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Pignedoli C, Rivest P. The gender of PrEP: Transgender men negotiating legitimacy in France. Soc Sci Med 2024; 348:116842. [PMID: 38593613 DOI: 10.1016/j.socscimed.2024.116842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/05/2024] [Accepted: 03/26/2024] [Indexed: 04/11/2024]
Abstract
Transmasculine people (TM) constitute an invisibilized group within the transgender population. Little is known about their relationship to sexuality in transgender medicine. Their presence and needs are still unacknowledged within HIV prevention research and services. Pre-exposure prophylaxis (or PrEP) is an oral medication that prevents HIV in HIV-negative individuals at risk of infection with the virus. This paper proposes to bring TM back into the focus of PrEP research by questioning how they navigate and situate themselves in relation to existing PrEP categorization and services, and how they think about and (re)shape the meanings of PrEP. It is based on the "interpretative descriptive" method and a transfeminist theoretical framework applied to the analysis of ten semi-structured interviews with TM conducted in France between 2019 and 2023. Findings show that PrEP is gendered. We identify specific barriers to getting PrEP as well as to access healthcare and we show that a cisnormative and homonormative approach to prevention generates them. PrEP use and PrEP disclosure are embedded in structural and symbolic power relations between cisgender and transgender MSM that are reflected in the intimate sphere. TM use PrEP to prevent sexual assault and to alleviate the difficulty of condom negotiation. PrEP comes into play following major changes in TM's sexualities and is integrated post-exposure.
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Affiliation(s)
- Clark Pignedoli
- Université d'Aix-Marseille, SESSTIM - SanteRCom, Faculté de Médecine, 27 Bd Jean Moulin, 13385, Marseille, Cedex 5, France.
| | - Paul Rivest
- Université d'Aix-Marseille, Ideas, 5 rue du Château de l'Horloge, 13090, Aix-en-Provence, France.
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Moale AC, Motter EM, Eisenhauer P, Gandhi N, Kim SP, Girard TD, Reynolds CF, Leland NE, Chang JC, Scheunemann LP. Integrating Perspectives on Family Caregiving After Critical Illness: A Qualitative Content Analysis. Am J Crit Care 2024; 33:180-189. [PMID: 38688852 DOI: 10.4037/ajcc2024309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND To date, no intervention has definitively improved outcomes for families of critical illness survivors. An integrated perspective on caregivers' needs after critical illness could help identify high-priority intervention targets and improve outcomes. OBJECTIVES To obtain diverse perspectives on the needs, barriers and facilitators, and social determinants of health associated with family caregiving across the critical illness continuum and assess the extent to which successful caregiving interventions in other populations may be adapted to the critical illness context. METHODS This qualitative content analysis of 31 semistructured interviews and 10 focus groups with family caregivers, health care providers, and health care administrators explored family caregivers' needs during post- intensive care unit (ICU) transitions and the barriers and facilitators associated with addressing them. Trained coders analyzed transcripts, identified patterns and categories among the codes, and generated themes. RESULTS Caregivers have 3 instrumental needs: formal and informal support, involvement in care planning, and education and training. Only caregivers described their self-care and mental health needs. Social determinants of health are the key barriers and facilitators shaping the caregivers' journey, and caregiving as a social determinant of health was a prominent theme. CONCLUSIONS Caregivers have instrumental, self-care, and mental health needs after critical illness. Adapting hands-on and skills training interventions to the post-ICU setting, while tailoring interventions to caregivers' health-related social context, may improve caregiver outcomes.
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Affiliation(s)
- Amanda C Moale
- Amanda C. Moale is a pulmonary and critical care medicine fellow, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Erica M Motter
- Erica M. Motter is a research coordinator, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Peter Eisenhauer
- Peter Eisenhauer is an internist, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nimit Gandhi
- Nimit Gandhi is an internist, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - S Peter Kim
- S. Peter Kim is an internist, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tim D Girard
- Tim D. Girard is a professor, Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Charles F Reynolds
- Charles F. Reynolds III is an emeritus professor, Department of Psychiatry, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center
| | - Natalie E Leland
- Natalie E. Leland is a professor, Department of Occupational Therapy, University of Pittsburgh
| | - Judy C Chang
- Judy C. Chang is a professor, Department of Obstetrics, Gynecology, and Reproductive Sciences and General Internal Medicine and Clinical and Translational Science Institute, University of Pittsburgh School of Medicine
| | - Leslie P Scheunemann
- Leslie P. Scheunemann is an assistant professor, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh Medical Center; and Division of Geriatric Medicine and Gerontology, University of Pittsburgh
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103
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Rogers JL, Clowse MEB, McKenna K, Starling S, Swezey T, Molokwu N, Corneli A, Pisetsky DS, Sun K, Criscione-Schreiber LG, Sadun RE, Maheswaranathan M, Burshell D, Doss J, Eudy AM. Patient and Physician Perspectives of Systemic Lupus Erythematosus Flare: A Qualitative Study. J Rheumatol 2024; 51:488-494. [PMID: 38101916 PMCID: PMC11065621 DOI: 10.3899/jrheum.2023-0721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) flares are associated with increased damage and decreased health-related quality of life. We hypothesized that there is discordance between physicians' and patients' views of SLE flare. In this study, we aimed to explore patient and physician descriptions of SLE flares. METHODS We conducted a qualitative descriptive study using in-depth interviews with a purposeful sample of patients with SLE (who met 1997 American College of Rheumatology or Systemic Lupus International Collaborating Clinics criteria) and practicing rheumatologists. Interviews were audio-recorded, transcribed, and analyzed using applied thematic analysis. RESULTS Forty-two patient participants with SLE, representing a range of SLE activity, completed interviews. The majority described flare symptoms as joint pain, fatigue, and skin issues lasting several days. Few included objective signs or laboratory measures, when available, as features of flare. We interviewed 13 rheumatologists from 10 academic and 3 community settings. The majority defined flare as increased or worsening SLE disease activity, with slightly more than half requiring objective findings. Around half of the rheumatologists included fatigue, pain, or other patient-reported symptoms. CONCLUSION Patients and physicians described flare differently. Participants with SLE perceived flares as several days of fatigue, pain, and skin issues. Providers defined flares as periods of increased clinical SLE activity. Our findings suggest the current definition of flare may be insufficient to integrate both perceptions. Further study is needed to understand the pathophysiology of patient flares and the best way to incorporate patients' perspectives into clinical assessments.
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Affiliation(s)
- Jennifer L Rogers
- J.L. Rogers, MD, M.E.B. Clowse, MD, MPH, K. Sun, MD, MS, L.G. Criscione-Schreiber, MD, MEd, R.E. Sadun, MD, PhD, M. Maheswaranathan, MD, D. Burshell, MPH, J. Doss, MD, MPH, A.M. Eudy, PhD, Division of Rheumatology and Immunology, Duke University School of Medicine
| | - Megan E B Clowse
- J.L. Rogers, MD, M.E.B. Clowse, MD, MPH, K. Sun, MD, MS, L.G. Criscione-Schreiber, MD, MEd, R.E. Sadun, MD, PhD, M. Maheswaranathan, MD, D. Burshell, MPH, J. Doss, MD, MPH, A.M. Eudy, PhD, Division of Rheumatology and Immunology, Duke University School of Medicine
| | - Kevin McKenna
- K. McKenna, MPH, S. Starling, DrPH, MPH, T. Swezey, PhD, N. Molokwu, MSW, A. Corneli, PhD, MPH, Population Health Sciences, Duke University School of Medicine
| | - Summer Starling
- K. McKenna, MPH, S. Starling, DrPH, MPH, T. Swezey, PhD, N. Molokwu, MSW, A. Corneli, PhD, MPH, Population Health Sciences, Duke University School of Medicine
| | - Teresa Swezey
- K. McKenna, MPH, S. Starling, DrPH, MPH, T. Swezey, PhD, N. Molokwu, MSW, A. Corneli, PhD, MPH, Population Health Sciences, Duke University School of Medicine
| | - Nneka Molokwu
- K. McKenna, MPH, S. Starling, DrPH, MPH, T. Swezey, PhD, N. Molokwu, MSW, A. Corneli, PhD, MPH, Population Health Sciences, Duke University School of Medicine
| | - Amy Corneli
- K. McKenna, MPH, S. Starling, DrPH, MPH, T. Swezey, PhD, N. Molokwu, MSW, A. Corneli, PhD, MPH, Population Health Sciences, Duke University School of Medicine
| | - David S Pisetsky
- D.S. Pisetsky, MD, PhD, Division of Rheumatology and Immunology, Duke University School of Medicine, and Durham VA Medical Center, Durham, North Carolina, USA
| | - Kai Sun
- J.L. Rogers, MD, M.E.B. Clowse, MD, MPH, K. Sun, MD, MS, L.G. Criscione-Schreiber, MD, MEd, R.E. Sadun, MD, PhD, M. Maheswaranathan, MD, D. Burshell, MPH, J. Doss, MD, MPH, A.M. Eudy, PhD, Division of Rheumatology and Immunology, Duke University School of Medicine
| | - Lisa G Criscione-Schreiber
- J.L. Rogers, MD, M.E.B. Clowse, MD, MPH, K. Sun, MD, MS, L.G. Criscione-Schreiber, MD, MEd, R.E. Sadun, MD, PhD, M. Maheswaranathan, MD, D. Burshell, MPH, J. Doss, MD, MPH, A.M. Eudy, PhD, Division of Rheumatology and Immunology, Duke University School of Medicine
| | - Rebecca E Sadun
- J.L. Rogers, MD, M.E.B. Clowse, MD, MPH, K. Sun, MD, MS, L.G. Criscione-Schreiber, MD, MEd, R.E. Sadun, MD, PhD, M. Maheswaranathan, MD, D. Burshell, MPH, J. Doss, MD, MPH, A.M. Eudy, PhD, Division of Rheumatology and Immunology, Duke University School of Medicine
| | - Mithu Maheswaranathan
- J.L. Rogers, MD, M.E.B. Clowse, MD, MPH, K. Sun, MD, MS, L.G. Criscione-Schreiber, MD, MEd, R.E. Sadun, MD, PhD, M. Maheswaranathan, MD, D. Burshell, MPH, J. Doss, MD, MPH, A.M. Eudy, PhD, Division of Rheumatology and Immunology, Duke University School of Medicine
| | - Dana Burshell
- J.L. Rogers, MD, M.E.B. Clowse, MD, MPH, K. Sun, MD, MS, L.G. Criscione-Schreiber, MD, MEd, R.E. Sadun, MD, PhD, M. Maheswaranathan, MD, D. Burshell, MPH, J. Doss, MD, MPH, A.M. Eudy, PhD, Division of Rheumatology and Immunology, Duke University School of Medicine
| | - Jayanth Doss
- J.L. Rogers, MD, M.E.B. Clowse, MD, MPH, K. Sun, MD, MS, L.G. Criscione-Schreiber, MD, MEd, R.E. Sadun, MD, PhD, M. Maheswaranathan, MD, D. Burshell, MPH, J. Doss, MD, MPH, A.M. Eudy, PhD, Division of Rheumatology and Immunology, Duke University School of Medicine
| | - Amanda M Eudy
- J.L. Rogers, MD, M.E.B. Clowse, MD, MPH, K. Sun, MD, MS, L.G. Criscione-Schreiber, MD, MEd, R.E. Sadun, MD, PhD, M. Maheswaranathan, MD, D. Burshell, MPH, J. Doss, MD, MPH, A.M. Eudy, PhD, Division of Rheumatology and Immunology, Duke University School of Medicine;
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Johannesson C, Nehlin C, Gordh T, Hysing EB, Bothelius K. Patients' experiences of treatment-relevant processes in multimodal pain rehabilitation for severe complex regional pain syndrome - a qualitative study. Disabil Rehabil 2024; 46:1862-1869. [PMID: 37191973 DOI: 10.1080/09638288.2023.2209744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 04/28/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE Complex regional pain syndrome (CRPS) is a longstanding condition with spontaneous and evoked pain, that usually occurs in an upper or lower extremity. Although it often resolves within the first year, it may for a minority progress to a chronic and occasionally severely disabling condition. The aim of this study was to explore patients' experiences and perceived effects of a specific treatment, designed for patients with severe and highly disabling CRPS, in order to identify possible treatment-relevant processes. METHODS The method used was a qualitative design, using semi-structured interviews with open-ended questions to capture participants' experiences and perceptions. Ten interviews were analyzed using applied thematic analysis. RESULTS Despite the fact that participants had a severe conditions, including nerve damage and a long duration of illness, they reported having been helped to increase flexible persistence, reduce fear and avoidance, and improve connections. This helped participants to significant improvements in daily life functioning. CONCLUSIONS The participants described distinct possible treatment-relevant processes leading to a substantial improvement in everyday life. The results imply that there is hope for this group that has been severely disabled for many years. This may help guide future clinical treatment trials.
