed around it can represent a barrier to adopting preventive practices. Hence, in order to improve efficacy, efficiency, and effectiveness, it is recommended that HIV prevention policies take into account the heterogeneity of meanings linked to the different social groups that have contracted the virus.

Disentangling the intersection of inequities with health and malaria exposure: key lessons from rural communities in Northern Borneo

BACKGROUND

The increasing incidence of Plasmodium knowlesi malaria poses a significant challenge to efforts to eliminate malaria from Malaysia. Macaque reservoirs, outdoors-biting mosquitoes, human activities, and agricultural work are key factors associated with the transmission of this zoonotic pathogen. However, gaps in knowledge regarding reasons that drive malaria persistence in rural Kudat, Sabah, Northern Borneo remain. This study was conducted to address this knowledge gap, to better understand the complexities of these entangled problems, and to initiate discussion regarding new countermeasures to address them. This study aims to highlight rural community members' perspectives regarding inequities to health relating to P. knowlesi malaria exposure.

METHODS

From January to October 2022, a study using qualitative methods was conducted in four rural villages in Kudat district of Sabah, Malaysia. A total of nine in-depth interviews were conducted with community and faith leaders, after the completion of twelve focus group discussions with 26 photovoice participants. The interviews were conducted using the Sabah Malay dialect, audio-recorded, transcribed, and translated into English. The research team led the discussion and analysis, which was approved by participants through member checking at the community level.

RESULTS

Participants identified disparity in health as a key issue affecting their health and livelihoods. Injustice in the social environment was also identified as a significant challenge, including the importance of listening to the voices of affected communities in disentangling the social and economic phenomena that can impact malaria control. Specific concerns included inadequate access to health-related resources and degradation of the environment. Participants recommended improving access to water and other necessities, increasing the availability of malaria control commodities in healthcare facilities, and developing sustainable programs to reduce socioeconomic disparities.

CONCLUSION

Inequities to health emerged as a key concern for malaria control in rural Kudat, Sabah. A locally targeted malaria programme cantered on improving the social and economic disparities associated with health outcomes, could be a potential strategy for malaria prevention in such areas. Community-level perspectives gathered from this study can be used as a foundation for future discussions and dialogues among policymakers and community members for achieving greater transparency, improving social equity, and interoperability in addressing P. knowlesi malaria control.

The unmet needs of patients in the early rehabilitation stage after lung cancer surgery: a qualitative study based on Maslow's hierarchy of needs theory

PURPOSE

This study aimed to explore the unmet needs of lung cancer patients in early rehabilitation, based on Maslow's hierarchy of needs theory.

METHODS

Information on the experiences of 20 patients was collected through semi-structured interviews. The interviews were conducted in the surgical nursing clinic within 1 week of discharge from hospital. The data were analysed using a combination of deductive (theory-driven) and inductive (data-driven) methods, using Maslow's Hierarchy of Needs as a framework for identifying and organising themes.

RESULTS

Patients had a mean age of 50.92 years (SD 11.88); n = 11 (55%) were female. Major themes aligned with the dimensions of Maslow's hierarchy of needs model. Five major themes with 12 corresponding sub-themes emerged: (1) physiological needs, including "self-care and independence in life", "return to pre-operative status as soon as possible", "increase exercise under specialist guidance" and "reduce cough and pain and improve sleep quality"; (2) safety and security needs, such as "symptom management", "regulation of the emotions of worry and fear" and "access accurate treatment information"; (3) love and belonging needs, including "accompany family members" and "chat with friends";(4)Esteem needs: "live with dignity";(5) Self-actualization, such as "accept and submit to the reality of cancer" and "live meaningfully".

CONCLUSIONS

The findings of this study indicated that there were many unmet needs for patients during the early recovery period after lung cancer surgery. An overview of the different areas of need identified in this study may guide future research and development of interventions to improve patients' quality of life during the home rehabilitation phase.

Patients' long-term perspectives on gains and losses after temporal lobe resection for epilepsy

OBJECTIVE

To investigate long-term (>10 years) experiences and overall satisfaction with temporal lobe resections (TLB) for epilepsy.

METHODS

Eligible participants were identified through the administrative epilepsy surgery registry at Oslo University Hospital. Data were collected through individual, semi-structured interviews with fifty participants. Interview records were analyzed using reflexive thematic analysis.

RESULTS

Participants' answers were divided into two main themes: "looking back on surgery" and"considering gains and losses from surgery". Most participants expressed satisfaction with having undergone surgery. Nevertheless, postsurgical problems had been encountered, and presurgical hopes had only partly been fulfilled. They described memory and naming problems with a major impact on daily life. Further, they had thoughts about effects on employment, independence, and feelings of loneliness, and expressed a need for more and better preoperative information.

CONCLUSIONS

Presurgical hopes go beyond seizure freedom and memory and naming problems are experienced lasting many years after surgery in the temporal lobe. Better preoperative information, particularly about unwanted cognitive effects, is of prime importance. By exploring patientś presurgical hopes, a common ground for expectations on surgery may be found along with strategies on how to cope with cognitive difficulties and possible negative life changes.

Freebirth, the only option for women who do not fit into common practice- A Swedish national interview study

OBJECTIVE

To explore women's experience of freebirth, as giving birth without the presence of a skilled healthcare professional such as a midwife.

METHODS

Online semi-structured interviews with nine multiparous women in Sweden. A qualitative experiential approach, as described by Burnard, was followed for data analysis.

RESULTS

The five main categories explored were: (i) previous negative experiences of hospital care as a reason for freebirth; (ii) receiving support for the decision of freebirth was crucial; (iii) longing for individual midwifery-assisted home-birthing support; (iv) to give birth in peace and in self-control, in the safe home environment; and (v) helpful support during labor and birth was appreciated.

CONCLUSIONS

The women in the study had a powerful and positive experience of freebirth, but individual midwifery birthing support was also requested. Easily available and respectful midwifery support should be offered to all childbearing women.

A participatory approach to understand the attitudes and perceptions towards priority endemic cattle diseases among dairy farmers and animal health experts in Henan province, China

The dairy industry is threatened by a variety of endemic diseases and emerging diseases, and various control programs have been initiated in China. The increased application of evidence to policymaking can help improve the efficiency of disease control programs; however, the relevant research literature is currently lacking. The objective of this study was to gain an in-depth understanding of the attitudes and perceptions towards priority endemic diseases among dairy farmers and animal health experts by taking Henan province of China as the example and using semi-structured interviews and focus group discussions, respectively. This study involved 24 farmers and 27 animal health experts from December 2019 to January 2021. The diseases considered by farmers to be of significance to their animals are different from those considered priorities by the participating experts and the government list. From the perspective of the individual farmers, the effects of zoonotic disease risks such as bovine brucellosis and tuberculosis appear to be less pronounced than "visible" losses at the farm level, contrary to the opinion of experts. Participating experts believed that poor on-farm biosecurity measures posed challenges to the control and eradication of priority endemic diseases; however, there are gaps in farmers' understanding of biosecurity principles, and low motivations to take such disease prevention measures. Several other challenges to the control and eradication of priority endemic diseases also emerged in the data, including the lack of diagnostic tools applicable in the field as well as differential diagnostic tools to differentiate natural infection from vaccination, lack of effective and commercially available vaccines against single or multiple pathogen(s) or new genotypes/serotypes, weak early warning and information networks and insufficient economic compensation. A holistic understanding of people's perceptions of disease control would facilitate the implementation of inclusive and engaging disease control strategies, thereby increasing the efficiency of disease control.

