NVivo

Acceptability of improved cook stoves-a scoping review of the literature

Improved cooking stoves (ICS) are intended to reduce indoor air pollution and the inefficient use of fuel yet there is often reticence to shift permanently to ICS. Drawing on a scoping review, this article aims to provide a comprehensive overview of factors affecting the acceptability of ICS. A scoping review was carried out using a systematic search strategy of literature. All articles identified in three major databases that included Pubmed/Medline, Scopus and Web of Science underwent screening followed by content analysis to generate major and minor themes using a structured social level analysis. The analysis identified factors at micro, meso, and macro-social levels that potentially contribute to an adoption of an improved cooking stove (ICS). The findings from the review were discussed and refined among a group of experts identified based on their prior academic or commercial contributions related to ICS. Adoption of ICS was dependent on functional outputs (e.g. cleanliness, and cooking efficiency) while meeting local social and cultural demands (e.g. cooking large meals, traditional meals, and taste). Health and cost benefits played an important role in the adoption and sustained use of ICS. The adoption of ICS was enabled by use among neighbors and other community members. Sustained use of ICS depended on fuel supply, fuel security and policies promoting its use. Policies offering subsidies in support of supply-chain garnered institutional trust among community members and resulted in the sustained use of ICS. In addition to design attributes of ICS that could meet both scientific and social demands, policies supporting promotion of clean energy, subsidies and supplies can substantially enhance the adoption of ICS.

Supporting Autistic Children's Participation in Research Studies: A Mixed-Methods Study of Familiarizing Autistic Children with A Humanoid Robot

It is important that autism research is inclusive and supports the participation of a wide range of autistic people. However, there has been limited research on how to make studies accessible for autistic participants. This mixed-methods study explored how to promote the comfort of autistic children in research, using the specific example of visiting a research lab and meeting a humanoid robot. In Phase 1, 14 parents of autistic children were interviewed about how their child could be made comfortable during a lab visit, including different approaches for familiarizing their child with the robot. In Phase 2, autistic children of the parents in Phase 1 (n = 10) visited the lab and completed familiarization activities with a humanoid robot. The opinions of the children and their parents about the children's experiences were recorded. Using reflexive thematic analysis, five overarching themes reflected how to best support autistic child participants. These themes encompassed elements of particular relevance to robot studies but also many practices of general relevance to participating in research: (1) preparation is key, (2) consideration of environmental factors, (3) using familiarization, (4) a supportive and engaged researcher, and (5) individualized approaches. Based on our findings, we report preliminary and generalizable best-practice recommendations to support autistic children in a research setting and promote positive experiences.

Development and validation of a competency evaluation index system for nurse endoscopists with different stages performing endoscopy nursing in China: A modified Delphi study

BACKGROUND

The advancement of endoscopic techniques has resulted in an increasing need for comprehensive competency in endoscopy nursing. However, there is currently no unified competency evaluation index system for nurse endoscopists in China.

AIMS

To develop and validate of a competency evaluation index system for nurse endoscopists with different stages performing endoscopy nursing in China.

DESIGN

A modified Delphi study.

SETTINGS

Data were collected in a medical university affiliated hospital.

PARTICIPANTS

A total of 569 participants in different fields were included at various phases of this research.

METHODS

The preliminary indicators were designed after conducting a literature review, semi-structured interviews and questionnaires. Two rounds of correspondence with 30 experts using the Delphi method were conducted to evaluate the content of the index followed by reliability and validity tests. The competency evaluation index system for nurse endoscopists at different stages was developed through expert meetings based on the Delphi consultation results according to the novice-to-expert model.

RESULTS

After two rounds of Delphi method consultation, we have established 4 first-level indicators ('Cognitive skill', 'Practice professional skills', 'Professional development skills' and 'Personal characteristics and inner qualities') and 21 s-level indicators, which are the detailed description of first-level indicators. According to the index weight analysis, the four first-level indicators are ranked from the largest to the smallest as practical professional skills, cognitive skills, professional development skills, personal characteristics and intrinsic qualities. Three different stages of nurse endoscopists competency evaluation forms and criteria were developed: primary stage (New skilled), intermediate stage (Capable) and advanced stage (Expert).