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Affiliation(s)
| | - Christina Nehlin
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Torsten Gordh
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Eva-Britt Hysing
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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105
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Lizon M, Taels L, Vanheule S. Specific interests as a social boundary and bridge: A qualitative interview study with autistic individuals. Autism 2024; 28:1150-1160. [PMID: 37665063 DOI: 10.1177/13623613231193532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
LAY ABSTRACT Growing evidence shows that specific interests can help autistic individuals cope with difficulties in social communication and interaction. However, it is unclear which specific characteristics of these interests make them suitable for this coping role. Therefore, this study explored how specific interests can help autistic individuals navigate social communication and interaction. We conducted semi-structured interviews with nine autistic individuals to inquire about their perspectives on the meanings and functions of their specific interest in their (social) life. We found that specific interests served two important social functions. First, the interests provided a way to disconnect from the challenging outside world, through a shift in the attentional focus of participants. Second, the interests served as a "social compass," providing structure and meaning to social situations and helping the participants feel more connected to others. Based on these findings, we propose a conceptual model suggesting that specific interests create the experience of a "protective boundary" between oneself and others, which helps autistic individuals feel safe during social interactions. Namely, engaging in specific interests not only creates a space where autistic individuals can retreat when they feel overwhelmed, but also provides a framework with delineations in time and space, as well as explicit rules for social interactions, which make them more predictable and regulated. The study suggests that incorporating specific interests into therapy can help improve social communication and interaction for autistic individuals while still prioritizing their personal well-being.
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106
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Levin L, Nevo M. Person, People, Planet: Eco-Systematic Analysis of Older Adults' Experiences of Engagement with Nature and Discourse About Nature. J Gerontol Soc Work 2024; 67:541-557. [PMID: 38600774 DOI: 10.1080/01634372.2024.2339973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
This study combined ecological, environmental, nature-based, and epistemic interpretations of older adulthood to gain a previously unresearched look at how older adults feel that their relations with nature are treated by others. Sixty older adults were interviewed in-depth, and data was analyzed using the Eco-Appreciation framework and Thematic Content Analysis. The results indicate the concurrence of processes of withdrawal of older adults from spaces of nature and discourse about nature. These processes obstruct older adults' wellbeing; entail the infliction of existential epistemic injustices and "eco-ageism" toward them; and emphasize the crucial role social work can play in responding thereto.
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Affiliation(s)
- Lia Levin
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Mali Nevo
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
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Kumar R. Agency & Identity Negotiations of "Good DNA" by Children with Incarcerated Parents Amidst Stigmatizing Mental Health Structures: A Culture-Centered Analysis. Health Commun 2024; 39:1140-1148. [PMID: 37121667 DOI: 10.1080/10410236.2023.2207239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Children with incarcerated parents (CIP) face higher burdens of mental illness owing to an accumulation of adverse childhood experiences (ACEs) marked by racialized and classed stigma. Utilizing instruments co-created by our CIP advisory board youth within a broader Youth Voice project, semi-structured in-depth interviews were conducted with 30 CIP, forming the primary data set for analysis within the present manuscript, in addition to two advisory board focus groups and 21 questionnaires. Drawing upon the culture-centered approach (CCA), this study explores CIP's articulations of agency and positive identification, including narratives of strength, survival, and "good DNA" in making meaning of mental health experiences. Demonstrating a complex interplay of silence and voice, CIP agentically reframe mainstream narratives about problematic behavior as overt responses to inadequate structural support, challenge notions of the absent incarcerated parent, engage in the praxis of retailoring state mental health resources to align with their lived experiences and participate as active content creators and storytellers within community media spaces.
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Affiliation(s)
- Rati Kumar
- School of Communication, San Diego State University
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108
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Wendrich K, Krabbenborg L. Negotiating with digital self-monitoring: A qualitative study on how patients with multiple sclerosis use and experience digital self-monitoring within a scientific study. Health (London) 2024; 28:333-351. [PMID: 37198747 DOI: 10.1177/13634593231175321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Research shows that patients can have values and use practices that are different from those envisioned by technology developers. Using sociomaterialism as an analytical lens, we show how patients negotiated with digital self-monitoring in the context of a scientific study. Our paper draws on interviews with 26 patients with the chronic neurological disease multiple sclerosis (MS) who were invited to use an activity tracker and a self-monitoring app for a period of 12 months as part of their everyday life. Our study aims to fill a gap: relatively little is known about how digital self-monitoring becomes materialized in the everyday lives of patients with chronic diseases. We show that patients engaged in digital self-monitoring because they are eager to participate in research to contribute knowledge that will benefit the larger community of patients rather than to improve their personal self-management. Although respondents adhered to digital self-monitoring during the study, it is not self-evident that they would do so for private self-monitoring purposes. It became clear that respondents did not necessarily perceive digital self-monitoring as useful for their self-management practices due to their established knowledge and routines. Moreover, respondents referred to the inconvenience of having to perform self-monitoring tasks and the emotional burden of being reminded of the MS because of the digital self-monitoring. We conclude by indicating what could be considered when designing scientific studies, including the suitability of conventional study designs for evaluating technologies used daily by patients and the challenge of integrating patients' experiential knowledge into scientific practices.
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109
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Kurz R, Hebron C. "Finding a new normal: the lived experience of persons' journey towards coping with persistent low back pain". Physiother Theory Pract 2024; 40:983-998. [PMID: 36373211 DOI: 10.1080/09593985.2022.2144782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Persistent low back pain (PLBP) is the biggest global cause of disability. Persons with PLBP experience biographic disruption and existential crisis. Guidelines recommend a biopsychosocial approach to management, with the emphasis on coping strategies. PURPOSE However, there is a paucity of research exploring the lived experience of persons who self-identify as coping with PLBP. METHOD The study used an interpretive phenomenological approach, analyzing transcripts from 1:1 interviews with six persons who self-identify as coping with PLBP. Poetic language was used to elicit empathic, embodied relational understanding and convey a richer understanding of the phenomenon that authentic quotations might not able to reveal. FINDINGS AND CONCLUSION Participants' descriptions conveyed the sense of a journey, starting with the loss of a sense of self as they engaged in the pain battle, followed by a transition toward a new 'normal,' in which time, acceptance and trust in their own intuition were meaningful components. Although anxiety and fear were a continued presence, but they became more manageable. Society's role in the coping process was significantly meaningful and is something which requires reflections from therapists' and more widely.
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Affiliation(s)
- Raffaela Kurz
- School of Health Sciences, University of Brighton, 49 Darley Road, Eastbourne BN20 7UR, UK
- Physiotherapy MSK Department, Sussex Community NHS Foundation Trust, Horsham Hospital, Hurst Road, Horsham RH12 2DR, UK
| | - Clair Hebron
- School of Health Sciences, University of Brighton, 49 Darley Road, Eastbourne BN20 7UR, UK
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Saghafi F, Hardy J, Leigh MC, Hillege S. Intensive care as a specialty of choice for registered nurses: A descriptive phenomenological study. Nurs Crit Care 2024; 29:536-544. [PMID: 37587726 DOI: 10.1111/nicc.12965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 06/18/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Shortage and retention of experienced nurses are crucial matters and internationally acknowledged, particularly in specialty areas such as Critical Care. AIM To explore the experiences of registered nurses in their first and fourth years of practice in an adult intensive care unit. STUDY DESIGN This descriptive phenomenological study was conducted over 4 years. Eligible participants were interviewed at two different points in their career. Ten registered nurses were interviewed after three to 6 months of employment in an adult intensive care unit (Phase One). Five of the same participants were interviewed in their fourth year of practice (Phase Two). FINDINGS Findings related to factors influencing the participants' choice of specialty and their retention are reported in this paper. Two themes emerged from Phase One: a unique environment, positive and negative emotions, unclear expectations, and the journey of a registered nurse. Two themes generated from data collected in Phase Two included a unique environment and being a proficient nurse. In both phases, nurses considered the Intensive Care Unit a stimulating learning environment. CONCLUSIONS This paper highlights that the registered nurse's perception of the Intensive Care Unit and Intensive Care Nursing influenced their choice of specialty, and learning opportunities influenced their decision to remain in the Intensive Care Unit. RELEVANCE TO CLINICAL PRACTICE The findings of this study inform action areas for healthcare organizations and nursing managers. Challenges, learning opportunities and the nature of critical care nursing should be considered target areas for organizations to promote and develop as part of critical care nurses' retention strategies. Education not only for new graduate nurses but also for all registered nurses should be ongoing.
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Affiliation(s)
- Farida Saghafi
- School of Nursing, College of Health and Medicine, University of Tasmania, Alexandria, New South Wales, Australia
| | - Jennifer Hardy
- School of Nursing and Midwifery, The University of Sydney, Camperdown, New South Wales, Australia
| | - Maria Cynthia Leigh
- School of Nursing, Midwifery and Paramedicine (NSW/ACT), Australian Catholic University, North Sydney, New South Wales, Australia
| | - Sharon Hillege
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
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Puddephatt JA, Booth M, Onwumere J, Das-Munshi J, Coomber R, Goodwin L. Exploring experiences with alcohol and how drinking has changed over time among minority ethnic groups with a diagnosed mental health problem. Soc Sci Med 2024; 348:116803. [PMID: 38583257 DOI: 10.1016/j.socscimed.2024.116803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/01/2024] [Accepted: 03/19/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Minority ethnic groups are more likely to experience poor mental health but less likely to seek formal support. Mental health problems and alcohol use (including non-drinking) co-occur, the reasons for this among minority ethnic groups are not well understood. This study explored i) alcohol use among minority ethnic individuals with a mental health problem,ii) how alcohol was used before individuals received support for their mental health,iii) how alcohol changed whilst and after individuals received treatment for their mental health. METHODS Participants were purposively sampled through community/online mental health organisations. Participants took part if they i)were not White British, ii) had a mental health diagnosis, iii) drank at hazardous and above levels or former drinkers. Telephone/online semi-structured interviews were conducted. Data were analysed using framework analysis with an intersectional lens. RESULTS 25 participants took part. Four themes were developed; "drinking motivations", "mental health literacy and implications on drinking behaviour", "cultural expectations and its influence on mental health problems and drinking practices", and "reasons for changes in drinking". Themes reflect reasons for drinking and the role of understanding the range of mental health problems and implicit cultural expectations. An intersectional lens indicated gendered, ethnic and religious nuances in experiences with alcohol and seeking support. Engaging with formal support prompted changes in drinking which were facilitated through wider support. CONCLUSION There were specific reasons to cope among minority ethnic individuals who have a mental health problem. Applying an intersectional lens provided an insight into the role of cultural and gendered expectations on mental health and drinking practices. Mental health literacy and implicit cultural expectations within specific minority ethnic groups can affect both mental health and drinking practices. Healthcare professionals and wider community play an important role in prompting changes in drinking among minority ethnic groups who have a mental health problem.
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Affiliation(s)
- Jo-Anne Puddephatt
- Division of Health Research, Lancaster University, Lancaster, UK; Department of Psychology, Edge Hill University, Ormskirk, UK.
| | - Millissa Booth
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Juliana Onwumere
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK; NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Jayati Das-Munshi
- South London and Maudsley NHS Foundation Trust, London, UK; King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK; ESRC Centre for Society and Mental Health, King's College London, UK
| | - Ross Coomber
- Department of Sociology, Social Policy and Criminology, University of Liverpool, Liverpool, UK; School of Justice, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Laura Goodwin
- Division of Health Research, Lancaster University, Lancaster, UK
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Yous ML, Hunter PV, Coker E, Fisher KA, Nicula M, Kazmie N, Bello-Haas VD, Hadjistavropoulos T, McAiney C, Thompson G, Kaasalainen S. Experiences of Families, Staff, Volunteers, and Administrators With Namaste Care for Persons With Advanced Dementia in Canadian Long-Term Care Homes. J Am Med Dir Assoc 2024; 25:830-836. [PMID: 37709261 DOI: 10.1016/j.jamda.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/14/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To explore the experiences of the Namaste Care intervention for persons with advanced dementia (ie, moderate and late-stage) in long-term care (LTC). DESIGN A qualitative descriptive design was used. Staff Carers (eg, personal support worker, nurse, or activity aide) delivered Namaste Care with the support of volunteers in a small group. Activities provided during the Namaste Care sessions to enhance quality of life included massages, aromatherapy, music, and snacks/beverages. SETTING AND PARTICIPANTS Family carers of residents with advanced dementia, LTC staff, administrators, and volunteers from 2 Canadian LTC homes, located in a midsize metropolitan area, were included. METHODS Experiences and acceptability of Namaste Care was assessed through semistructured interviews ranging from 30 to 60 minutes following the 6-month study duration period with family carers, LTC staff, administrators, and volunteers. Thematic analysis was used for interview transcripts. RESULTS A total of 16 family carers and 21 LTC staff, administrators, and volunteers participated in the study. Namaste Care was found to be acceptable and successful in enhancing the quality of life of residents due to collaborative efforts of all group of participants. Families, volunteers, and staff noted positive responses in residents, such as smiling and laughing. The program environment supported the development of relationships within the LTC community, which included families, residents, staff, and volunteers. CONCLUSIONS AND IMPLICATIONS Namaste Care was perceived by the LTC community as an acceptable intervention for persons with advanced dementia. It was perceived as offering multiple benefits for residents with advanced dementia such as improved communication and mood.