Understanding stigma through the lived experiences of people with opioid use disorder

BACKGROUND

Stigma toward substance use disorders reduces treatment seeking and recovery efforts of persons who could most benefit from services. This is particularly true for opioid use disorder (OUD) stigma, which in recent years has likely fueled the overdose epidemic. Understanding the stigma surrounding OUD and stigma reduction efforts that can be implemented are needed to enhance treatment and recovery efforts. This project explores the lived experiences of persons who were in recovery from OUD or a family member of someone with OUD with a focus on stigma.

METHODS

We utilized a qualitative method to examine secondary data of published transcripts where people's (N = 30) experiences with stigma emerged through storytelling.

RESULTS

Thematic analysis found three overarching types of stigma that were described by participants, 1) Social stigma: misconceptions contributing to social stigma, labeling and associative stereotypes, persistence of stigma throughout recovery; 2) Self-stigma: internalized feelings due to stigma, concealing and continuing substance use, inadequacies of navigating recovery; and 3) Structural stigma: treatment and recovery resource barriers, challenges of reintegration.

CONCLUSIONS

The experiences described by participants highlight the multifaceted impact of stigma on the individual as well as society and add to our understanding of the lived experience of stigma. Future recommendations are discussed to improve the experience of individuals with lived experience of OUD; including implementing evidence-based strategies to reduce stigma such as using stigma-free or person first language, dispelling common myths, and supporting comprehensive recovery pathways.

Negotiating precarity: Recent immigrants' perceptions of waiting for public healthcare in Ontario, Canada

Canada is widely known for its universal publicly funded health care system. While its health care system is an important part of Canadian identity, recent immigrants living in some provinces and territories are not covered by the publicly funded healthcare system until they have met a minimum residency requirement. This article seeks to understand the multiple manifestations of financial and emotional precarity that recent immigrants face as they navigate a lack of access to health care during their first three months of arrival in Ontario. This paper draws on qualitative semi-structured interview data from 46 recent immigrants who came from 12 different countries and had been living in Ontario, Canada. We found that the wait period to obtain health care often added to the prohibitive costs associated with immigration and settlement. During the wait period, recent immigrants faced financial burdens and their inability to access publicly funded hospitals and medical services when needed which resulted in feelings of vulnerability, anxiety, and emotional hardship. Given the financial and emotional precarities faced by recent immigrants during the wait period, we argue that the Canadian 'universal' healthcare system excludes and creates barriers to timely and equitable access to healthcare services for recent immigrants. We recommend to permanently eliminate the wait period policy to ensure the health and wellbeing of recent immigrants.

Experiences of moving an older parent into a care home or nursing home in the UK: a qualitative study

The study explored the personal experiences of individuals making the decision to move an older parent into a residential care facility via retrospective narrative. It aimed to gain an understanding of how individuals experienced this transition, the emotions they felt at specific moments throughout the transition, and the perceived effect it had on their psychological wellbeing. 13 semi-structured video interviews were conducted online with individuals who had been active in the decision of moving an older parent into a care home or nursing home. The data was analysed using thematic analysis, along with relational analysis to explore relations between themes. Findings informed 8 different themes, which were subsumed under three meta-themes of The Decision Process, Conflicting Emotions and Reflective Evaluation. It was found that the decision was recalled as a complex and often stressful negotiation between multiple stakeholders, that emotions ranged from grief to guilt and relief, and that reflections emphasised the positive that had come out of the transition. The results from this study provide valuable insights into the uniqueness of this transition from the perspective of relatives and the range of emotions experienced at different stages of the transition.

Parents' experiences of having their children take part in participatory action research creating a serious game about radiotherapy

INTRODUCTION

Radiotherapy (RT) is one of several treatment modalities used for children diagnosed with cancer. Several studies have designed interventions aimed to alleviate the stress that can occur in conjunction with RT. To include children in the design of interventions is rare and dependent on the parents giving consent to participation in research on their children's behalf. The aim was to illuminate, from the parents' perspective, the experience of their children being part in the co-creation of a serious game and their previous experiences of RT.

METHODS

Ten parents of children taking part in a participatory action research study of the development of a serious game were invited to an interview and seven parents consented. An inductive, manifest content analysis was performed.

RESULTS

The analysis resulted in an overarching theme: Parents' pre-understanding from their child's cancer treatment created a sensitivity to their child's wishes and a willingness to contribute to science. Four categories are presented: Intrinsic factors influenced the intent to participate, Extrinsic factors that had an effect on participation, Parents role in the game development, and Radiotherapy impinged the child and the parent.

CONCLUSION

To be able to pay it forward to healthcare and other families with a child diagnosed with cancer was a contributing factor for parents' willingness to consent to participation after their children had undergone RT, especially since their children wanted to do so. Parents indicated interest in the developmental process and in following their children being part of the creation of a serious game about RT.

IMPLICATION FOR PRACTICE

To understand why parents allow their children to participate in studies creates opportunities for the research community to structure studies that facilitate participation.

Reliability of qualitative and quantitative assessment of adhesive remnants after debonding of ceramic brackets bonded with Transbond™XT on human molar teeth: An in vitro study

OBJECTIVE

To test the hypothesis that there are any differences between qualitative and quantitative methods of adhesive remnants index (ARI) scores on the buccal surfaces of the upper molar.

MATERIALS AND METHODS

The study included 34 upper first human molars. After etching for 20seconds by using 35% orthophosphoric acid (Ultra-Etch, Ultradent Products Inc., USA) and then rinsed with distilled water for 15seconds, the adhesive (Transbond™XT, 3M™, USA) was applied and cured with the polymerization lamp (Bluephase Style, Ivoclar Vivadent, Liechtenstein) for 10seconds. Ceramic brackets (Damon® Clear™, Ormco, USA) were placed by composite (Transbond™XT, 3M™, USA) on the buccal surface of the molars. Following 24-hour storage of the samples in distilled water (WB-12, Phoenix Instrument, Gabsen, Germany) at 37°C, the brackets were debonded using a debonding plier (Damon Clear Debonding Plier, Ormco, USA). ARI and a modified ARI-scoring system were used. Three independent observers scored the ARI with the naked eye under 10x, 20x, and 32x magnifications using Stereomicroscope Stemi DV4 (Zeiss, Germany). Afterward, the digital microscope VHX-5000 (Keyence, Japan) under 50x magnification was used for the quantitative analysis of the adhesive remnants by just one evaluator. The Fleiss' Kappa-coefficient test was used to assess interrupter reliability.

RESULTS

Fleiss' Kappa-coefficient test show that the highest amount of agreement between observers is observed using the naked eye for both of the scoring methods P<0.001. Increasing the magnification led to the moderate decrease of inter-observer agreement. For evaluations with naked eye, a higher agreement is observed for the modified ARI score compared to the ARI scored. The agreement between the quantitative and qualitative evaluation of the ARI score rose with increasing magnification.

CONCLUSION

The assessment of adhesive remnants should be done either with naked eye or under 10x magnification, as they showed the highest rate of intra-observer agreement.

Health and meaning through "doings": A qualitative study with young unaccompanied refugees in Norway

BACKGROUND

Young unaccompanied refugees who settle in a new country are at substantial risk of developing health problems while striving to uphold a meaningful, new life. We lack knowledge about how they use their personal agency to self-care in the context of their local communities. This article examines how young unaccompanied refugees create healthy identities and looks into the social structures that promote health in their everyday life.

METHODS

Nineteen in-depth interviews were conducted with young unaccompanied refugees settled in Norway, originating from Afghanistan, Eritrea, and Syria. Interpretive phenomenological analysis was used. Our theoretical framework combined Antonovsky's (1987) theory of health, Honneth's (2005) philosophy of recognition, and Prilleltensky's (2020) social psychological concept of mattering.