CONCLUSIONS

The establishment of a competency evaluation index system based on the novice-to-expert model can accurately assess competency levels and help to effectively train the nurse endoscopists at different stages. Future research should focus on imbedding these competencies in nurse education.

Completion of the PainData questionnaire - A qualitative study of patients' experiences

OBJECTIVES

This study aimed to explore barriers experienced by patients with chronic pain to completing the PainData questionnaire (PDq) at the Interdisciplinary Pain Centre, Herlev and Gentofte Hospital (HGH). The PDq collects patient-reported data relevant for treatment decisions and research. However, at HGH the response rate prior to treatment initiation is only 67% despite a national response rate of over 80%.

METHODS

This qualitative study used individual, semi-structured interviews with patients from HGH. Content analysis was performed, and the study adhered to the COREQ guideline.

RESULTS

Fifteen participants (4 men, 11 women; median age 57) were interviewed. Four major categories were identified: (1) challenges originating from pain deterioration and stress hindering questionnaire completion, (2) lack of opportunity for nuanced responses, (3) inadequate patient understanding of the questionnaire's purpose, and (4) appreciation among participants of PainData's recognition of the long-term consequences of chronic pain.

CONCLUSION

This study highlighted key barriers to completing the PDq, including challenges related to its design and patients' resources. To address these issues, administrators could simplify the questionnaire. Individual clinics could enhance response rates by improving communication about the importance of patient-reported data, refining invitation strategies, and providing additional practical support. Despite these challenges, completion of the PDq encouraged participants to reflect on critical aspects of chronic pain, including its physical and mental health impacts. While the study provided valuable insights, the limited duration of interviews, due to participant fragility, was a notable limitation.

Taking Action to Support Nursing Home Resident Well-Being: Perspectives of U.S. Nursing Home Staff During COVID-19

BACKGROUND AND OBJECTIVES

Coronavirus disease 2019 (COVID-19) negatively influenced resident well-being in nursing homes (NHs). We examine perceptions and experiences of U.S. NH staff during the COVID-19 pandemic regarding resident well-being.

RESEARCH DESIGN AND METHODS

We sampled 68 NHs (out of 13,423) in strata defined by quality ratings, urban/rural location, and whether they served a resident population of <70% White. We enrolled 10 NHs and interviewed 11 nursing staff (8 certified nursing assistants/aides, 3 registered or licensed practical/vocational nurses), 12 managerial staff (4 administrators, 8 directors of nursing), and 5 infection preventionists. Thematic analysis identified themes related to challenges of quarantine/isolation, attempted solutions, and lessons learned concerning resident well-being.

RESULTS

Nursing home managerial, infection prevention, and nursing staff described how COVID-19 policies contributed to increased resident loneliness and declines in physical and cognitive well-being. Solutions/strategies employed across the United States and in low- and high-quality NHs included proactive mental health support, resident-centered family visitation, increased communication and care planning with families and efforts to maintain resident normalcy.

DISCUSSION AND IMPLICATIONS

Strategies to mitigate and alleviate concerns with resident well-being were both structural and made via staff choices. NH leadership needs to proactively plan how to adapt processes and structures that prioritize resident well-being along with resident care in times of crisis. Research is needed to outline the planning, implementation, and recommendations required to operationalize these strategies into practice. Determining the most effective ways to implement these structural changes within NH practices and workflows is critical to ensure that staff have sufficient time to spend with residents.

Development of a Complex Intervention for Promoting Participation in Resistance Exercise Among Community-Dwelling Frail Older Adults in China: A Multimethod Qualitative Study

Background and Objectives

Regular resistance exercise (RE) showed a promising effect in reducing frailty in older adults. However, the participation of RE among this population remains low. This study was, therefore, aimed at developing a complex intervention tailored to community-dwelling frail older adults in China to promote participation in RE and reduce frailty ultimately.