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Affiliation(s)
- Marie-Lee Yous
- School of Nursing, McMaster University, Hamilton, ON, Canada.
| | - Paulette V Hunter
- Department of Psychology, St Thomas More College, University of Saskatchewan, Saskatoon, SK, Canada
| | - Esther Coker
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | | | - Maria Nicula
- Health Research Methodology, McMaster University, Hamilton, ON, Canada
| | - Nadia Kazmie
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | | | - Thomas Hadjistavropoulos
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada
| | - Carrie McAiney
- School of Public Health Sciences, University of Waterloo, Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
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Andersson Nystedt T, Svensson P, Herder T, Asamoah BO, Ouis P, Agardh A. Coming across a hidden problem in an excluded population in Sweden: professionals' experiences of young migrants' disclosures of sexual violence. Cult Health Sex 2024; 26:621-637. [PMID: 37489949 DOI: 10.1080/13691058.2023.2234431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/05/2023] [Indexed: 07/26/2023]
Abstract
Growing evidence suggests that young migrants are particularly vulnerable to sexual violence. As young migrants often lack family and social networks, professionals are often the recipients of disclosures of sexual violence. This study aimed to explore how professionals experience young migrants' disclosures of sexual violence. A qualitative design was used, based on 14 semi-structured interviews with a range of professionals from the public sector and civil society in southern Sweden. The data were analysed using qualitative content analysis. The overarching theme developed was 'coming across the hidden problem of sexual violence in an excluded population' supported by three sub-themes: 'linking structural marginalisation and vulnerability to sexual violence'; 'realising that sexual violence is one among many other concerns'; and 'taking pride in backing up young people betrayed by society'. Professionals expressed a strong sense of responsibility due to the complex vulnerabilities of young migrants and their lack of access to services. This, coupled with the lack of clarity about how to respond to disclosures of sexual violence, can lead to moral distress. There is a need to strengthen support for professionals, including recognition of ethical dilemmas and the establishment of formal connections between organisations making access more straightforward and predictable.
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Affiliation(s)
- Tanya Andersson Nystedt
- Social Medicine and Global Health, Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Pia Svensson
- Social Medicine and Global Health, Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Tobias Herder
- Social Medicine and Global Health, Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Benedict Oppong Asamoah
- Social Medicine and Global Health, Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Pernilla Ouis
- Department of Social Work, Faculty of Health and Society, Malmö University, Malmö, Sweden
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Anette Agardh
- Social Medicine and Global Health, Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Malmö, Sweden
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114
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Nishimura HM, Nakyanjo N, Ddaaki W, Kiyingi AC, Mukwana E, Nalugoda F, Ssekyewa C, Denison J, Grabowski MK, Kagaayi J, Kennedy CE. Dissolution of transactional sex relationships during COVID-19: a qualitative study of Ugandan men's experiences during COVID-19 lockdowns. Cult Health Sex 2024; 26:687-700. [PMID: 37647132 DOI: 10.1080/13691058.2023.2238796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 07/17/2023] [Indexed: 09/01/2023]
Abstract
The COVID-19 pandemic and subsequent mitigation measures led to social disruption and negative economic shocks for a large proportion of Uganda's population. The social and economic consequences of COVID-19 on Ugandan men's sexual behaviours, including transactional sex relationships, are unclear. We conducted in-depth interviews between November 2021-February 2022 with 26 men in a high HIV prevalence region of Uganda. Data were analysed thematically to understand how sexual relationships, including transactional sex, were impacted by COVID-19. We found that COVID-19 mitigation measures had far-reaching social and economic impacts on most respondents, particularly those employed in the informal economy. Men described experiencing job loss, food insecurity and restricted mobility, which limited opportunities to provide for and meet with transactional sex partners. Inability to provide financial resources meant that men could not form new transactional sex relationships and men who could no longer provide for their existing transactional sex partners consistently reported relationship dissolution. Men who reported stable employment during the pandemic described few changes in transactional sex relationships. Similarly, men in non-transactional relationships did not report relationship dissolution despite decreased financial provision. Further research should assess the potential short- and long-term impacts of COVID-19 mitigation measures on transactional sex relationships.
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Affiliation(s)
- Holly M Nishimura
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | | | | | - Julie Denison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - M Kate Grabowski
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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115
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Godoy Junior CA, Miele F, Mäkitie L, Fiorenzato E, Koivu M, Bakker LJ, Groot CUD, Redekop WK, van Deen WK. Attitudes Toward the Adoption of Remote Patient Monitoring and Artificial Intelligence in Parkinson's Disease Management: Perspectives of Patients and Neurologists. Patient 2024; 17:275-285. [PMID: 38182935 DOI: 10.1007/s40271-023-00669-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE Early detection of Parkinson's Disease (PD) progression remains a challenge. As remote patient monitoring solutions (RMS) and artificial intelligence (AI) technologies emerge as potential aids for PD management, there's a gap in understanding how end users view these technologies. This research explores patient and neurologist perspectives on AI-assisted RMS. METHODS Qualitative interviews and focus-groups were conducted with 27 persons with PD (PwPD) and six neurologists from Finland and Italy. The discussions covered traditional disease progression detection and the prospects of integrating AI and RMS. Sessions were recorded, transcribed, and underwent thematic analysis. RESULTS The study involved five individual interviews (four Italian participants and one Finnish) and six focus-groups (four Finnish and two Italian) with PwPD. Additionally, six neurologists (three from each country) were interviewed. Both cohorts voiced frustration with current monitoring methods due to their limited real-time detection capabilities. However, there was enthusiasm for AI-assisted RMS, contingent upon its value addition, user-friendliness, and preservation of the doctor-patient bond. While some PwPD had privacy and trust concerns, the anticipated advantages in symptom regulation seemed to outweigh these apprehensions. DISCUSSION The study reveals a willingness among PwPD and neurologists to integrate RMS and AI into PD management. Widespread adoption requires these technologies to provide tangible clinical benefits, remain user-friendly, and uphold trust within the physician-patient relationship. CONCLUSION This study offers insights into the potential drivers and barriers for adopting AI-assisted RMS in PD care. Recognizing these factors is pivotal for the successful integration of these digital health tools in PD management.
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Affiliation(s)
- Carlos Antonio Godoy Junior
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 PA, Rotterdam, Netherlands.
| | - Francesco Miele
- Department of Political and Social Sciences, University of Trieste, Trieste, Italy
| | - Laura Mäkitie
- Department of Neurology, Brain Center, Helsinki University Hospital, Helsinki, Finland
- Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | | | - Maija Koivu
- Department of Neurology, Brain Center, Helsinki University Hospital, Helsinki, Finland
- Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Lytske Jantien Bakker
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 PA, Rotterdam, Netherlands
| | - Carin Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 PA, Rotterdam, Netherlands
| | - William Ken Redekop
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 PA, Rotterdam, Netherlands
| | - Welmoed Kirsten van Deen
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 PA, Rotterdam, Netherlands
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Tay T, James KS. Exploring the Experiences of Undergraduate Medical Students on Surgical Placement - A Qualitative Study. J Surg Educ 2024; 81:671-679. [PMID: 38556437 DOI: 10.1016/j.jsurg.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/25/2024] [Accepted: 02/03/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE Multiple elements in the clinical learning environment have been found to influence medical students' learning experiences. A rich area of research, many factors are already known to influence students' experiences of learning which go on to impact later training choices. However, there is a knowledge gap specifically related to undergraduate medical students' experiences of surgical placement. This study aims to explore the lived experiences of medical students in their surgery rotation(s). DESIGN A phenomenological study using semistructured interviews was conducted. Transcribed interview recordings were thematically analyzed using an iterative approach. SETTING Participants were studying in a large medical school in the north of England. PARTICIPANTS Fitting with the method, 6 undergraduate medical students, with at least 1 surgery placement took part in the study. RESULTS Participants described issues including knowing the details of clinical opportunities, the clinical environment, and the portfolio; having a sense of involvement and previous surgical experiences; teaching and assessments; observation; and interactions. These experiences were also found to influence later career aspirations. CONCLUSIONS The findings suggest that undergraduate surgical learning experiences can be influenced by various themes: knowing the details of progression, the clinical environment, having a sense of involvement and previous experiences, constructive alignment of teaching and assessment, and professional identity formation. Future studies can explore methods such as personalized learning outcomes to enhance the overall learning experience of medical students.
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Affiliation(s)
- Tricia Tay
- Royal Lancaster Infirmary, Lancaster University, Ashton Road, Lancaster, United Kingdom.
| | - Kirstin Stuart James
- Edinburgh Surgery Online: Clinical Sciences Teaching Organisation, The University of Edinburgh, Simon Laurie House, Edinburgh, United Kingdom; Edinburgh Medical School: Medical Education, The University of Edinburgh, Chancellor's Building, Little France Crescent, EH16 4SB, UK
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117
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Padfield N, Agius Anastasi A, Camilleri T, Fabri S, Bugeja M, Camilleri K. BCI-controlled wheelchairs: end-users' perceptions, needs, and expectations, an interview-based study. Disabil Rehabil Assist Technol 2024; 19:1539-1551. [PMID: 37166297 DOI: 10.1080/17483107.2023.2211602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/03/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE Brain-computer interface (BCI)-controlled wheelchairs have the potential to improve the independence of people with mobility impairments. The low uptake of BCI devices has been linked to a lack of knowledge among researchers of the needs of end-users that should influence BCI development. MATERIALS AND METHODS This study used semi-structured interviews to learn about the perceptions, needs, and expectations of spinal cord injury (SCI) patients with regards to a BCI-controlled wheelchair. Topics discussed in the interview include: paradigms, shared control, safety, robustness, channel selection, hardware, and experimental design. The interviews were recorded and then transcribed. Analysis was carried out using coding based on grounded theory principles. RESULTS The majority of participants had a positive view of BCI-controlled wheelchair technology and were willing to use the technology. Core issues were raised regarding safety, cost and aesthetics. Interview discussions were linked to state-of-the-art BCI technology. The results challenge the current reliance of researchers on the motor-imagery paradigm by suggesting end-users expect highly intuitive paradigms. There also needs to be a stronger focus on obstacle avoidance and safety features in BCI wheelchairs. Finally, the development of control approaches that can be personalized for individual users may be instrumental for widespread adoption of these devices. CONCLUSIONS This study, based on interviews with SCI patients, indicates that BCI-controlled wheelchairs are a promising assistive technology that would be well received by end-users. Recommendations for a more person-centered design of BCI controlled wheelchairs are made and clear avenues for future research are identified.
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Affiliation(s)
- Natasha Padfield
- Centre for Biomedical Cybernetics, University of Malta, Msida, Malta
| | | | - Tracey Camilleri
- Department of Systems and Control Engineering, University of Malta, Msida, Malta
| | - Simon Fabri
- Department of Systems and Control Engineering, University of Malta, Msida, Malta
| | - Marvin Bugeja
- Department of Systems and Control Engineering, University of Malta, Msida, Malta
| | - Kenneth Camilleri
- Centre for Biomedical Cybernetics, University of Malta, Msida, Malta
- Department of Systems and Control Engineering, University of Malta, Msida, Malta
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Howe K, Stites E, Bassett L, Ewart M, Hammada KA, Sulaiman S, Lony N, Maguek TN. Health and well-being of young mothers displaced by conflict: Experiences from South Sudan and the Kurdistan Region of Iraq. Soc Sci Med 2024; 348:116710. [PMID: 38636208 DOI: 10.1016/j.socscimed.2024.116710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 04/20/2024]
Abstract
Giving birth during adolescence is linked to a variety of negative outcomes, including poor health and well-being. Girls who have been displaced by conflict are at increased risk for becoming young mothers. While prevalence rates and health outcomes have been documented, rarely have the complex personal narratives of early motherhood been examined from the perspectives of mothers themselves, particularly in the Global South. This study relies on in-depth, inductive, narrative analysis of qualitative interviews with 67 young mothers and 10 relatives in South Sudan and the Kurdistan Region of Iraq (KRI) who had been displaced by conflict. This study provides deep insights into the contributing circumstances and consequences of young motherhood from sexual and reproductive health and well-being perspectives, with additional insights on mothering in humanitarian crisis.
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119
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Gittings L, Hodes R, Kom P, Mbula S, Pantelic M. 'Remember there is that thing called confidentiality': experiences of institutional discrimination in the health system among adolescent boys and young men living with HIV in the Eastern Cape province of South Africa. Cult Health Sex 2024; 26:575-587. [PMID: 37480578 DOI: 10.1080/13691058.2023.2232023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 06/28/2023] [Indexed: 07/24/2023]
Abstract
Adolescents and men are two populations that perform poorly within the HIV cascade of care, having worse AIDS-related health outcomes, and experiencing higher levels of HIV-related stigma. This paper explores institutional health system discrimination as experienced by adolescent boys with perinatally-acquired HIV, situating them within the social and gendered contexts of the Eastern Cape Province, South Africa. Life history narratives (n = 36) and in-depth semi-structured interviews (n = 32) with adolescent boys living with HIV aged 13-22 were conducted in 2017-2018. In-depth semi-structured interviews with biomedical and traditional health practitioners (n = 14), analysis of health facility files (n = 41) and clinic observations were also conducted. Together, triangulated sources point to an incongruence between the complex needs of adoelscent boys and young men living with HIV and their experiences within the health system. Two institutional discrimination-related deterrents to retention in care were identified: (1) lack of confidentiality due to health facility layouts and practices that visibilised people living with HIV; and (2) mistreatment in the form of shouting. This article contributes to the limited literature on the experiences of young men within the HIV continuum of care, focusing on how stigma influences how young men experience and engage with the health sector.