RESULTS

Young unaccompanied refugees create healthy identities through "doings", i.e. meaningful activities that provide recognition and the feeling of adding value. They confirm health as a relational phenomenon, including horizontal relations at, for example, school, work, gym, and other leisure activities in the local community. Vertical relations involving legal status, residence permits, and community values, were also highly important. The participants' relation to parents/families in their country of origin was often complex, associated both with burdensome obligations to provide and a potential to care and matter.

CONCLUSION

Young unaccompanied refugees are dependent on inclusive, supportive policies and structures which enable them to develop healthy identities. These findings should encourage policymakers and society to strengthen and expand arenas for "doings" and meaning for young unaccompanied refugees.

Designing and conducting qualitative research across countries and cultures: challenges for inclusiveness and rigour

Qualitative research is fundamental to understanding the nature and complexity of human phenomena. While cultural and psychometric validations exist for quantitative tools, the same cannot be said of qualitative ones. There are other many challenges when conducting a multinational qualitative study, which includes different cultural and linguistic 'biases'. This paper presents some key issues that researchers may encounter when designing and developing multinational and multicultural qualitative studies, and also provides some strategies to overcome difficulties and ensure rigour.

Age-Related Microaggressions: A Descriptive Study

BACKGROUND AND OBJECTIVES

The aim of this study was to expand the literature on ageism by exploring the phenomenon of age-related microaggressions.

RESEARCH DESIGN AND METHODS

Fifty-one participants completed an online survey asking a series of questions about their experiences with microaggressions related to their age. Responses were summarized using a thematic analysis.

RESULTS

Participants reported frequently experiencing age-related microaggressions, particularly microinsults. Microaggressions occurred in a variety of settings, often by individuals unfamiliar to the older adult. Although most participants reported having negative emotional reactions to microaggression and believing these acts are intentional, in most cases perpetrators are not confronted.

DISCUSSION AND IMPLICATIONS

Our hope is this descriptive study will serve as a foundational framework for conducting future exploration of age-related microaggressions and their effects on older adults and society at large.

Motivations for Forgiving an Offender with Practical Implications for Those in the Helping Professions: A Qualitative Study

While the forgiveness literature is rapidly growing, little attention has been paid to the general public's motivations for forgiving. Using a qualitative approach, this study examined 100 participants' stated reasons for forgiving. The following seven themes have emerged: (1) forgiveness is the key to inner peace, (2) relationships matter, (3) forgiveness is conditional, (4) they forgive because of love/concern for the other in the human community, (5) forgiveness is a (moral and religious) duty, (6) they forgive for the sake of others, and (7) they forgive for growth. When considering motivations for forgiveness, participants tended to focus on what they could restore or gain as a consequence of forgiving, supporting the findings of past studies. However, some notable differences were also found when questions were asked in different ways. Major findings, implications for those in the helping professions, and limitations and future directions are discussed.

"Food is more than just a source of nutrients": A qualitative phenomenological study on Food Involvement

The role of food in people's life has changed dramatically in recent years. In particular, it is becoming more symbolic and linked to subjective values. For this reason, recent scientific research has delved into the construct of Food Involvement. However, to the best of our knowledge, there are no empirical studies aimed at exploring this construct deepening the symbolic value assumed by it. Accordingly, the current study aims to qualitatively explore the personal meanings that consumers attribute to Food Involvement and to detect the psychological domains that characterize this lived experience. The study included a purposive sample of adults selected according to three different prototypical profiles until reaching data saturation: mothers, cooks or athletes, all with medium or high levels of Food Involvement. Fourteen in-depth phenomenological interviews were conducted and analyzed according to the principles of Interpretative Phenomenological Analysis (IPA). Results showed that Food Involvement is characterized by a deep relationship between the consumer and food that allows satisfying one's ambitious transformative project that involves the self, the other or both actors. This symbolic role played by Food Involvement was recognized by both those with medium or high involvement. However, the orientations in one's transformative process of mothers, athletes and cooks is different. In particular, the transformative project of mothers is oriented towards the other, that of cooks towards the self and athletes' project towards the self and others. This study gives a scientific contribution to the literature about Food Involvement to create effective measurement scales that assess the symbolic role that Food Involvement has in people's lives.

A safe place - Adolescents' and young adults' perceptions of youth clinics in northern Sweden

BACKGROUND/OBJECTIVE

Adolescents and young adults are a diverse group with varied health needs. In Sweden, youth clinics are critical for improving their sexual, reproductive, mental, and general health. The aim of this qualitative study was to gain a deeper understanding of key conditions needed for youth friendliness, and to better understand youth-friendly health services from the perspective of adolescents and young adults in northern Sweden.

METHODS

Information was collected through focus group discussions and interviews with 23 adolescents and young adults (aged 16 to 25) at youth clinics in each of the four northernmost regions of Sweden. Interviews were analysed inductively using Braun and Clarke's thematic analysis.

RESULTS

Three themes and six sub-themes emerged. A safe, empowering and holistic space, outlines how youth-friendly physical spaces and staff contributed to a sense of safety in contrast to other healthcare facilities. The theme Youth clinics are accessible - but reaching out is challenging, refers to low thresholds for visiting youth clinics and perceived barriers to access. The third theme "You feel a bit vulnerable" - the importance of privacy, highlights privacy dimensions and young people's vulnerability when their privacy is compromised.

CONCLUSION

Adolescents and young adults perceived youth clinics as being youth-friendly. Key conditions for youth friendliness were safety, respect, a holistic and empowering approach, accessibility, and privacy. Youth-friendly opening hours and outreach to specifically target groups with access barriers are needed. Young people should be involved in the development of equitable youth-friendly health services.

How does interprofessional education influence students' perceptions of collaboration in the clinical setting? A qualitative study

BACKGROUND

Interprofessional education (IPE) aims to improve students' collaborative competencies and behaviour. The effect of classroom IPE on students' perceptions of collaboration in clinical practice, and how knowledge is possibly transferred, has yet to be investigated. The research question of this study was: How does IPE in a classroom setting influence students' perceptions of collaboration in clinical practice? Social capital theory is used as the theoretical lens. Social capital theory describes how social relationships generate benefits for the individuals involved. Social capital can be divided into three forms of social cohesion: bonding, bridging and linking social capital. Bonding refers to connections that are close and strong, such as family. Bridging social capital occurs in more distant relationships. Linking social capital refers to relationships between individuals with different power or social status.

METHODS

A qualitative study with semi-structured face-to-face interviews was conducted to explore students' perceptions and experiences. Nursing and medical students who had participated in four classroom IPE-sessions were asked about the perceived influence of the IPE-sessions they had attended on their interprofessional collaboration. Thematic analysis was conducted, with sensitising concepts of 'bonding', 'bridging' and 'linking social capital' from the social capital theory.

RESULTS

Twenty-two interviews were conducted. Students experienced: 1) exchange of discipline specific knowledge, 2) general knowledge about each other's responsibilities, 3) reduction of hierarchy, and 4) improvement in patient care. The first two themes reflect bridging social capital, since students experience that the other student is from a different group. The third theme reflects linking social capital, since students experience a difference in (social) status. The fourth theme most explicitly reflects 'getting ahead' or doing better, what is referred to as an effect of increased social capital.

CONCLUSION

This study reveals new insights regarding how increased social capital of undergraduate students after IPE-sessions in a classroom setting influences the way they conceptualise and experience interprofessional collaboration in clinical practice. These insights contribute to the understanding of the effectiveness of IPE in undergraduate curricula. Further research on long-term effects is underway.

Self-stigma Among Children Living with Atopic Dermatitis in Hong Kong: a Qualitative Study

BACKGROUND

Stigma has been recently identified as a crucial factor associated with the psychosocial burden of those who have chronic skin diseases. The self-stigma experiences of children living with atopic dermatitis (AD) have yet to be fully investigated, and questions of how these children respond to public stigma and how AD symptoms further affect their self-stigma experiences remain unresolved. The current qualitative study aimed to (1) describe the main manifestations of self-stigma in children living with AD; (2) investigate factors that might influence their self-stigma experiences; and (3) explore the potential mechanisms underlying the impacts of AD on their psychosocial well-being from the self-stigma perspective.

METHODS

We performed a secondary analysis of the qualitative literal transcription data which were collected earlier by using the participatory, drawing-based qualitative interviews with 17 children aged 8-12 who were diagnosed with severe or moderate AD.

RESULTS

The qualitative findings indicated that the visible and invisible symptoms of AD and its management exerted unique influences on self-stigma in children living with AD, which manifested in cognitive, affective, and behavioral aspects and ultimately affected their psychosocial well-being.

CONCLUSIONS

Findings of this study allowed us to advocate for eliminating public stigma of people with skin diseases and propose recommendations for helping children living with AD relieve their self-stigma.

To see, meet and adapt - an interview study about physiotherapists' pedagogical approach to dementia

Background

Physiotherapists need to use pedagogical approaches and strategies in their work. However, there is no previous definition of what a pedagogical approach in physiotherapy means neither in general nor specifically to dementia. The purpose of this study was therefore to gain greater insight into physiotherapists’ pedagogical approach to dementia by investigating physiotherapists’ views and working methods in contact with older people with dementia, relatives, and nursing staff in elderly care.

Methods

This was a qualitative study with an inductive approach. Semi-structured individual interviews were conducted with 15 physiotherapists with experience of working with older people with dementia in elderly care. The interviews were analyzed with qualitative content analysis.

Results

The term “pedagogical approach” could sometimes be experienced as “vague” or “hard to grasp”. Our research nonetheless identified one overarching theme To see, meet and adapt which is based on insights from the interviews grouped in to five categories. This theme can be seen as an expression of the physiotherapists’ pedagogical approach in contact with older people with dementia, relatives, and nursing staff. It captures the participants’ desire to always see the person in front of them, meet them where they are and adapt their own way of working accordingly. Creating a trusting relationship was described as important and made it easier for the participants to adapt their working methods. The participants’ adaptations could apply to the way they communicated with people with dementia, and how they organized tutoring/education of relatives and nursing staff to maximize learning. Learning through experience and reflection was described as a key to advancing the pedagogical approach and the participants experienced their own learning as constantly ongoing.

Conclusions

This study provides increased understanding into physiotherapists’ pedagogical approach in contact with older people with dementia, relatives, and nursing staff in elderly care and shows that learning through experience and reflection can contribute to the development of the pedagogical approach. Thus, opportunity for reflection should be accommodated in the physiotherapists’ work. The importance of more pedagogical education for physiotherapists both in bachelor and master level were also highlighted. Increasing mobility and physical activity in older people with dementia is important since physical inactivity and sedentary behavior is common. Future research may be directed at further exploring physiotherapists’ pedagogical approach in tutoring/education of nursing staff, with the aim of increasing physical activity among older people with dementia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02697-7.

Understanding quality of life across different clinical subtypes of multiple sclerosis: a thematic analysis

PURPOSE

Multiple sclerosis (MS) is a neurological disease that has different clinical presentations and illness trajectories. The aim of this study was to explore factors that are important for quality of life (QoL) of people with MS (pwMS), and to understand how they may differ across three subtypes.

METHODS

Both convenience and purposive sampling were employed. Semi-structured interviews were conducted with people with relapsing-remitting MS (n = 16), secondary progressive MS (n = 14), and primary progressive MS (n = 13). All interviews were audio recorded and then transcribed verbatim for thematic analysis involving both inductive and deductive processes. A separate analysis for each subtype was made during the inductive process before examining for similarities and differences across the three subtypes in the deductive process.

FINDINGS

Four factors were identified to have an important influence on QoL of pwMS: restricted and disrupted enjoyment, disturbed future, challenged sense of self, and well-being of significant others. The themes reflect how pwMS commonly perceived enjoyment as a purpose of life, while also illustrating how their QoL may be questioned because of new perspectives going forward with MS, challenges to their sense of self, and increased concerns for their significant others as a result of MS. Subtype differences were attributed to different illness trajectories: relapsing or progressive.

CONCLUSIONS

There are subtype differences in the negative impact of MS on QoL. Clinicians are encouraged to understand the challenges of different illness trajectories, in particular the traumatic nature of relapses and steady worsening of symptoms among those with progressive subtypes of MS.

The German Organ Transplant Scandal - Unwritten rules of organizational wrongdoings

Using data from organ transplant medicine in Germany, we propose a method for understanding the content of unwritten rules supportive of violations of written rules in light of the "German Organ Transplant Scandal". Grounded in the sociology of organizational crime, we reconstruct the cultural repertoires of medical professionals working with organ allocation when confronted with the applicable guidelines using collective mindset analysis. Four dimensions of cognitive and normative rules of interpretation were identified and discussed as a an occupational-professional form of deviance. Apart from not relying on data from the alleged perpetrators and still gazing at the latent structures of meaning behind misconduct, our approach offers a more general methodological framework for empirical studies of the unwritten rules at work in an organizational field where wrongdoing has been reported.

Embracing challenging complexity: exploring handwashing behavior from a combined socioecological and intersectional perspective in Sierra Leone

Background

Handwashing with soap is a cost-effective, efficient health behavior to prevent various diseases. Despite its immense health benefits, the lowest prevalence of handwashing is found in low-income countries. Here, its practice is not only determined by individual behavior, but also heavily shaped by deprivations in the social and structural ecology. Moreover, handwashing barriers are not equally experienced as overlapping social identities (e.g., age and gender) intersect and create inequities between members of different social groups. To embrace the complexities of handwashing beyond individual-level behavior and singular social identities, a combined socioecological and intersectional perspective is employed. This multi-level approach with regards to intersecting privileges and disadvantages serves as a basis to promote this highly important health behavior.

Methods

This study used a qualitative, theory-based approach and combined data from two samples: experts in health promotion (n = 22) and local citizens stratified by gender and rural/urban location (n = 56). Data was collected in face-to-face interviews in Sierra Leone between November 2018 and January 2019 and analyzed using thematic analysis and typology of the qualitative data.

Results

The conceptualization of multi-level determinants of handwashing within a socioecological model showed the high relevance of inhibiting social and structural factors for handwashing practice. By establishing seven distinguishing social identity dimensions, data demonstrates that individuals within the same social setting yet with distinct social identities experience strikingly differing degrees of power and privileges to enact handwashing. While a local leader is influential and may also change structural-level determinants, a young, rural wife experiences multiple social and structural constraints to perform handwashing with soap, even if she has high handwashing intentions.

Conclusion

This study provides a holistic analytical framework for the identification of determinants on multiple levels and accumulating intersections of socially produced inequalities for handwashing and is applicable to other health topics. As the exploration of handwashing was approached from a solution-focused instead of a problem-focused perspective, the analysis can guide multi-level intervention approaches (e.g., using low-cost, participatory activities at the community level to make use of the available social capital).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11923-1.