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Affiliation(s)
- Lesley Gittings
- School of Health Studies, Faculty of Health Sciences, Western University, London, Canada
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Rebecca Hodes
- Department of Anthropology, Archaeology and Social Development, Humanities Faculty, Pretoria University, South Africa
| | - Phakamani Kom
- Oxford Research South Africa, East London, South Africa
| | | | - Marija Pantelic
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Falmer, UK
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
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Mani V, Pomer A, Madsen C, Coles CL, Schoenfeld AJ, Weissman JS, Koehlmoos TP. Filling the Gaps in the Pandemic Response: Impact of COVID-19 on Telehealth in the Military Health System. Telemed J E Health 2024; 30:1443-1449. [PMID: 38126844 DOI: 10.1089/tmj.2023.0478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Introduction: As a result of the COVID-19 pandemic, telehealth use became widespread, allowing for continued health care while minimizing COVID-19 transmission risk for patients and providers. This rapid scale-up highlighted shortcomings of the current telehealth infrastructure in many health systems. We aimed to identify and address gaps in the United States Military Health System (MHS) response to the COVID-19 pandemic related to the implementation and utilization of telehealth. Methods: We conducted semistructured key informant interviews of MHS stakeholders, including policymakers, program managers, and health care providers. We recruited respondents using purposive and snowball sampling until we reached thematic saturation. Interviews were conducted virtually from December 2022 to March 2023 and coded by deductive thematic analysis using NVivo. Results: We interviewed 28 key informants. Several themes emerged from the interviews and were categorized into four defined areas of obstacles to the effective utilization of telehealth: administrative, technical, organizational, and quality issues. While respondents had positive perceptions of telehealth, issues such as billing, licensure portability, network connectivity and technology, and ability to monitor health outcomes represent major barriers in the current system, preventing the potential for further expansion. Conclusions: While the shift to telehealth during the COVID-19 pandemic demonstrated robust potential within the MHS, it highlighted shortcomings that impair the utility and expansion of telehealth on a level comparable to that of other large health systems. Future focus should be directed toward generating and implementing actionable recommendations that target these identified challenges in the MHS.
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Affiliation(s)
- Vivitha Mani
- Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Alysa Pomer
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA Massachusetts, USA
| | - Cathaleen Madsen
- Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Christian L Coles
- Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Andrew J Schoenfeld
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA Massachusetts, USA
| | - Joel S Weissman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA Massachusetts, USA
- Department of Health Policy and Management, Harvard Medical School, Boston, Massachusetts, USA
| | - Tracey Pèrez Koehlmoos
- Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Sax Dos Santos Gomes L, Efendi F, Putri NK, Bolivar-Vargas M, Saadeh R, Villarreal PA, Aye TT, De Allegri M, Lohmann J. The impact of international health worker migration and recruitment on health systems in source countries: Stakeholder perspectives from Colombia, Indonesia, and Jordan. Int J Health Plann Manage 2024; 39:653-670. [PMID: 38326291 DOI: 10.1002/hpm.3776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 01/25/2024] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION To address domestic shortages, high-income countries are increasingly recruiting health workers from low- and middle-income countries. This practice is much debated. Proponents underline benefits of return migration and remittances. Critics point in particular to the risk of brain drain. Empirical evidence supporting either position is yet rare. This study contributes to filling this gap in knowledge by reporting high-level stakeholders' perspectives on health system impacts of international migration in general, and active recruitment of health workers in specific, in Colombia, Indonesia, and Jordan. METHOD We used a multiple case study methodology, based on qualitative methods integrated with information available in the published literature. RESULTS All respondents decried a lack of robust and detailed data as a serious challenge in ascertaining their perspectives on impacts of health worker migration. Stakeholders described current emigration levels as not substantially aggravating existing health workforce availability challenges. This is due to the fact that all three countries are faced with health worker unemployment grounded in unwillingness to work in rural areas and/or overproduction of certain cadres. Respondents, however, pleaded against targeting very experienced and specialised individuals. While observing little harm of health worker migration at present, stakeholders also noted few benefits such as brain gain, describing how various barriers to skill enhancement, return, and reintegration into the health system hamper in practice what may be possible in theory. CONCLUSION Improved availability of data on health worker migration, including their potential return and reintegration into their country of origin's health system, is urgently necessary to understand and continuously monitor costs and benefits in dynamic national and international health labour markets. Our results imply that potential benefits of migration do not come into being automatically, but need in-country supportive policy and programming, such as favourable reintegration policies or programs targeting engagement of the diaspora.
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Affiliation(s)
| | - Ferry Efendi
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | | | - Mery Bolivar-Vargas
- Faculty of Economic and Administrative Sciences, Universidad Jorge Tadeo Lozano, Bogotá, Colombia
| | - Rami Saadeh
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Pedro A Villarreal
- German Institute for International and Security Affairs, Berlin, Germany
- Max Planck Institute for Comparative Public Law and International Law, Heidelberg, Germany
| | - Thit Thit Aye
- Heidelberg Institute of Global Health, University Hospital and Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, University Hospital and Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Julia Lohmann
- Heidelberg Institute of Global Health, University Hospital and Medical Faculty, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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Xie F, Xie S, Pullenayegum E, Ohinmaa A. Understanding Canadian stakeholders' views on measuring and valuing health for children and adolescents: a qualitative study. Qual Life Res 2024; 33:1415-1422. [PMID: 38438665 PMCID: PMC11045599 DOI: 10.1007/s11136-024-03618-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 03/06/2024]
Abstract
OBJECTIVE Valuing child health is critical to assessing the value of healthcare interventions for children. However, there remain important methodological and normative issues. This qualitative study aimed to understand the views of Canadian stakeholders on these issues. METHODS Stakeholders from health technology assessment (HTA) agencies, pharmaceutical industry representatives, healthcare providers, and academic researchers/scholars were invited to attend an online interview. Semi-structured interviews were designed to focus on: (1) comparing the 3-level and 5-level versions of the EQ-5D-Y; (2) source of preferences for valuation (adults vs. children); (3) perspective of valuation tasks; and (4) methods for valuation (discrete choice experiment [DCE] and its variants versus time trade-off [TTO]). Participants were probed to consider HTA guidelines, cognitive capacity, and potential ethical concerns. All interviews were recorded and transcribed verbatim. Framework analysis with the incidence density method was used to analyze the data. RESULTS Fifteen interviews were conducted between May and September 2022. 66.7% (N = 10) of participants had experience with economic evaluations, and 86.7% (N = 13) were parents. Eleven participants preferred the EQ-5D-Y-5L. 12 participants suggested that adolescents should be directly involved in child health valuation from their own perspective. The participants were split on the ethical concerns. Eight participants did not think that there was ethical concern. 11 participants preferred DCE to TTO. Among the DCE variants, 6 participants preferred the DCE with duration to the DCE with death. CONCLUSIONS Most Canadian stakeholders supported eliciting the preferences of adolescents directly from their own perspective for child health valuation. DCE was preferred if adolescents are directly involved.
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Affiliation(s)
- Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada.
| | - Shitong Xie
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Eleanor Pullenayegum
- The Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, The University of Toronto, Toronto, Canada
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, Edmonton, Canada
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Mattila M, Honkanen S, Sjögren T, Piirainen A, Aartolahti E. Interaction during equine-facilitated rehabilitation from the rehabilitees' perspective - A phenomenological study. Physiother Theory Pract 2024; 40:999-1010. [PMID: 36437737 DOI: 10.1080/09593985.2022.2151332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 11/09/2022] [Accepted: 11/19/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Interaction has a multidimensional role in equine-facilitated rehabilitation. PURPOSE The aim of this study was to understand rehabilitees' experiences of interaction during equine-facilitated rehabilitation. METHODS Six children and four adults with individual diagnoses or reasons to participate in equine-facilitated rehabilitation were included in this qualitative study. Data were collected by interviewing individually the rehabilitees. A phenomenological Spiegelberg's seven-phase meaning analysis was performed to reveal the meanings. RESULTS Seven meanings were identified: 1) Trust; 2) Friendly horse; 3) Mirror of feelings; 4) Inspiring riding; 5) Feeling competent; 6) Rehabilitee-oriented approach; and 7) Uniting experience. In addition, the essential meanings of the phenomenon form three different circles: circle of recognition, circle of supporting active agency and circle of empowerment. CONCLUSION Interaction during equine-facilitated rehabilitation is essential to rehabilitees in many ways that have important roles in the entire rehabilitation process that aims for empowerment in the rehabilitees' daily lives.
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Affiliation(s)
- Minna Mattila
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Sari Honkanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Tuulikki Sjögren
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Arja Piirainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Eeva Aartolahti
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Institute of Rehabilitation, JAMK University of Applied Science, Jyväskylä, Finland
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Song J, Zhang YX, Qin MN, Ren JX, Jia YN, Yu H, Zhou YQ. Experiences of returning to work in patients with schizophrenia after treatment: A longitudinal qualitative study. Int J Soc Psychiatry 2024; 70:588-600. [PMID: 38343195 DOI: 10.1177/00207640231223423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
BACKGROUND Returning to work (RTW) has always been regarded as one of the important indicators to evaluate the therapeutic effect of patients with schizophrenia. The existing studies on RTW in patients with schizophrenia are mostly focused on intervention measures, and the qualitative research on RTW is very limited. The purpose of this study was to evaluate the experience of the RTW after treatment in patients with schizophrenia. METHOD A longitudinal qualitative study was conducted involving 24 patients with schizophrenia in China. The interviews were held at three time-points during their RTW process, (1) when patients had improved and were close to discharge, (2) within 1 month post-discharge, and (3) 6 months post-discharge. The interview recordings were transcribed by the research team, and transcripts were independently analyzed by two independent coders using reflexive thematic analysis. RESULTS A total of 24 patients with schizophrenia participated in 72 personal interviews. The thematic framework based on the experience of patients with schizophrenia reveals a three-phases of the process of RTW: improved, being at a loss, and job crisis. The study identified one theme of the first phase: the expectation and optimism. Two themes in the second phase: (1) psychological distress of upcoming work; (2) expectation of assistance pre-work. And four themes in the third phase: (1) tremendous pressure of RTW; (2) lack of medical and social support; (3) social status and interpersonal relationships change; and (4) high level of financial pressure. CONCLUSION The experience of RTW is a dynamic process with great challenges in each phase, patients with schizophrenia have been deeply affected by what they have experienced. There is an urgent need to ensure that existing community and social support is integrated into daily care to support patients with schizophrenia to RTW successful. The findings of this study also suggest relevant departments and employers should be aware of the barriers to RTW for patients with schizophrenia, and take certain measures to change the current situation.
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Affiliation(s)
- Jin Song
- Department of Nursing, Harbin Medical University, Heilongjiang, China
| | - Yu-Xin Zhang
- Department of Nursing, Xuzhou Medical University, Jiangsu, China
| | - Meng-Nan Qin
- Department of Nursing, Harbin Medical University, Heilongjiang, China
| | - Jia-Xin Ren
- Department of Nursing, Harbin Medical University, Heilongjiang, China
| | - Yan-Nan Jia
- Department of Nursing, Harbin Medical University, Heilongjiang, China
| | - Hong Yu
- Department of Nursing, Harbin Medical University, Heilongjiang, China
| | - Yu-Qiu Zhou
- Department of Nursing, Harbin Medical University, Heilongjiang, China
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Cholo FA, Dada S, Martin CE, Mullick S. Experiences of oral pre-exposure prophylaxis use among heterosexual men accessing sexual and reproductive health services in South Africa: a qualitative study. J Int AIDS Soc 2024; 27:e26249. [PMID: 38695102 PMCID: PMC11063779 DOI: 10.1002/jia2.26249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/09/2024] [Indexed: 05/04/2024] Open
Abstract
INTRODUCTION South African men face a substantial burden of HIV and are less likely to test for HIV and initiate antiretroviral therapy if tested positive and more likely to die from AIDS-related causes than women. In addition to condoms and circumcision, guidelines provide for the use of daily oral pre-exposure prophylaxis (PrEP) as an HIV prevention intervention for any men who recognize their need and request PrEP. However, heterosexual men have not been a focus of PrEP programmes, and since its introduction, there is limited literature on PrEP use among men in South Africa. This study explores the experiences, motivators and barriers to oral PrEP use among heterosexual men accessing primary healthcare services in South Africa. METHODS This study forms part of a mixed-methods implementation science study aimed at generating evidence for oral PrEP introduction and conducted in primary healthcare clinics in South Africa since 2018. Men aged ≥15 years who initiated oral PrEP and enrolled in a parent cohort study were purposefully invited to participate in an in-depth interview (IDI). Between March 2020 and May 2022, 30 men participated in IDIs exploring their motivators for PrEP use, and experiences with accessing health services. Interviews were audio recorded, transcribed and analysed thematically. RESULTS The final analysis included 28 heterosexual men (18-56 years old). Motivations to initiate PrEP included fear of acquiring HIV, self-perceived vulnerability to HIV and mistrust in relationships; health systems factors which motivated PrEP use included the influence of healthcare providers, educational materials and mobile services. Perceived reduction in HIV vulnerability and changing proximity to partners were reasons for PrEP discontinuation. Side effects, daily-pill burden and stigma were noted as challenges to PrEP use. Health system barriers to PrEP use included limited PrEP availability, school and work demands, and inconsistent mobile clinic schedules. CONCLUSIONS Our study reports on the experiences of heterosexual men accessing oral PrEP in real-world settings and contributes to the limited literature among this population. We highlight multiple levels which could be strengthened to improve men's PrEP use, including individual support, education among partners and communities, and addressing health system barriers to access.