The Experience of Child Neuropsychiatry Residents who Volunteered in Italian COVID-19-Designated Hospitals

OBJECTIVE

During the first months of 2020, the coronavirus disease of 2019 (COVID-19) spread rapidly and soon reached a pandemic level. With the increasing number of hospitalizations, medical and nursing personnel resources were soon inadequate. As a consequence, medical volunteers became a key human resource and young medical residents in any specialty were hired on a voluntary basis to contribute to take care of patients with COVID-19. This study reports on the lived experience of residents in child neuropsychiatry who volunteered in Italian hotspot COVID-19-designated hospitals during the epidemic outbreak.

METHODS

A phenomenological, qualitative approach using semi-structured interviews with open-ended questions was used to obtain in-depth narratives of the experience of residents in child neuropsychiatry volunteering in North Italy COVID-19-designated hospitals. All residents (n = 8) participated in the study. Interviews were conducted by an expert researcher trained in qualitative methods. Data analysis was performed by independent coders.

RESULTS

Five core themes could be identified from the interviews: acting as mediators on two fronts, facing the shock of COVID-19 reality, capitalizing from specialty education, growing as persons and professionals, and humanizing medical care.

CONCLUSIONS

This study is unique in providing an in-depth understanding of the experience of young residents in child neuropsychiatry volunteering in general hospitals during the COVID-19 pandemic in Northern Italy. The findings suggest that this experience may be highly beneficial for both the residents and the hospital quality of care. Insights for an accurate planning of residents' engagement in future healthcare emergencies are provided.

Does volunteering change attitudes towards people with disabilities? A qualitative study of the experience of orthodox Jewish nursing students

BACKGROUND

People with disabilities identify negative staff attitudes and behaviors as barriers to accessing health services. Studies show that nursing education activities specific to people with disabilities improves nursing care. This study explores the experience of orthodox Jewish nursing students volunteering with people with disabilities, how their attitudes towards this population changed.

DESIGN

A qualitative design was used. This research is part of an extensive ongoing study of orthodox and ultra-orthodox (Haredi) students volunteering with people with disabilities.

METHODS

Data from 13 semi-structured interviews, conducted between July and September 2017, with 14 male students (two students chose to be interviewed together) and four people with disabilities were analyzed using thematic analysis.

RESULTS

Volunteering enhanced students' awareness of the needs of people with disabilities, changed their attitude towards this population and enhanced their confidence as nurses. The individuals with disabilities valued the help they received as well as the opportunity to change the students' prior notions and stigmas regarding disability.

CONCLUSIONS

Projects such as ours could improve the attitude of nursing staff towards individuals with disabilities and improve nursing care. We recommend involving people with disabilities in designing such projects.

Structural and functional analysis of cases of family treatment treated in the public social services system

The purpose of this work has been to analyze, from a structural and functional approach, the families at risk or unprotected by the Family Treatment Teams, inserted in the Public System of Social Services. For this purpose, qualitative research methods and techniques have been used on 26 interdisciplinary reports generated in the most representative cases of family intervention. Significant results have been obtained describing family structures, life-cycle adaptation, pattern repetition across generations, life events and family functioning, and linked patterns. The data reveal that these are families with common problems related mainly to the behaviour of minors and the coverage of basic needs. Negligence is the central element in this type of families as well as the maladjustment to the life cycle of the family system. All this from patterns of repetition linking dysfunctional.

Staffing the unit with nurses: the role of nurse managers

PURPOSE

To explore the staffing practices of nurse managers at the unit.

DESIGN/METHODOLOGY/APPROACH

Introduction: Ensuring that units are staffed with adequate nurses to render quality nursing care to clients has become increasingly challenging for most hospitals. There is growing evidence linking best patient outcomes and fewer adverse events to the presence of nurses at the bedside. Hospitals require to attract and retain nurses in the units to address the issues of quality, staff and patient safety. Methods: The study used a descriptive phenomenological design to purposively select 15 nurse managers (NMs) and 47 nurses for in-depth interviews and focus group discussions respectively.

FINDINGS

The study found that the demand for nurses to work in the unit was not scientific. Nurses affirmed their frustration of inadequate numbers of staff in the unit especially, at the periphery hospitals. Time can be used as a source of motivation for nurses and nurses should be involved in the development of the duty roster to enable effective compliance. Compensation for additional duties is relevant in nursing.

RESEARCH LIMITATIONS/IMPLICATIONS

The research was carried only in one region in Ghana, and the findings may not be the same in the other regions.

PRACTICAL IMPLICATIONS

Inadequate staffing level has serious implications on patient safety, quality of care and staff outcomes. This situation necessitates the implementation of health sector staffing norms to ensure the right calibre of mix staff are recruited and retained.

ORIGINALITY/VALUE

This study is the first in Ghana that we aware of that explore staffing practices at the unit that identifies factors that impact staff schedules for effective care.

'Life with a device': the octogenarians' experiences with an implantable cardioverter-defibrillator-a qualitative study

AIMS

Implantable cardioverter-defibrillator (ICD) treatment has expanded due to its effectiveness. However, there are concerns about complications, and use in the most elderly has been questioned. There is scarce data on qualitative aspects regarding experiences of living with an ICD among patients above the age of 80 years. The aim of this study was to explore octogenarians' experience, knowledge, and attitude of living with an ICD.

METHOD AND RESULTS

We used semi-structured interviews to collect data from 20 patients, aged 80-89 years (90% men). The data were then structured and analysed through deductive thematic analysis network approach using the ATLAS.ti v.8.4 software. The framework of the analysis was based on the Successful Aging Theory. Three main themes emerged regarding the patients' experiences: Life goes on; Their Health, The Janus-Faced Device; Their attitudes, and Mind the gap; Their knowledge. None of the octogenarians regretted receiving their ICD, instead, they presented with feelings such as gratitude towards the device. However, a lack of knowledge about the devices was expressed, which can be a risk for potential complications, in turn causing suffering and unnecessary concerns.

CONCLUSION

Overall, the ICD did not pose a threat towards successful ageing. It was mainly considered a life-saving device. However, the lack of knowledge might hinder informed choices close to death and contribute to ethical dilemmas when deactivation of the ICD is a reasonable option.

Experiences with the routine use of the Edinburgh Postnatal Depression Scale from health visitors' and midwives' perspectives - An exploratory qualitative study

BACKGROUND

The Edinburgh Postnatal Depression Scale has been practiced as a routine screening for postnatal depression at a municipal health care centre for more than ten years.

OBJECTIVES

The aim of this study was to examine how health visitors and midwives perceive and practice this routine screening.

STUDY DESIGN

We chose an exploratory qualitative approach, with analysis of data from focus group interviews.

METHODS

Ten health visitors and two midwives participated in two focus group interviews by sharing their thoughts and reflections. The analysis was performed in collaboration with all authors according to thematic network analysis.

FINDINGS

The Edinburgh Postnatal Depression Scale is well accepted as a screening tool. In addition to giving health visitors and midwives information about mothers who need special attention concerning mental health challenges, the Edinburgh Postnatal Depression Scale is a tool for talking about problems related to early motherhood. A trusting relationship is a prerequisite for these conversations. The health visitors seldom use the word 'depression' in contact with the individual mother. They sometimes lose opportunities to identify mothers in need of help because of a tight time schedule and social and cultural factors. Collaboration on a daily basis with colleagues and family therapists, and monthly guidance from mental health professionals are necessary to secure professional quality and confidence.

CONCLUSION

The Edinburgh Postnatal Depression Scale is a useful screening tool, but there are social and cultural challenges, and the available time during screening consultations is often too short. Collaboration with and guidance from other professionals are necessary.

Utilizing asynchronous email interviews for health research: overview of benefits and drawbacks

Objective

Through collating observations from various studies and complementing these findings with one author’s study, a detailed overview of the benefits and drawbacks of asynchronous email interviewing is provided. Through this overview, it is evident there is great potential for asynchronous email interviews in the broad field of health, particularly for studies drawing on expertise from participants in academia or professional settings, those across varied geographical settings (i.e. potential for global public health research), and/or in circumstances when face-to-face interactions are not possible (e.g. COVID-19).

Results

Benefits of asynchronous email interviewing and additional considerations for researchers are discussed around: (i) access transcending geographic location and during restricted face-to-face communications; (ii) feasibility and cost; (iii) sampling and inclusion of diverse participants; (iv) facilitating snowball sampling and increased transparency; (v) data collection with working professionals; (vi) anonymity; (vii) verification of participants; (viii) data quality and enhanced data accuracy; and (ix) overcoming language barriers. Similarly, potential drawbacks of asynchronous email interviews are also discussed with suggested remedies, which centre around: (i) time; (ii) participant verification and confidentiality; (iii) technology and sampling concerns; (iv) data quality and availability; and (v) need for enhanced clarity and precision.

Providing safe maternity care under challenging conditions in rural Ethiopia: a qualitative study

Background

Women’s health and the reduction in the global maternal mortality rate is a research priority worldwide. The aim of this study was to investigate the structural conditions that influence the maternity care provided for women in rural Ethiopia.

Methods

A qualitative descriptive study was conducted, composed of 28 individual in-depth interviews with midwives and women who had given birth during the past 8 months, and observations of maternity care at health centres and a primary hospital. A thematic analysis was conducted.

Results

The midwives do their utmost to save the lives of mothers and prioritise saving lives over providing compassionate care. Inadequate resources, such as equipment, medicine and water, affect the quality of care they provide for the birthing women. This creates a conflict between the midwives’ ideals and what conditions allow them to do. Families and the women’s network play important roles in providing care and support to the women who give birth in health facilities.

Conclusions

Structural conditions make it difficult for Ethiopian midwives in rural areas to provide optimal maternity care. In addition to the availability of professional midwifery care, the expectant mothers’ families and networks also tend to provide important support and care. Further studies on how to improve the quality of maternity care from the women’s perspective are needed.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06324-4.

Daily life one year after corrective osteotomy for malunion of a distal radius fracture an interview study

The aim of this study was to explore the everyday life experiences of people one year after corrective osteotomy following a symptomatic, malunited, distal radius fracture.Semi-structured interviews were conducted with twenty respondents, median age 65 (22-81) years. The respondents were recruited consecutively. The interviews were subjected to qualitative content analysis. Three authors took part in the analysis.The result is presented as one theme, 'Daily life works again' with five categories: Relief of inconveniences and symptoms, Managing new symptoms and complications, Regaining abilities, Normalised social relationships, Increased wellbeing. The symptoms had declined in severity, some participants regarded themselves as fully restored and used their hand again without hesitation. Others were still bothered by their wrist occasionally and a few had to manage complications. The participants had regained the ability to perform many everyday life activities and reported increased independence and less irritation between spouses, as well as increased wellbeing.One year after a corrective osteotomy following malunion of a distal radius fracture, the patients' experiences represent a continuum. Some are still restricted by their wrist occasionally, the majority experience an increased ease in their performance of activities of daily life and some regard themselves as fully restored. The recovery has a positive impact on social relationships and the patients' wellbeing.

Contextualizing barriers to long-acting reversible contraception in Delaware

OBJECTIVE

We conducted this study to examine barriers to long-acting reversible contraception (LARC) that persist in the context of a large-scale LARC program, Delaware Contraceptive Access Now (Del-CAN), that has actively endeavored to remove such barriers.

STUDY DESIGN

In 2016-2017, we conducted in-depth interviews with 86 self-identified women of reproductive age, diverse along the lines of age, race, and class, in the state of Delaware on their attitudes, beliefs, and behaviors regarding contraception. We analyzed the interviews using an inductive coding process.

RESULTS

We found that, even in the midst of Del-CAN's efforts, meso and macro-level contexts, including provider-patient communication and clinic/practice structures, reinforced LARC barriers related to knowledge, access, and side effects.

CONCLUSIONS

The multi-level contexts and nuances we illuminate in our study currently fall outside the purview of well-intentioned, large-scale initiatives such as Del-CAN, that attempt to address and ameliorate oft-researched barriers. Thus, these barriers persist within provider-patient interactions and clinic/practice policies and structures.

IMPLICATIONS

The evaluated LARC-based intervention, Del-CAN, cannot fully address issues around provider autonomy, inadequate provider-patient communication, or practice-specific policies and criteria. In order for this intervention, and others like it, to be successful, they must be aware of and prepared to address such dimensions in their efforts.

What information did pregnant women want related to risks and benefits attending X-ray examinations?

BACKGROUND

In connection with X-ray examinations of pregnant patients, good communication of benefit and risk is important to provide adequate patient care. Pregnant women often become concerned about the foetus and are unsure of the risk of malformations and the development of cancer. Health professionals who are involved in imaging pregnant women require specif knowledge about risks and benefits so they can convey information without creating unnecessary fear.

PURPOSE

This study identifies the information needs of pregnant women in connection with X-ray examinations and how they prefer to have the information communicated.

METHOD

A qualitative study using semi-structured interviews of seven pregnant women aged 28-36 in weeks 16-33 of their pregnancy. The interviews were analysed using interpretive phenomenological analysis.

RESULTS

The participants had expectations regarding the information provided about X-ray examinations during pregnancy. They needed concrete information on radiation doses, risks and any effects on the foetus. The risk was thought to be low, but several of the participants would still have been concerned when undergoing an X-ray examination.

CONCLUSION

To provide adequate care of pregnant women in connection with X-ray examinations, healthcare professionals must have knowledge of pregnancy and radiation and have expertise in risk communication. This will prevent unnecessary concern in the pregnant woman, ensure that justified necessary examinations are carried out, and avoid adverse decisions such as termination of pregnancy based on erroneous grounds.

"Context, content, and system" supporting digital health hub (DHH)-enabled models of care (MoCs) for fragility hip fractures: perspectives of diverse multidisciplinary stakeholders in South Australia from qualitative in-depth interviews

Combining thematic analysis and a human-computer persuasive systems framework suggests that hip fracture recovery among older people can be enhanced through person-centered digital health hub models of care focused on behavior change education and integrated care. The findings intend to guide settings involving comorbid conditions and low- and middle-income countries in developing innovative digital health solutions.

PURPOSE

The purpose of this study was to understand stakeholders' perspectives on the development of a digital health-enabled model of care for fragility hip fractures and to map out factors that could influence the design and implementation of such a model.

METHODS

Qualitative in-depth interviews were conducted with stakeholders from various clinical disciplines, allied health, and computer science. A hybrid process involving thematic analysis of the raw data using inductive coding was the first step. In the second step, the tenets of a theoretical framework (health behavior change supporting systems) were deductively applied to the thematic constructs generated as part of the first step of the analysis.

RESULTS

In total, 24 in-depth interviews were conducted with stakeholders. We identified 18 thematic constructs presented under the categories of context, content, and system. Context covered patient characteristics such as frailty, digital literacy, and patient or carer participation, whereas healthcare delivery aspects included the structure and culture of existing practice and the need for innovative holistic models of care. Content outlines the active ingredients and approach in developing a digital health hub, and it highlights the importance of targeted education and behavior change. The system is a complicated matrix crossing different aspects of healthcare and offering a value proposition design through personalization across modes of content delivery. This must foster trust, ensure adequate financing, and support ownership and privacy by establishing appropriate mechanisms for embedding change.

CONCLUSION

The findings from this study provide insights around potential factors related to patients, community support, and healthcare delivery influencing the design and next-stage implementation of a digital health hub model of care for fragility hip fractures.