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Affiliation(s)
| | - Siphokazi Dada
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | - Saiqa Mullick
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
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Faulkner L, Hughes CM, Barry HE. 'I think we could probably do more': an interview study to explore community pharmacists' experiences and perspectives of frailty and optimising medicines use in frail older adults. Age Ageing 2024; 53:afae089. [PMID: 38706393 DOI: 10.1093/ageing/afae089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Community pharmacists potentially have an important role to play in identification of frailty and delivery of interventions to optimise medicines use for frail older adults. However, little is known about their knowledge or views about this role. AIM To explore community pharmacists' knowledge of frailty and assessment, experiences and contact with frail older adults, and perceptions of their role in optimising medicines use for this population. METHODS Semi-structured interviews conducted between March and December 2020 with 15 community pharmacists in Northern Ireland. Interviews were transcribed verbatim and analysed thematically. RESULTS Three broad themes were generated from the data. The first, 'awareness and understanding of frailty', highlighted gaps in community pharmacists' knowledge regarding presentation and identification of frailty and their reluctance to broach potentially challenging conversations with frail older patients. Within the second theme, 'problem-solving and supporting medication use', community pharmacists felt a large part of their role was to resolve medicines-related issues for frail older adults through collaboration with other primary healthcare professionals but feedback on the outcome was often not provided upon issue resolution. The third theme, 'seizing opportunities in primary care to enhance pharmaceutical care provision for frail older adults', identified areas for further development of the community pharmacist role. CONCLUSIONS This study has provided an understanding of the views and experiences of community pharmacists about frailty. Community pharmacists' knowledge deficits about frailty must be addressed and their communication skills enhanced so they may confidently initiate conversations about frailty and medicines use with older adults.
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Affiliation(s)
- Lucy Faulkner
- Primary Care Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Carmel M Hughes
- Primary Care Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Heather E Barry
- Primary Care Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
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Seeley A, Glogowska M, Hayward G. How do primary care clinicians approach the management of frailty? A qualitative interview study. Age Ageing 2024; 53:afae093. [PMID: 38706395 DOI: 10.1093/ageing/afae093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Around 15% of adults aged over 65 live with moderate or severe frailty. Contractual requirements for management of frailty are minimal and neither incentivised nor reinforced. Previous research has shown frailty identification in primary care is ad hoc and opportunistic, but there has been little focus on the challenges of frailty management, particularly within the context of recent introduction of primary care networks and an expanding allied health professional workforce. AIM Explore the views of primary care clinicians in England on the management of frailty. DESIGN AND SETTING Semi-structured interviews were conducted with clinicians across England, including general practitioners (GPs), physician associates, nurse practitioners, paramedics and clinical pharmacists. Thematic analysis was facilitated through NVivo (Version 12). RESULTS A total of 31 clinicians participated. Frailty management was viewed as complex and outside of clinical guidelines with medication optimisation highlighted as a key example. Senior clinicians, particularly experienced GPs, were more comfortable with managing risk. Relational care was important in prioritising patient wishes and autonomy, for instance to remain at home despite deteriorations in health. In settings where more formalised multidisciplinary frailty services had been established this was viewed as successful by clinicians involved. CONCLUSION Primary care clinicians perceive frailty as best managed through trusted relationships with patients, and with support from experienced clinicians. New multidisciplinary working in primary care could enhance frailty services, but must keep continuity in mind. There is a lack of evidence or guidance for specific interventions or management approaches.
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Affiliation(s)
- Anna Seeley
- Nuffield Department of Primary Care and Health Sciences, University of Oxford
| | - Margaret Glogowska
- Nuffield Department of Primary Care and Health Sciences, University of Oxford
| | - Gail Hayward
- Nuffield Department of Primary Care and Health Sciences, University of Oxford
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128
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Titze S, Strain T, Wagner P, Schuster A, Karner J, Dorner TE. The Impact of Removing the 10-Minute Bout Requirement and of Different Survey Administration Methods on National Physical Activity Estimates in Austria. J Phys Act Health 2024; 21:491-499. [PMID: 38460506 DOI: 10.1123/jpah.2023-0459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/03/2024] [Accepted: 01/30/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Monitoring survey methods, as well as movement recommendations, evolves over time. These changes can make trend observations over time difficult. The aim of this study was to examine the differences between 2 computer-assisted survey administration methods and the effect of the omission of the 10-minute minimum bout requirement in physical activity (PA) questions on PA outcomes. METHODS We used data from the second Austrian PA Surveillance System for 2998 adults (18-64 y), applying computer-assisted personal interviewing and computer-assisted web interviewing. Within the computer-assisted web interviewing sample only, we added PA questions without the 10-minute requirement. Quantile and logistic regressions were applied. RESULTS Between computer-assisted web interviewing and computer-assisted personal interviewing, within the computer-assisted personal interviewing sample, we found lower PA estimates in the leisure domain and work and household domain, but not in the travel domain, and no significant difference in the proportion of people meeting the PA recommendations. In all 3 PA domains, the median minutes did not differ when assessed with or without the 10-minute requirement. However, the percentage participation in the travel domain and work and household domain performing >0 minutes per week PA was higher when there was no 10-minute requirement. The proportion of people meeting the Austrian aerobic recommendation for adults when computed with or without the 10-minute requirement did not differ. CONCLUSION Our findings suggest that the omission of the 10-minute requirement does not seem to result in marked differences in PA estimates or the proportion of adults meeting the recommendations.
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Affiliation(s)
- Sylvia Titze
- Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
| | - Tessa Strain
- Physical Activity for Health Research Center, University of Edinburgh, Edinburgh, Scotland
| | | | | | | | - Thomas E Dorner
- Academy for Aging Research, Haus der Barmherzigkeit, Vienna, Austria
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Bostan S, Yesildag AY, Balci F. Family Physicians' Perspectives on the Pros, Cons, and Application Areas of Telemedicine: A Qualitative Study. Telemed J E Health 2024; 30:1450-1458. [PMID: 38294897 DOI: 10.1089/tmj.2023.0574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
Background: There is evidence that telemedicine can be used safely, easily, and cost-effectively in primary health care services. This study aims to determine family physicians' opinions regarding the potential advantages, disadvantages, and usage areas of telemedicine in primary health care services. Methods: This study was designed with a qualitative case study. The Standards for Reporting Qualitative Research (SRQR) checklist was followed throughout the research process. Interviews were conducted with family physicians working in a provincial center using snowball sampling in the study. MaxQDA 20 software was used for analysis process, and themes and subthemes were identified through a deductive-reflective thematic analysis method. The family physicians who participated in the study are between 29 and 56. In addition, family medicine specialists, general practitioners, and academic department heads were included in the study. Family physicians are evenly distributed in terms of gender and professional experience. Results: All interviewed family physicians stated that they had not received professional or technical training in delivering telemedicine. It was observed that family physicians had different perspectives on telemedicine in primary care. The data obtained in the study were analyzed under the main themes of the advantages, disadvantages, and services that can be provided in primary telemedicine. Physicians have different views on telemedicine, including negative, undecided, and positive opinions. Conclusion: It is understood that many services could be delivered remotely if the scope, procedures, and processes of the services to be provided are determined with guidelines. It is recommended that family physicians receive professional and technical training in telemedicine.
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Affiliation(s)
- Sedat Bostan
- Health Management Department, Karadeniz Technical University, Trabzon, Turkey
| | - Ahmet Y Yesildag
- Health Management Department, Karadeniz Technical University, Trabzon, Turkey
- Health Sciences Institute, Ankara University, Ankara, Turkey
| | - Fatma Balci
- Health Management Department, Karadeniz Technical University, Trabzon, Turkey
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Bano S. Transgender migration and displacement: the experience of khwaja sira sex workers in Lahore. Cult Health Sex 2024; 26:638-653. [PMID: 37480579 DOI: 10.1080/13691058.2023.2234447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 07/05/2023] [Indexed: 07/24/2023]
Abstract
This study uses an aspirations-capabilities framework to provide insight into transgender mobility based on in-depth interviews with 30 khwaja sira sex workers in Lahore. Respondents narrated mobility as a defining and persistent feature of their lives linked to their gender variance and experience of everyday violence and discrimination. Mobilities were experienced as oppressive or liberating depending on how much control they provided sex workers within managing risk in their lives. Respondents differentiated between two main forms of mobility: migration and displacement. Descriptions of migration included movement from their family of birth to a khwaja sira community as well as between khwaja sira communities, and entailed both rural-urban and inter-city travel. Unforced migration was associated with resilience as it increased sex workers control over the social environment. Experiences of forced and intra-city movement resulting from everyday interactions with clients and law enforcement agents were seen as displacement. These experiences resulted in enhanced social, physical, and occupational vulnerability and decreased khwaja sira sex workers' control over their social environment.
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Affiliation(s)
- Shermeen Bano
- Department of Sociology, Forman Christian College (A Chartered University), Lahore, Pakistan
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131
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Parsons JA, Romanis EC. "All hands on deck": a qualitative study of safeguarding and the transition to telemedical abortion care in England and Wales. Soc Sci Med 2024; 348:116835. [PMID: 38626482 DOI: 10.1016/j.socscimed.2024.116835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 03/12/2024] [Accepted: 03/25/2024] [Indexed: 04/18/2024]
Abstract
The COVID-19 pandemic raised significant challenges for in-person healthcare provision, leading healthcare providers to embrace digital health like never before. Whilst changes were made as part of a public health response, many have now become permanent fixtures of the healthcare landscape, significantly altering the way care is provided not only for patients, but also for the healthcare professionals that provide care. In abortion care in England and Wales, previously stringent regulations on in-person care provision were relaxed to permit the use of telemedicine and self-administration of medications at home. These changes have since been made permanent. However, there remains opposition to remote abortion care pathways on the basis of safeguarding. Opponents argue that it is not feasible to effectively safeguard patients accessing abortion care remotely. We conducted a qualitative study using semi-structured interviews with abortion care providers in England and Wales. Participants were asked about their views and experiences of the transition to remote care provision, with a particular focus on how they adapted their safeguarding practice. In this article, we present three themes that highlight the changing roles of healthcare professionals in abortion care: (1) a challenging backdrop and resulting apprehension, (2) adaptive practices, and (3) the continued importance of professional curiosity. Across all three themes, participants reflected significantly on how changes were made and what they experienced in the period of transition to telemedicine. In particular, they discussed the changing nature of their professional roles amidst digitalisation. Our findings provide a basis for reflection on the increasing introduction of digital approaches to healthcare provision, highlighting points for caution and emphasising the need to involve professionals in the transition process to ensure vital buy-in. Through this, we articulate two novel understandings of digitalisation: (1) the impact of speed-associated pressures on professional adaptation during digitalisation, and (2) off-proforma safeguarding through telemedicine as a form of invisible non-routine work.
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Affiliation(s)
- Jordan A Parsons
- Birmingham Medical School, University of Birmingham, Birmingham, B15 2TT, UK; Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK.
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Young EE, Kane J, Timmons K, Kelley J, Hagedorn PA, Brady PW, Marshall TL. Improving communication of diagnostic uncertainty to families of hospitalized children. Diagnosis (Berl) 2024; 11:186-191. [PMID: 37877354 DOI: 10.1515/dx-2023-0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/03/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVES Diagnostic uncertainty is not reliably communicated to patients and caregivers. This study aims to identify barriers and facilitators to effective communication of diagnostic uncertainty, including development of potential tools and strategies for improvement, as perceived by healthcare professionals and caregivers. METHODS We completed structured interviews with providers and caregivers of hospitalized children with uncertain diagnoses (UD). The interview guides addressed barriers to communication, key components for communication of uncertainty, and qualities of effective communication. The interviews concluded with respondents prioritizing potential interventions to improve communication of uncertainty. Interviews were audio recorded, transcribed, and independently analyzed by two team members to identify common themes. RESULTS Ten provider and five caregiver interviews were conducted. Common barriers to communication of uncertainty included time constraints, language barriers, and lack of clear definition of UD. Caregiver suggestions for improvement included sharing expectations of the diagnostic process and use of both written and visual communication tools. Interview respondents favored interventions of a sign summarizing the key components of diagnostic uncertainty for display in patient rooms and a structured diagnostic pause during daily rounds. CONCLUSIONS We identified several potential interventions that may enhance communication of diagnostic uncertainty and better engage patients and caregivers in the diagnostic process.
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Affiliation(s)
- Eleanor E Young
- Pediatric Residency Training Program, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Joelle Kane
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kristen Timmons
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jodi Kelley
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Philip A Hagedorn
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Department of Information Services, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Patrick W Brady
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Trisha L Marshall
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
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Stegerhoek PM, van der Zande J, IJzerman H, Verhagen EALM, Kuijer PPFM, Bolling C. More than Just Workload-Personnel's Perspective on Workload at the Royal Netherlands Marechaussee: A Qualitative Study. J Occup Environ Med 2024; 66:e185-e192. [PMID: 38412395 DOI: 10.1097/jom.0000000000003073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
OBJECTIVES We investigated the perspective on workload within the Royal Netherlands Marechaussee, part of the Dutch armed forces. METHODS This qualitative study follows an emergent design based on grounded theory principles and used semistructured interviews and focus groups with 91 Royal Netherlands Marechaussee employees. The interviews ( n = 31) and focus groups ( n = 14) were transcribed verbatim and analyzed by two researchers (C.B. and J.v.d.Z.) according to comparative data analysis. RESULTS Participants believed the perception of workload to be more important than the actual workload. Furthermore, participants mentioned that indirect factors, such as organizational factors and recruitment, could modulate their workload perception. CONCLUSIONS The perception of workload is key within the context of the Royal Netherlands Marechaussee. Modifiable factors related to the perceived workload could facilitate employee well-being without reducing the actual workload.