Ways of understanding cognitive impairment in cardiac arrest survivors: A phenomenographic study

AIM

To describe the variation in ways that registered nurses perceive and understand cognitive impairment in cardiac arrest survivors.

DESIGN

A qualitative, inductive design with individual semi-structured interviews was applied. Data was analysed using a phenomenographic approach.

SETTING

The participants were nineteen Swedish registered nurses, experienced in cardiovascular care and providing follow-up care.

FINDINGS

The nurses perceived the cognitive impairment of the survivors in qualitatively different ways, as illustrated in two categories: 'The perceptible and obvious' and 'The elusive and challenging'. The nurses perceived a variety of signs of cognitive impairment, emotional expressions related to these, and recovery from cognitive impairment. They perceived confidence in capturing cognitive function when they understood the signs of cognitive impairment as severe and obvious. However, it was perceived as difficult to assess cognitive function when impairments were subtle, resulting in uncertainty in terms of how to make assessments. Nurses made use of their own strategies for assessments, which were sometimes found to be inadequate when they understood that they had misinterpreted the survivors' cognitive impairment.

CONCLUSION

Nurses feel uncertainty regarding detecting mild impairment in cardiac arrest survivors. By involving next of kin, nurses will gain a broader understanding of survivors' cognitive function.

Perceptions of the social and physical environment of adolescents' dietary behaviour in neighbourhoods of different socioeconomic position

A higher proportion of adolescents from families in a lower socioeconomic position (SEP) tends to have more unhealthy dietary behaviours, and overweight and obesity, than their counterparts in higher SEPs. More research is needed to understand the causes of these differences, in particular the influence of the neighbourhood environment, which has been explored less. The presented qualitative study explores how adolescents and their parents from higher and lower SEP neighbourhoods perceive the social and physical environment influencing adolescents' dietary behaviours. We conducted 6 semi-structured focus groups with 35 13-14 year olds and 8 interviews with some of their parents. The interviewees were recruited from one higher and two lower SEP neighbourhoods in Oslo, Norway. Theme-based inductive coding was used for analysis, and the results discussed in light of an ecological framework. The results indicate that all the adolescents experience several barriers to healthy dietary behaviours. For adolescents in the lower SEP neighbourhood, one or both parents desired their cultural cuisine served at home, whereas the adolescents wanted and often consumed western dishes. Fast-food restaurants or hanging out at the mall was perceived as the preferred social arena, often due to lack of involvement in either leisure-time physical activities or youth clubs as a safe, engaging option. The adolescents in the higher SEP neighbourhood perceived social norms which accentuated healthy dietary choices. When more possibilities for activities were present and the adolescents expressed being highly engaged in leisure-time physical activity, this also seemed to facilitate healthier dietary behaviours. These findings indicate how several factors simultaneously can influence dietary behaviour. Use of a multi-layered approach when exploring the environmental influences could increase knowledge about tackling social inequalities in dietary behaviours among adolescents.

Exploring how the urban neighborhood environment influences mental well-being using walking interviews

Mental well-being in cities is being challenged worldwide and a more detailed understanding of how urban environments influence mental well-being is needed. This qualitative study explores neighborhood factors and their interactions in relation to mental well-being. Individual semi-structured walking interviews were conducted with 28 adults living in the Brussels-Capital Region. This paper provides a detailed description of physical neighborhood factors (green-blue spaces, services, design and maintenance, traffic, cellphone towers) and social neighborhood factors (neighbor ties, neighbor diversity, social security) that link to mental well-being. A socio-ecological framework is presented to explain interactions among those neighborhood factors, and personal and institutional factors, in relation to mental well-being. The findings are linked to existing concepts and theories to better understand the mechanisms underlying the associations between the urban neighborhood environment and mental well-being. Finally, implications of the walking interview method are discussed.

Selection of New Psychiatry Residents Within a National Program: a Qualitative Study of Faculty Perspectives on Competencies and Attributes

OBJECTIVE

Admission committees use multiple sources of information to select residents. However, the way in which faculty members use each data source remains unclear and highly context-specific. The present study seeks to understand how faculty members use various sources of information about candidates to make admission decisions to a National Psychiatry Residency Program.

METHODS

The theory of core competencies was used as a foundation for this qualitative study. Framework analysis was used to structure the project and data presentation. Twenty key informants from the faculty were purposefully sampled in accordance with the initial theory. Open-ended semi-structured interviews were conducted to obtain their views about the essential competencies of psychiatrists and the ways in which these competencies could be reliably gauged.

RESULTS

Participants described numerous competencies that they believed were essential to becoming competent psychiatrists. These competencies fell within the six core competencies of the Accreditation Council for Graduate Medical Education framework. However, several non-competency attributes (such as perseverance, empathy, and compassion) were also relevant in the selection process. To reduce the impact of self-presentation bias, to which these attributes were vulnerable, the faculty relied heavily on sources of information obtained from third parties, such as feedback from co-workers with first-hand experience of the candidate during their clinical placements.

CONCLUSION

Faculty members place importance on informal informant-derived information about a candidate's non-competency attributes in addition to core competencies when deciding whether or not to select a candidate for admission into a residency training program.

Insights from healthcare academics on facilitating interprofessional education activities

Facilitators are of paramount importance to the success of interprofessional education (IPE) activities; hence, it is crucial to explore their perspectives and experiences in delivering IPE in Qatar. Using an exploratory case study approach, semi-structured interviews were conducted, in 2018, among faculty members, who had facilitated at least one IPE activity in Qatar, from healthcare professional education programs at Qatar University Colleges of Pharmacy, Medicine, and Health Sciences, Weill Cornell Medicine in Qatar, the University of Calgary in Qatar, and the College of North Atlantic. Interviews were recorded and transcribed verbatim. Inductive thematic content analysis was implemented. Twenty-one interviews were conducted with the following professions represented: medicine (n = 6), pharmacy (n = 5), nursing (n = 4), biomedical science (n = 3), respiratory theory (n = 2) and public health (n = 1). Four main themes emerged from the interviews: drivers to facilitator involvement that included interest and commitment to IPE and awareness of collaborative practice benefits; facilitator participation which was based on facilitator attributes and preparedness and readiness for IPE facilitation; the organizational support in terms of dedicated structure for IPE and IPE design and delivery and; student participation in terms of group dynamics and student engagement. Some key recommendations include having a dedicated unit for IPE, scheduling protected time for IPE, and organizing facilitators' training and debriefing workshops. The facilitators valued and appreciated IPE in preparing students for future collaborative practice. These findings can inform the development of quality and sustainable IPE activities in the future.

Epidurals during normal labour and birth - Midwives' attitudes and experiences

BACKGROUND

Midwives have their own beliefs and values regarding pain during childbirth. Their preferences concerning labour pain management may influence women's choices.

AIM

To gain a deeper understanding of midwives' attitudes and experiences regarding the use of an epidural during normal labour.

METHODS

A qualitative approach was chosen for data collection. Ten in-depth interviews were conducted with midwives working in three different obstetric units in Norway. The transcribed interviews were analysed using Malterud's systematic text condensation.

FINDINGS

The analysis provided two main themes: "Normal childbirth as the goal" and "Challenges to the practice, knowledge, philosophy and experience of midwives". Distinctive differences in experiences and attitudes were found. The workplace culture in the obstetric units affected the midwives' attitudes and their midwifery practice. How they attended to women with epidural also differed. An epidural was often used as a substitute for continuous support when the obstetric unit was busy.