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Affiliation(s)
- Pablo M Stegerhoek
- From the Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Science, Amsterdam UMC, Amsterdam, the Netherlands (P.M.S., E.A.L.M.V., P.P.F.M.K., C.B.); Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Academic Medical Centre Amsterdam, the Netherlands (P.M.S., J.v.d.Z., P.P.F.M.K.); and Royal Netherlands Marechaussee, Health Care Section, Plein-Kalvermarkt-Complex, Den Haag, the Netherlands (P.M.S., J.v.d.Z., H.I.J.)
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Walsh CA, Dukart A, Roger K, Goodridge D. Disclosure and Reporting of Abuse Against Older Adults: Perspectives of Older Adults with Abuse Histories and Service Providers in Alberta, Canada. J Gerontol Soc Work 2024; 67:444-473. [PMID: 38590169 DOI: 10.1080/01634372.2024.2339990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 04/03/2024] [Indexed: 04/10/2024]
Abstract
This exploratory qualitative study seeks to understand the barriers and facilitators of disclosure and reporting of abuse against older adults by conducting interviews with older adults with lived experience of abuse and service providers working directly with this population in Alberta, Canada. Thematic analysis revealed three key themes: (1) Barriers to disclosure and reporting of abuse; (2) Facilitators to disclosure and reporting; and (3) Key tensions between service providers' and older adults' perceptions of the disclosure and reporting process. Based on these findings, we offer recommendations to increase awareness, promote disclosure, and improve services for older adults experiencing abuse.
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Affiliation(s)
- Christine A Walsh
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Amber Dukart
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Kerstin Roger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Donna Goodridge
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
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Haen LS, McGown M, Taylor S, Conroy L, Velonis A. Systemic Occupational Health Needs of Gender-Based Violence Advocates: Findings From the Early Months of the Pandemic. J Occup Environ Med 2024; 66:e145-e152. [PMID: 38349323 DOI: 10.1097/jom.0000000000003065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
OBJECTIVE This study explores occupational health burdens faced by domestic and sexual violence advocates, many of which intensified during the COVID-19 pandemic. It identifies key stressors and offers advocate-driven recommendations to improve their wellbeing, addressing the lack of system-level interventions in the occupational health literature. METHODS Semistructured interviews were conducted with 22 advocacy professionals. Thematic content analysis guided transcript coding, and researchers shared initial results with participants in two member checking sessions to validate the preliminary findings. RESULTS Advocates experienced logistical, emotional, and systemic stressors, including loss of peer support and unempathetic workplace cultures. Recommendations prioritize advocate wellbeing and call for systemic changes. CONCLUSIONS Advocates' occupational stressors highlight the need for system-level solutions to enhance their occupational wellbeing, particularly during large-scale emergencies. Collaborative efforts among employers, funders, and staff are essential to address system deficiencies.
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Affiliation(s)
- Lisa Sophia Haen
- From the Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois (L.S.H., M.M.G., S.T., A.V.); and Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois (L.C.)
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Harthoorn FS, Scharenborg SWJ, Brink M, Peters-Bax L, Henssen DJHA. Students' and junior doctors' perspectives on radiology education in medical school: a qualitative study in the Netherlands. BMC Med Educ 2024; 24:479. [PMID: 38693517 PMCID: PMC11062010 DOI: 10.1186/s12909-024-05460-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 04/23/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Modern medicine becomes more dependent on radiologic imaging techniques. Over the past decade, radiology has also gained more attention in the medical curricula. However, little is known with regard to students' perspectives on this subject. Therefore, this study aims to gain insight into the thoughts and ideas of medical students and junior doctors on radiology education in medical curricula. METHODS A qualitative, descriptive study was carried out at one medical university in the Netherlands. Participants were recruited on social media and were interviewed following a predefined topic list. The constant comparative method was applied in order to include new questions when unexpected topics arose during the interviews. All interviews were transcribed verbatim and coded. Codes were organized into categories and themes by discussion between researchers. RESULTS Fifteen participants (nine junior doctors and six students) agreed to join. From the coded interviews, four themes derived from fifteen categories arose: (1) The added value of radiology education in medical curricula, (2) Indispensable knowledge on radiology, (3) Organization of radiology education and (4) Promising educational innovations for the radiology curriculum. CONCLUSION This study suggests that medical students and junior doctors value radiology education. It provides insights in educational topics and forms for educational improvement for radiology educators.
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Affiliation(s)
- Frederike S Harthoorn
- Radboud University Nijmegen, Nijmegen, The Netherlands.
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Sascha W J Scharenborg
- Radboud University Nijmegen, Nijmegen, The Netherlands
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Monique Brink
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Liesbeth Peters-Bax
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dylan J H A Henssen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
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Alderson J, Thornton M, Skae M, Jones J, Nicoll N, Harcourt D, Woodward M, Crowne EC. Parental concerns about genital differences in children with congenital adrenal hyperplasia persist regardless of the selected intervention. J Sex Med 2024; 21:361-366. [PMID: 38481013 DOI: 10.1093/jsxmed/qdae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/20/2024] [Accepted: 02/04/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Congenital Adrenal Hyperplasia (CAH) due to 21-hydroxylase deficiency (21HD) can affect the in utero development of the genital anatomy of people with the 46XX karyotype. Health professionals engage parents in decision-making regarding managing genitals with this difference, including genital surgery options and patient communication. AIM We sought to investigate parental communication with their daughters regarding clitoral size variation related to neonatal CAH. METHODS Semistructured in-person interviews of 24 parents of chromosomal XX children with clitoral size variation attributable to a neonatal CAH diagnosis comprised 3 management categories: (1) clitoral reduction surgery (RS) (7 parents, 9 children), (2) clitoral concealment surgery (CS) (8 parents, 8 children), and no surgery on or around the clitoris (NS) (9 parents, 7 children). OUTCOMES Four representative themes, Obvious Choice, Still Different, Parental Burden, and Ignorance Is Bliss, were common across all 3 treatment groups. RESULTS For most parents, none of the 3 options of genital appearance alteration via clitoral reduction, clitoral concealment surgery, or avoidance of clitoral surgery ameliorated concerns, with most parents expressing an aversion to educating their child on the topic of genital differences, past treatment, or future function. CLINICAL IMPLICATIONS Reliance on surgical treatment pathways to manage this psychosocial concern is ineffective in alleviating parental uncertainty without the application of psychosocial interventions. STRENGTHS AND LIMITATIONS This was a qualitative study but was limited to parents of children with a specific genital difference, without direct exploration of parental values regarding the clitoris or the application of adequate psychosocial care. CONCLUSION Healthcare services must have an impact on parental ability to engage in essential communication with their children in cases such as clitoral size variation related to neonatal CAH. Improved communication skills allow parents to engage in more genuine decision-making and adapt to enduring genital reality, including possible future sexual challenges for their adult child, without resorting to burdensome strategies focused on attempts to perpetuate a benevolent ignorance.
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Affiliation(s)
- Julie Alderson
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, United Kingdom
| | - Maia Thornton
- University of the West of England, Stoke Gifford, Bristol BS16 1QY, United Kingdom
| | - Mars Skae
- Manchester University NHS Foundation Trust, Cobbett House Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
| | - Julie Jones
- Manchester University NHS Foundation Trust, Cobbett House Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
| | - Nicky Nicoll
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, United Kingdom
| | - Diana Harcourt
- University of the West of England, Stoke Gifford, Bristol BS16 1QY, United Kingdom
| | - Mark Woodward
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, United Kingdom
| | - Elizabeth C Crowne
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, United Kingdom
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Weigold S, Schorr SG, Faust A, Woydack L, Strech D. Informed consent and trial prioritization for clinical studies during the COVID-19 pandemic. Stakeholder experiences and viewpoints. PLoS One 2024; 19:e0302755. [PMID: 38687699 PMCID: PMC11060594 DOI: 10.1371/journal.pone.0302755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/05/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Very little is known about the practice-oriented challenges and potential response strategies for effective and efficient translation of informed consent and study prioritization in times of a pandemic. This stakeholder interview study aimed to identify the full spectrum of challenges and potential response strategies for informed consent and study prioritization in a pandemic setting. METHODS We performed semi-structured interviews with German stakeholders involved in clinical research during the COVID-19 pandemic. We continued sampling and thematic text analysis of interview transcripts until thematic saturation of challenges and potential response strategies was reached. RESULTS We conducted 21 interviews with investigators, oversight bodies, funders and research support units. For the first topic informed consent we identified three main themes: consent challenges, impact of consent challenges on clinical research, and potential strategies for consent challenges. For the second topic prioritization of clinical studies, we identified two main themes: perceived benefit of prioritization and potential strategies for prioritization. All main themes are further specified with subthemes. A supplementary table provides original quotes from the interviews for all subthemes. DISCUSSION Potential response strategies for challenges with informed consent and study prioritization partly share common ground. High quality procedures for study prioritization, for example, seem to be a core response strategy in dealing with informed consent challenges. Especially in a research environment with particularly high uncertainty regarding potential treatment effects and further limitations for valid informed consent should the selection of clinical trials be very well justified from a scientific, medical, and ethics viewpoint.
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Affiliation(s)
- Stefanie Weigold
- QUEST Center for Responsible Research, Berlin Institute of Health (BIH) at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Susanne Gabriele Schorr
- QUEST Center for Responsible Research, Berlin Institute of Health (BIH) at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Alice Faust
- QUEST Center for Responsible Research, Berlin Institute of Health (BIH) at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Lena Woydack
- QUEST Center for Responsible Research, Berlin Institute of Health (BIH) at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Daniel Strech
- QUEST Center for Responsible Research, Berlin Institute of Health (BIH) at Charité – Universitätsmedizin Berlin, Berlin, Germany
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Lockett M, Mash RJ. Lived experiences of women with spontaneous abortion at a district hospital, South Africa. S Afr Fam Pract (2004) 2024; 66:e1-e9. [PMID: 38708752 DOI: 10.4102/safp.v66i1.5917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/23/2024] [Accepted: 02/25/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Spontaneous abortions occur in 12.5% of pregnancies and have a significant impact on the well-being of women. Dissatisfaction with health services is well-documented, but no studies have been conducted in district health services of the Western Cape. The aim was to explore the lived experiences of women presenting with spontaneous abortions to the emergency department at Helderberg Hospital. METHODS A descriptive phenomenological qualitative study used criterion-based purposive sampling to identify suitable participants. Data were collected through semi-structured individual interviews. Atlas-ti (version 22) software assisted with data analysis using the framework method. RESULTS A total of nine participants were interviewed. There were four main themes: a supportive environment, staff attitudes and behaviour, the impact of time, and sharing of information. The comfort, cleanliness and privacy of the environment were important. COVID-19 had also impacted on this. Showing interest, demonstrating empathy and being nonjudgemental were important, as well as the waiting time for definitive treatment and the time needed to assimilate and accept the diagnosis. In addition, the ability to give relevant information, explain the diagnosis and help patients share in decision-making were key issues. CONCLUSION This study highlighted the need for a more person-centred approach and managers should focus on changes to organisational culture through training and clinical governance activities. Attention should be paid to the physical environment, availability of patient information materials and sequential coordination of care with primary care services.Contribution: This study identifies issues that can improve person-centredness and women's satisfaction with care for spontaneous abortion.
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Affiliation(s)
- Marshall Lockett
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
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Zapata Mayor JC, Hoyos Hernández PA. Health care: life stories by trans women in Colombia. Int J Equity Health 2024; 23:85. [PMID: 38689319 PMCID: PMC11061956 DOI: 10.1186/s12939-023-01859-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 03/12/2023] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND In Colombia, health care for people with trans life experiences is characterised by countless barriers to health services and care. Commonly, trans people have experienced stigma and discrimination among health professionals, a lack of services and professionals specialized to guarantee affirmative processes from non-hegemonic gender perspectives, and there exists a marked pathologization and medicalization of services. Therefore, it is necessary to provide affirmative health services to improve health and well-being from the recognition of their needs and experiences. The article describes life narratives about health care for the gender transitions of trans women in Colombia. METHODS A qualitative narrative study was conducted with 139 trans women in seven cities in Colombia. In-depth interviews and discussion groups were conducted between June 2019 and March 2020. Data were analyzed using thematic analysis and the Atlas Ti cloud program. National and international ethical guidelines were followed in the development of the research. RESULTS This research provided an overview of the health experiences of Colombian trans women. They reported their experiences of pathologizing approaches to transgender healthcare, stigma, discrimination, and barriers to accessing preventive, specialized, and regular healthcare services. For this reason, they opted for self-medicated gender transition processes and self-management of health care. An important aspect to consider within healthcare is that not all women want binary gender transition processes. CONCLUSION Participants felt that in Colombia there is a lack of affirmative health care for transgender women and that there are many limitations to care related to the gender transition processes. This exposes them to more situations that violate their rights and influences their lack of confidence and their search for professional health care. In Colombia, it is important to develop strategies for education, information, and communication, as well as a handbook for health workers on specialized healthcare for trans women.
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Sung B, O'Driscoll F, Gregory A, Grailey K, Franklin H, Poon S, Lawrence-Jones A, Shepherd L, McCrudden C, Klaber B, Pavlakis C, Darzi A, Huf S. Identifying barriers to outpatient appointment attendance in patient groups at risk of inequity: a mixed methods study in a London NHS trust. BMC Health Serv Res 2024; 24:554. [PMID: 38693519 PMCID: PMC11061980 DOI: 10.1186/s12913-024-10947-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/03/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND There is significant health inequity in the United Kingdom (U.K.), with different populations facing challenges accessing health services, which can impact health outcomes. At one London National Health Service (NHS) Trust, data showed that patients from deprived areas and minority ethnic groups had a higher likelihood of missing their first outpatient appointment. This study's objectives were to understand barriers to specific patient populations attending first outpatient appointments, explore systemic factors and assess appointment awareness. METHODS Five high-volume specialties identified as having inequitable access based on ethnicity and deprivation were selected as the study setting. Mixed methods were employed to understand barriers to outpatient attendance, including qualitative semi-structured interviews with patients and staff, observations of staff workflows and interrogation of quantitative data on appointment communication. To identify barriers, semi-structured interviews were conducted with patients who missed their appointment and were from a minority ethnic group or deprived area. Staff interviews and observations were carried out to further understand attendance barriers. Patient interview data were analysed using inductive thematic analysis to create a thematic framework and triangulated with staff data. Subthemes were mapped onto a behavioural science framework highlighting behaviours that could be targeted. Quantitative data from patient interviews were analysed to assess appointment awareness and communication. RESULTS Twenty-six patients and 11 staff were interviewed, with four staff observed. Seven themes were identified as barriers - communication factors, communication methods, healthcare system, system errors, transport, appointment, and personal factors. Knowledge about appointments was an important identified behaviour, supported by eight out of 26 patients answering that they were unaware of their missed appointment. Environmental context and resources were other strongly represented behavioural factors, highlighting systemic barriers that prevent attendance. CONCLUSION This study showed the barriers preventing patients from minority ethnic groups or living in deprived areas from attending their outpatient appointment. These barriers included communication factors, communication methods, healthcare the system, system errors, transport, appointment, and personal factors. Healthcare services should acknowledge this and work with public members from these communities to co-design solutions supporting attendance. Our work provides a basis for future intervention design, informed by behavioural science and community involvement.
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Affiliation(s)
| | - Fiona O'Driscoll
- Helix Centre, Institute of Global Health Innovation, Imperial College London, Room 1035/7, QEQM Wing, St Mary's Campus, London, W2 1NY, UK.
| | - Alice Gregory
- Helix Centre, Institute of Global Health Innovation, Imperial College London, Room 1035/7, QEQM Wing, St Mary's Campus, London, W2 1NY, UK
| | - Kate Grailey
- Helix Centre, Institute of Global Health Innovation, Imperial College London, Room 1035/7, QEQM Wing, St Mary's Campus, London, W2 1NY, UK
| | | | - Sharon Poon
- Imperial College Healthcare NHS Trust, London, UK
| | - Anna Lawrence-Jones
- Institute of Global Health Innovation, Imperial College London, London, UK
- National Institute for Health and Care Research (NIHR) North West London Patient Safety Research Collaboration (PSRC), London, UK
| | - Leila Shepherd
- Helix Centre, Institute of Global Health Innovation, Imperial College London, Room 1035/7, QEQM Wing, St Mary's Campus, London, W2 1NY, UK
| | - Clare McCrudden
- Helix Centre, Institute of Global Health Innovation, Imperial College London, Room 1035/7, QEQM Wing, St Mary's Campus, London, W2 1NY, UK
| | - Bob Klaber
- Imperial College Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | - Chris Pavlakis
- Helix Centre, Institute of Global Health Innovation, Imperial College London, Room 1035/7, QEQM Wing, St Mary's Campus, London, W2 1NY, UK
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Sarah Huf
- Institute of Global Health Innovation, Imperial College London, London, UK
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Ceasar RC, Ladi-Seyedian SS, Escobar D, Han J, Koh K, Porten S, Chu C, Gould EE, Bhanvadia S. "I think my vagina is still there?": Women's perspectives on sexual function and dysfunction following radical cystectomy for bladder cancer, a qualitative study. J Sex Med 2024; 21:464-470. [PMID: 38491395 DOI: 10.1093/jsxmed/qdae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/22/2024] [Accepted: 01/28/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Women's sexual health after radical cystectomy is an important but poorly understood aspect of bladder cancer survivorship. Dedicated investigation is needed to elucidate patient perceptions on sexual function and dysfunction in this setting. AIMS In this study we sought to qualitatively examine women's perceptions and experiences of sexual health following radical cystectomy for bladder cancer. METHODS We conducted one-on-one qualitative telephone interviews with 40 women who underwent radical cystectomy in the past 6 months to 5 years and signed a research consent form to be contacted for future studies. We examined women's experiences of engaging in sexual activity after surgery and their attitudes toward sex and body image. We audio recorded, transcribed, and coded the interviews using ATLAS.ti software and applied grounded theory methods for analysis. OUTCOMES For data that emerged during the qualitative interviews that was related to lack of knowledge about how physical and psychological sexual health would be affected after surgery, we reviewed and discussed transcripts that enabled coding of the data into emerging topic areas. RESULTS Our analysis yielded 4 main themes. (1) Women reported receiving little to no information from providers about female sexual dysfunction prior to or after radical cystectomy. Women wished they had been provided more information about female sexual dysfunction from their clinicians, including strategies for postoperative self-pleasure and nonintercourse methods of sexual pleasure with partners. (2) Women shared that they were not sexually active following surgery due to physical and mental barriers. (3) When women did try to engage in sex, they described feeling disappointed that it did not feel the same as prior to surgery. (4) Some women found that physical therapy helped them to physically and mentally recover their strength to engage in sexual activity again. CLINICAL IMPLICATIONS Clinicians must directly address sexual health concerns with patients who undergo radical cystectomy. STRENGTHS AND LIMITATIONS This study has several key strengths. Investigation into women's sexual function and dysfunction addresses a gap in understanding of this component of women's health-related quality of life after radical cystectomy, which represents an unmet need. The large number of interviews conducted as well as the in-depth information obtained through one-on-one interviews are additional strengths. This study also has limitations, including possible shortcomings of telephone interviews compared with in-person interviews. However, telephone interviews were beneficial because the interviews took place during the COVID-19 pandemic and spared patients from extra visits or from having to travel long distances to the respective medical centers. Other possible limitations were that patients may have been reluctant to share all of their experiences and that patients who underwent urostomies, also termed ileal conduits, were overrepresented in this study compared with women who underwent continent urine diversions, which allow greater control over urine output. CONCLUSION Broadening the understanding of sexual health beyond sexual intercourse to encompass sexuality and self-pleasure can provide clinicians, patients, and their families with more effective preparation and strategies to care for an essential aspect of their wellbeing.
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Affiliation(s)
- Rachel Carmen Ceasar
- Department of Population and Public Health Sciences, University of Southern California, Keck School of Medicine, 1845 N Soto St, Los Angeles, CA 90032, United States
| | - Seyedeh-Sanam Ladi-Seyedian
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave, Los Angeles, CA 90033, United States
| | - Domenique Escobar
- Department of Urology, University of California, San Francisco, 400 Parnassus Ave, San Francisco, CA 94143, United States
| | - Jullet Han
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave, Los Angeles, CA 90033, United States
| | - Kailyn Koh
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave, Los Angeles, CA 90033, United States
| | - Sima Porten
- Department of Urology, University of California, San Francisco, 400 Parnassus Ave, San Francisco, CA 94143, United States
| | - Carissa Chu
- Department of Urology, University of California, San Francisco, 400 Parnassus Ave, San Francisco, CA 94143, United States
| | - Erin E Gould
- Department of Population and Public Health Sciences, University of Southern California, Keck School of Medicine, 1845 N Soto St, Los Angeles, CA 90032, United States
| | - Sumeet Bhanvadia
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave, Los Angeles, CA 90033, United States
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Petrie FJ, Mackintosh KA, Starbuck C, Williams EMP, McNarry MA. Concussion response and recovery in men and women's rugby union: A reflexive thematic analysis of player interviews. PLoS One 2024; 19:e0296646. [PMID: 38687724 PMCID: PMC11060544 DOI: 10.1371/journal.pone.0296646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/12/2023] [Indexed: 05/02/2024] Open
Abstract
Numerous concussion-management protocols have been developed in rugby, though little is known about player's personal experiences of concussion. Specifically, research typically refers to clinical recovery, with social and psychological sequelae post-concussion gaining little attention. This study aimed to explore the experiences of rugby players in relation to being concussed and recovering from concussion. UK-based rugby players (10 men, 9 women and 1 non-binary person) from school, university, club, military and semi-professional teams took part in semi-structured interviews (36 ± 12 minutes). Interviews were transcribed verbatim, and a reflexive thematic analysis was conducted. Players considered pitch-side healthcare a necessity, though amateur players highlighted the difficulty in consistently accessing this resource. In the absence of medical staff, players were reliant on the goodwill of volunteers, but their response to concussion did not always align with current concussion guidance. Players highlighted that concussion recovery could be socially isolating and that current return-to-play programmes did little to restore lost confidence, resulting in retirement from the game in some instances. Participants expressed a desire for more in-person concussion education and for greater coverage of holistic methods to support their recovery. This study highlights a need for further investigation of the post-concussion social and psychological changes that players may experience during their recovery. Greater focus on information relating to concussion recovery and return-to-contact in education programmes would likely benefit player welfare.
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Affiliation(s)
- Freja J. Petrie
- Applied Sports, Technology, Exercise and Medicine, Swansea University, Swansea, Wales, United Kingdom
| | - Kelly A. Mackintosh
- Applied Sports, Technology, Exercise and Medicine, Swansea University, Swansea, Wales, United Kingdom
| | - Chelsea Starbuck
- Applied Sports, Technology, Exercise and Medicine, Swansea University, Swansea, Wales, United Kingdom
| | - Elisabeth M. P. Williams
- Applied Sports, Technology, Exercise and Medicine, Swansea University, Swansea, Wales, United Kingdom
| | - Melitta A. McNarry
- Applied Sports, Technology, Exercise and Medicine, Swansea University, Swansea, Wales, United Kingdom
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Armengol M, Hayward G, Abbott MG, Bird C, Bergmann JHM, Glogowska M. Clinician and parent views on urine collection in precontinent children in the UK: a qualitative interview study. BMJ Open 2024; 14:e081306. [PMID: 38684250 DOI: 10.1136/bmjopen-2023-081306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE To explore the experiences of healthcare professionals (HCPs) and parents of urine collection methods, to identify barriers to successful sampling and what could improve the process. DESIGN Qualitative research, using individual semistructured interviews with HCPs and parents. The interviews were audiorecorded, transcribed and thematically analysed. SETTING UK-based HCPs from primary and secondary care settings and parents with experience with urine collection in primary and/or secondary care settings. PARTICIPANTS HCPs who were involved in aiding, supervising or ordering urine samples. Parents who had experience with urine collection in at least one precontinent child. RESULTS 13 HCPs and 16 parents were interviewed. 2 participating HCPs were general practitioners (GPs), 11 worked in paediatric secondary care settings (8 were nurses and 3 were doctors). Two parents had children with underlying conditions where frequent urine collection was required to rule out infections.HCPs and parents reported that there were no straightforward methods of urine collection for precontinent children. Each method-'clean catch', urine bag and urine pad-had limitations and problems with usage. 'Clean catch', regarded as the gold standard by HCPs with a lower risk of contamination, often proved difficult for parents to achieve. Other methods had elevated risk of contamination but were more acceptable to parents because they were less challenging. Many of the parents expressed the need for more information about urine collection. CONCLUSIONS Current methods of urine collection are challenging to use and may be prone to contamination. A new device is required to assist with urine collection in precontinent children, to simplify and reduce the stress of the situation for those involved. Parents are key partners in the process of urine collection with young children. Meeting their expressed need for more information could be an important way to achieve better-quality samples while awaiting a new device.
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Affiliation(s)
- Monica Armengol
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Chris Bird
- Emergency Department, Birmingham Children's Hospital, Birmingham, UK
| | | | - Margaret Glogowska
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Sampson FC, Hughes J, Long J, Buykx P, Goodacre SW, Snooks H, Edwards A, Evans B, Jones J, Moore C, Johnston S. Is a randomised controlled trial of take home naloxone distributed in emergency settings likely to be feasible and acceptable? Findings from a UK qualitative study exploring perspectives of people who use opioids and emergency services staff. BMC Emerg Med 2024; 24:75. [PMID: 38679713 PMCID: PMC11057101 DOI: 10.1186/s12873-024-00987-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/15/2024] [Indexed: 05/01/2024] Open
Abstract
OBJECTIVE Distribution of take-home naloxone (THN) by emergency services may increase access to THN and reduce deaths and morbidity from opioid overdose. As part of a feasibility study for a randomised controlled trial (RCT) of distribution of THN kits and education within ambulance services and Emergency Departments (EDs), we used qualitative methods to explore key stakeholders' perceptions of feasibility and acceptability of delivering the trial. METHODS We undertook semi-structured interviews and focus groups with 26 people who use opioids and with 20 paramedics and ED staff from two intervention sites between 2019 and 2021. Interviews and focus groups were recorded, transcribed verbatim and analysed using Framework Analysis. RESULTS People using opioids reported high awareness of overdose management, including personal experience of THN use. Staff perceived emergency service provision of THN as a low-cost, low-risk intervention with potential to reduce mortality, morbidity and health service use. Staff understood the trial aims and considered it compatible with their work. All participants supported widening access to THN but reported limited trial recruitment opportunities partly due to difficulties in consenting patients during overdose. Procedural problems, restrictive recruitment protocols, limited staff buy-in and patients already owning THN limited trial recruitment. Determining trial effectiveness was challenging due to high levels of alternative community provision of THN. CONCLUSIONS Distribution of THN in emergency settings was considered feasible and acceptable for stakeholders but an RCT to establish the effectiveness of THN delivery is unlikely to generate further useful evidence due to difficulties in recruiting patients and assessing benefits.