DISCUSSION

Midwives estimate labour pain differently, and this might impact the midwifery care. However, midwives' interests and preferences concerning labour pain management should not influence women's choices. Midwives are affected by the setting where they work, and research highlights that an epidural might lead to a focus on medical procedures instead of the normality of labour.

CONCLUSION

Midwives should be aware of how powerful their position is and how the workplace culture might influence their attitudes. The focus should be on "working with" women to promote a normal birth process, even with an epidural.

Designing and psychometric of reproductive health related behaviors assessment tool in Iranian males: an exploratory mixed method study protocol

BACKGROUND

Male reproductive health is a relatively new concept, and most men are neglected in reproductive health discussions. Therefore, it appears that there is insufficient information about the male reproductive health. This study aims to design a psychometric instrument for assessing the male reproductive health-related behavior.

METHODS/DESIGN

This is a sequential exploratory mixed-method study with a classical instrument development design. It will be conducted in two qualitative and quantitative phases on the studied units including the men living in Tehran. In the first phase, a qualitative study of a contractual content analysis approach will be conducted in order to perceive the concept of male reproductive health-related behavior, determine the dimensions of the questionnaire, and explore the items. In the second phase, a quantitative study will be carried out to evaluate the psychometric properties as well as (form, content, and construct) validity and reliability of the instrument designed in the first phase. Finally, the instrument will be scored and interpreted.

DISCUSSION

Discovering men's perception of concept of reproductive health-related behavior can help design a valid and reliable questionnaire which can be used in studies evaluating the male reproductive health-related behavior.

ETHICAL CODE

IR.TUMS.FNM.REC.1397.157.

Vulnerability in health and social capital: a qualitative analysis by levels of marginalization in Mexico

Background

Social capital is employed as an asset when there is a lack of an efficient health-care system. However, this relationship is not homogeneous and can differ according to the characteristics of individuals and their context. In this paper, we aim to analyze the role of social capital in the solution of healthcare problems among individuals with different levels of marginalization and unequal access to health services.

Methods

This qualitative study examines the role of social capital in the demand for healthcare among Mexican individuals with different levels of marginalization. The research draws data from semi-structured interviews (N = 247) that were collected in four Mexican states with different social welfare benefits: Mexico City, Tamaulipas, the State of Mexico, and Oaxaca. The interviewees were selected using the snowball method and other eligibility criteria such as education, age, and gender.

Results

Findings suggest that social capital is a relevant factor in solving healthcare problems, depending on the level of marginalization. The role of social capital can be explained by the precariousness of medical service delivery, the poor health infrastructure, and the difficult access to health care in Mexico. Networks are the main resource to deal with health related issues, food, medicine, and out-of-the-pocket medical expenses in contexts of high levels of marginalization. In the middle level of marginalization, networks also help in raising funds for more-specialized medical services and higher quality hospitals. In the least-marginalized levels, social capital is used as companionship for sick individuals, while support networks act as emotional relief. At this level, most individuals have private health insurance, and many of them have major medical healthcare coverage.

Conclusions

Participants reported low levels of trust in the health care system because of the poor infrastructure and quality of medical service delivery. Although the main criticism is focused on public healthcare institutions, there is a lack of trust in private medical services as well. These facts are related to the access and quality of medical service delivery and turn social capital into a significant asset. Despite that social bonds or links are valuable resources that individuals can use to solve healthcare related issues, the use of social capital is not homogenous. Indeed, it can be influenced by several factors that were represented in this study through the municipal marginalization index.

"We went as a team closer to the truth": impacts of interprofessional education on trauma- and violence- informed care for staff in primary care settings

Building on trauma-informed care (TIC), Trauma and Violence-Informed Care (TVIC) aims to minimize re-traumatization for people who have previously experienced violence, support people currently experiencing violence and draw attention to structural violence. Previous research has not explored how health care providers understand TVIC nor studied either TIC or TVIC in primary health care (PHC). This analysis of the perspectives of fourteen PHC staff regarding the impacts of interprofessional TVIC education sessions was conducted as part of a larger study of an intervention to promote equity in PHC. Researchers drew on general clinic observations and observations of TVIC training sessions and analyzed in-depth interviews with PHC staff who took part in TVIC training, using an interpretive description approach. While the impacts varied, all participants described enhancements in their knowledge, awareness and/or confidence in providing care related to trauma and violence. Factors intrinsic to the process of educating staff, including providing staff with data on trauma and violence in the patient population, and supporting interprofessional discussions, influenced how participants understood, integrated, and prioritized TVIC. Importantly, structural, organizational, and personal contexts significantly influenced how participants enacted TVIC in practice. This study contributes knowledge about interprofessional TVIC education and how diverse professionals understand and enact TVIC concepts in PHC, pointing to the role of TVIC in challenging the biomedical paradigm in PHC and the difficulties of using a structural lens in clinical practice.

Adult patients' experiences of symptom management during pulmonary exacerbations in cystic fibrosis: A thematic synthesis of qualitative research

Objective

The aim of this review was to describe how patients experience an exacerbation of cystic fibrosis in terms of symptom management.

Methods

A systematic literature search was performed in MEDLINE, CINAHL, EMBASE, PSYCINFO and ASSIA. Studies were included that contained any direct quotes or summaries of quotes from patients with cystic fibrosis aged 16 or older and were related to symptom experience and management during an exacerbation. Framework analysis, guided by Symptom Management Theory, was used to present the findings.

Results

The review included 18 qualitative studies. In addition to physiological symptoms, patients highlighted the significant role of psychological symptoms. Delayed help-seeking was a common first response. Participants choose their self-management strategies taking both physiological and psychological symptoms into account. Maintaining normality was an important short-term outcome for patients, leading to conflict with health professionals. Patients’ symptom management during exacerbation was greatly influenced by the structure of cystic fibrosis care.

Discussion

Our findings provide an initial understanding of factors influencing patient self-management during an exacerbation. The transferal of these findings into clinical practice will provide a basis for shared goal setting and intervention planning. In addition, our findings have implications for future development of patient-reported outcome measures and intervention research.

Traffic police officers' experience of post-crash care to road traffic injury victims: a qualitative study in Tanzania"

BACKGROUND

Recently, road traffic injuries (RTIs) have become a major health problem affecting health systems in many low- and middle-income countries. Regardless of whether an ambulance is available for evacuation, police officers have been shown to arrive at the crash scene first, becoming, in effect, the first responders to RTI victims. Therefore, the study aimed to explore the experiences of traffic police officers in regard to the provision of care to RTI victims in the prehospital environment, including the role of traffic police upon arriving at the crash scene, the challenges they face, and their opinions about how to improve care to RTI victims.

METHOD

The study used a qualitative approach in which data were obtained from 10 individual interviews and three focus group discussions. There were 41 participants, 27 of them were male and 14 were female. About half (48.7%) of the study participants were aged between 30 to 39 years. Qualitative content analysis was used to analyse all the materials.

RESULTS

Three themes emerged from the analysis. The theme "Maintain safety while saving injured victims' lives and facilitating access to a health facility" was comprised of safety, sorting, initial help, and assisting access to hospital care. "Overwhelmed working with limited resources and support" included limited care and transport resources, police fatigue, and little or no support. "Improving supportive system and empowering frontline personnel" included the need for an emergency care system, availability of resources and an emergency medical support system, and training for police and drivers regarding victims' first-aid care, and road safety.

CONCLUSION

The study findings characterize an environment in which the police first responders have no knowledge or skills and no equipment and supplies to provide care to RTI victims at the scene before rushing them to definitive care. The results suggest a favorable climate for training and equipping officers so that they can deliver competent postcrash care at the scene while emergency medical services are yet to be established. However, more research will be needed to determine the efficacy of such training and its acceptability in the Tanzanian context.