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Affiliation(s)
- F C Sampson
- Division of Population Health, University of Sheffield, Sheffield, UK.
| | - J Hughes
- Division of Population Health, University of Sheffield, Sheffield, UK
| | - J Long
- Division of Population Health, University of Sheffield, Sheffield, UK
| | - P Buykx
- School of Humanities, Creative Industries and Social Sciences, University of Newcastle, Newcastle, Australia
| | - S W Goodacre
- Division of Population Health, University of Sheffield, Sheffield, UK
| | - H Snooks
- Department of Medicine, Swansea University, Swansea, UK
| | - A Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Bridie Evans
- Department of Medicine, Swansea University, Swansea, UK
| | - Jenna Jones
- Department of Medicine, Swansea University, Swansea, UK
| | - Chris Moore
- Welsh Ambulance Service NHS Trust, Cardiff, UK
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Farokhzadian J, Shahrbabaki PM, Farahmandnia H, Eskici GT, Goki FS. Exploring the consequences of nurses' involvement in disaster response: findings from a qualitative content analysis study. BMC Emerg Med 2024; 24:74. [PMID: 38679695 PMCID: PMC11057086 DOI: 10.1186/s12873-024-00994-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND The presence of nurses during disasters can lead to many consequences. Understanding the nurses' experiences of these consequences can provide valuable insights. Therefore, this study was conducted to explore the experiences of Iranian nurses regarding the consequences they faced when being present during disasters. METHODS This qualitative descriptive study employed a content analysis approach to examine the topic at hand. 20 nurses working in the emergency units of Kerman hospitals were selected through purposive sampling. In-depth semi-structured interviews were conducted to collect the data. The data were analyzed using qualitative content analysis proposed by Graneheim and Lundman. MAXQDA 10 was used to manage data. RESULTS After analysis of the interviews, two main categories were identified: overlapping of job frustrations and acquiring experience in difficult conditions. The main category of acquiring experience in difficult conditions comprised the following subcategories: improved quality of care, experience and dedication in fulfilling the role, reduced stress, occupational motivation and enthusiasm, increased self-confidence, and improved social status. On the other hand, the category of overlapping of job frustrations also consisted of the subcategories of physical strength deterioration, psychological and emotional distress, discontinued from supports, feelings of hopelessness, increased exposure to violence and aggression, and occurrence of family problems. CONCLUSION Being present during disasters and obtaining the necessary competencies can have positive consequences that serve as turning points in the personal and professional growth of nurses. Additionally, favorable outcomes can help nurses cope with adverse circumstances. Managers can utilize the findings of this study to develop strategies aimed at reducing negative outcomes and enhancing positive ones among nurses during disasters.
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Affiliation(s)
| | | | - Hojjat Farahmandnia
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Gülcan Taskiran Eskici
- Department of Nursing Administration, Faculty of Health Sciences, Ondokuz Mayis University, Samsun, Turkey
| | - Faezeh Soltani Goki
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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147
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Gamble AR, McKay MJ, Anderson DB, Pappas E, Alvarez Cooper I, Macpherson S, Harris IA, Filbay SR, McCaffery K, Thompson R, Hoffmann TC, Maher CG, Zadro JR. Development of a patient decision aid for children and adolescents following anterior cruciate ligament rupture: an international mixed-methods study. BMJ Open 2024; 14:e081421. [PMID: 38684251 DOI: 10.1136/bmjopen-2023-081421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
AIM To develop and user test an evidence-based patient decision aid for children and adolescents who are considering anterior cruciate ligament (ACL) reconstruction. DESIGN Mixed-methods study describing the development of a patient decision aid. SETTING A draft decision aid was developed by a multidisciplinary steering group (including various types of health professionals and researchers, and consumers) informed by the best available evidence and existing patient decision aids. PARTICIPANTS People who ruptured their ACL when they were under 18 years old (ie, adolescents), their parents, and health professionals who manage these patients. Participants were recruited through social media and the network outreach of the steering group. PRIMARY AND SECONDARY OUTCOMES Semistructured interviews and questionnaires were used to gather feedback on the decision aid. The feedback was used to refine the decision aid and assess acceptability. An iterative cycle of interviews, refining the aid according to feedback and further interviews, was used. Interviews were analysed using reflexive thematic analysis. RESULTS We conducted 32 interviews; 16 health professionals (12 physiotherapists, 4 orthopaedic surgeons) and 16 people who ruptured their ACL when they were under 18 years old (7 were adolescents and 9 were adults at the time of the interview). Parents participated in 8 interviews. Most health professionals, patients and parents rated the aid's acceptability as good-to-excellent. Health professionals and patients agreed on most aspects of the decision aid, but some health professionals had differing views on non-surgical management, risk of harms, treatment protocols and evidence on benefits and harms. CONCLUSION Our patient decision aid is an acceptable tool to help children and adolescents choose an appropriate management option following ACL rupture with their parents and health professionals. A clinical trial evaluating the potential benefit of this tool for children and adolescents considering ACL reconstruction is warranted.
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Affiliation(s)
- Andrew R Gamble
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Marnee J McKay
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David B Anderson
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Evangelos Pappas
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | | | - Sophie Macpherson
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ian A Harris
- Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW, Sydney, New South Wales, Australia
| | - Stephanie R Filbay
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachel Thompson
- Discipline of Behavioural and Social Sciences in Health, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Christopher G Maher
- Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Joshua R Zadro
- Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
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148
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Van der Merwe LLA, Moyo I, Mavhandu-Mudzusi AH. Determinants of antiretroviral therapy adherence among transgender women in South Africa. S Afr Fam Pract (2004) 2024; 66:e1-e8. [PMID: 38708751 DOI: 10.4102/safp.v66i1.5869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Transgender women bear a huge burden of human immunodeficiency virus (HIV) in South Africa. However, they are not fully engaged in healthcare across the HIV continuum of care. In addition, transgender women face multiple facets of stigma and discrimination as well as socio-economic inequalities, which all have a negative impact on antiretroviral therapy (ART) adherence. OBJECTIVE The study aimed at exploring and describing the experiences of ART adherence of transgender women living with HIV in the Buffalo City Metro Municipality. METHODS The study employed an interpretative phenomenological analysis (IPA) design. Twelve participants were enrolled using a snowballing sampling technique. Data were collected using semi-structured interviews and analysed using an IPA framework. RESULTS While exploring determinants to ART adherence among transgender women living with HIV in Buffalo City Metro, two superordinate themes emerged: enablers to ART adherence and psychosocial factors promoting adherence. The study found that factors such as differentiated ART service delivery, ARV medicines-related factors, motivators for taking treatment and support systems facilitated ART adherence. CONCLUSION Emerging from this study is the need to scale up differentiated, person-centred ART service deliveries that will enhance access and adherence to treatment for transgender women.Contribution: This study provides unique insights on factors enhancing ART adherence among transgender women. There is a paucity of literature on access to HIV care services for key and vulnerable populations, and these findings will be shared in the country and in the region.
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Carroll P, Dervan A, McCarthy C, Woods I, Beirne C, Harte G, O’Flynn D, O’Connor C, McGuire T, Leahy LM, Gonzalez JG, Stasiewicz M, Maughan J, Quinlan J, Smith É, Moriarty F, O’Brien FJ, Flood M. The role of Patient and public involvement (PPI) in pre-clinical spinal cord research: An interview study. PLoS One 2024; 19:e0301626. [PMID: 38683786 PMCID: PMC11057720 DOI: 10.1371/journal.pone.0301626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 03/19/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Patient and public involvement in research (PPI) has many benefits including increasing relevance and impact. While using PPI in clinical research is now an established practice, the involvement of patients and the public in pre-clinical research, which takes place in a laboratory setting, has been less frequently described and presents specific challenges. This study aimed to explore the perspectives of seriously injured rugby players' who live with a spinal cord injury on PPI in pre-clinical research. METHODS Semi-structured interviews were conducted via telephone with 11 seriously injured rugby players living with spinal cord injury on the island of Ireland. A purposive sampling approach was used to identify participants. Selected individuals were invited to take part via gatekeeper in a charitable organisation that supports seriously injured rugby players. Interviews were transcribed verbatim and analysed thematically. FINDINGS Six themes were identified during analysis: 'appreciating potential benefits of PPI despite limited knowledge', 'the informed perspectives of people living with spinal cord injury can improve pre-clinical research relevance', 'making pre-clinical research more accessible reduces the potential for misunderstandings to occur', 'barriers to involvement include disinterest, accessibility issues, and fear of losing hope if results are negative', 'personal contact and dialogue helps people feel valued in pre-clinical research, and 'PPI can facilitate effective dissemination of pre-clinical research as desired by people living with spinal cord injury.' CONCLUSION People affected by spinal cord injury in this study desire further involvement in pre-clinical spinal cord injury research through dialogue and contact with researchers. Sharing experiences of spinal cord injury can form the basis of PPI for pre-clinical spinal cord injury research.
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Affiliation(s)
- Pádraig Carroll
- School of Pharmacy and Biomolecular Science, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG), Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI, Dublin, Ireland
| | - Adrian Dervan
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG), Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI, Dublin, Ireland
| | - Ciarán McCarthy
- c/o Irish Rugby Football Union Charitable Trust, Dublin, Ireland
| | - Ian Woods
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG), Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI, Dublin, Ireland
| | - Cliff Beirne
- Faculty of Sports and Exercise Medicine (Royal College of Physicians in Ireland & RCSI), Dublin, Ireland
| | - Geoff Harte
- c/o Irish Rugby Football Union Charitable Trust, Dublin, Ireland
| | - Dónal O’Flynn
- c/o Irish Rugby Football Union Charitable Trust, Dublin, Ireland
| | - Cian O’Connor
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG), Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI, Dublin, Ireland
| | - Tara McGuire
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG), Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI, Dublin, Ireland
| | - Liam M. Leahy
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG), Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI, Dublin, Ireland
| | - Javier Gutierrez Gonzalez
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG), Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI, Dublin, Ireland
| | - Martyna Stasiewicz
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG), Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI, Dublin, Ireland
| | - Jack Maughan
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG), Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI, Dublin, Ireland
| | - John Quinlan
- Tallaght University Hospital, Tallaght, Dublin, Ireland
| | - Éimear Smith
- National Rehabilitation Hospital, Dublin, Ireland
| | - Frank Moriarty
- School of Pharmacy and Biomolecular Science, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Fergal J. O’Brien
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG), Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI, Dublin, Ireland
| | - Michelle Flood
- School of Pharmacy and Biomolecular Science, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG), Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Advanced Materials and BioEngineering Research (AMBER) Centre, Trinity College Dublin (TCD) and RCSI, Dublin, Ireland
- PPI Ignite Network, Galway, Ireland
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150
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Bonan C, Reis APD, Rodrigues AP, Menezes GMDS, McCallum CA, Duarte NIG, Macedo U, Santana MDDS, Oliveira DCCD, Domingues RMSM, Leal MDC. Health care itineraries for women in situations of abortion: methodological aspects of a qualitative study for Birth in Brazil II survey. CAD SAUDE PUBLICA 2024; 40:e00006223. [PMID: 38695458 PMCID: PMC11057479 DOI: 10.1590/0102-311xpt006223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 07/20/2023] [Accepted: 10/06/2023] [Indexed: 05/06/2024] Open
Abstract
In recent decades, several academic studies on abortion have been produced in Brazil, with different designs, objectives, and methodologies. However, due to the diversity of situations in which Brazilian women experience abortion, the complexity of this topic, and its modulations in different political and sociocultural contexts, it still challenges academicians and the fields of health and reproductive rights. In this article, we present methodological aspects of a qualitative study on health care itineraries of women in situations of abortion, a component of the Birth in Brazil II survey, whose objective is to discuss the effects of gender; race/ethnicity; social class; generational, regional, and territorial inequalities on care itineraries. We discuss the study design development, the construction of the theoretical framework and specific analytical axes, the development of interview instrument, definition of participant selection criteria, strategies to contact participants and conduct the interviews, management of field work and materials produced, analytical procedures, and ethical issues. In total, 120 narrative interviews were conducted in order to include a diversity of women and obtain detailed results from the quantitative analysis under Birth in Brazil II survey. The context of criminalization of abortion has an impact on the production of knowledge on this subject, creating challenges such as difficult access to women, women's anonymity, privacy and data confidentiality, creation of objective and subjective conditions so that they can narrate their experiences in depth. With this article, we seek to contribute to the debate about these challenges in abortion research in Brazil.
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Affiliation(s)
- Claudia Bonan
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Ana Paula Dos Reis
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| | | | | | | | - Nanda Isele Gallas Duarte
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Ulla Macedo
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brasil
| | | | - Débora Cecília Chaves de Oliveira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Maria do Carmo Leal
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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