Research Design and Methods

Using a multimethods qualitative study design, this study included 2 parts: (1) a qualitative study was performed to explore barriers and facilitators for participation in RE among frail older adults through stakeholder interviews. The interview was guided by the comprehensive framework of implementation research; (2) two rounds of expert consultation, guided by the social cognitive theory, were conducted to identify the key barriers and facilitators, and corresponding implementation strategies for promoting participation in RE. A complex intervention was developed accordingly.

Results

Interviews were conducted with 16 frail older adults (mean age = 72.9) and 10 community workers (mean working years = 11.2). A total of 10 barriers and 16 facilitators were identified; safety concerns, decline in physical function, and lack of knowledge were frequently mentioned barriers, while health needs, social support, and professional guidance were common facilitators. Then 10 experts (mean working years = 20.9) were consulted to determine the main barriers and facilitators, and a list of corresponding implementation strategies was developed subsequently. Thus, a tailored complex intervention delivered by community workers in the community setting, including the core component of "group elastic-band RE," and supplementary components of "community education, feedback, goal setting, and reinforcement guidance" was developed.

Discussion and Implications

This study constructed a list of key barriers and facilitators as well as corresponding implementation strategies for promoting participation in RE among community-dwelling frail older adults. A tailored complex intervention was developed accordingly, which will facilitate the management of frail older adults in the Chinese community setting.

Bon Sante (Good Health): Factors Influencing PrEP Use Among Haitians/Haitian Americans

BACKGROUND

The HIV/AIDS epidemic has disproportionately affected Black individuals in the USA, and this health disparity has increased over time. Despite the effectiveness of pre-exposure prophylaxis (PrEP) as a prevention tool for HIV, there are disparities in its use, and uptake of this intervention remains low among racial and ethnic minorities, including Haitians/Haitian Americans. In this study, factors influencing PrEP use among Haitians/Haitian Americans in Miami, FL, are explored to provide necessary data to address disparities.

METHODS

The research team collaborated with local organizations to recruit 30 individuals (Haitians/Haitian Americans) between February 4 and October 1, 2021, and conducted semi-structured interviews. All interviews were audio-recorded and transcribed, and NVivo® was used to analyze the transcripts for emergent themes.

RESULTS

The study sample comprised 30 adults of Haitian descent in Miami, FL (50% female, approximately 67% with a high school education or more, mean age = 43.7 ± 13 years, and 74.2% born in Haiti). Four primary themes emerged from the analysis: (1) limited PrEP awareness, (2) underutilization of PrEP, (3) inadequate discussion of HIV prevention strategies, and (4) PrEP delivery encompassing barriers and facilitators for PrEP delivery and promotion strategies.

CONCLUSION

This study indicated that there is a critical need to increase Haitians/Haitian Americans' knowledge regarding PrEP. Health communication interventions tailored specifically for Haitians/Haitian Americans that target stigma, attitudes toward HIV, and risk perception may be significant in increasing PrEP in this population.

Conventional medication adherence and self-treatment practices among South Asian immigrants: a qualitative study

Introduction Globally, cardiovascular disease (CVD) is a common cause of death. The highest CVD rate is among South Asian populations and South Asian immigrants have a higher risk of developing CVD than other ethnic groups. While treatment of established CVD risk factors is recommended, medication adherence may be poor. Aim This qualitative study aimed to explore medication adherence practices of New Zealand South Asians who are prescribed medications for type 2 diabetes, and/or hypertension, and/or dyslipidaemia, established risk factors for CVD. Method Twenty-one semi-structured telephone interviews were conducted with South Asians with type 2 diabetes, and/or hypertension, and/or dyslipidaemia. Data were transcribed, then analysed thematically using NVivo12. Codes and inductively derived themes were discussed. Results Five themes with 12 subthemes were identified. The five themes included daily routine and medication adherence practices, perceived necessity of medications and concerns about side effects, concern and hesitancy to start conventional medications, integration of herbal and alternative therapies, and the role of healthcare providers and communication. Discussion These findings highlight the importance of personalised approaches to medication management that consider patients' beliefs, daily routines, and cultural contexts to reduce CVD risk and improve health outcomes among South Asians.

Living with a chronic hematological malignancy: Perspectives on PRO-based management of symptoms

PURPOSE

To explore study participants' experiences with chronic hematologic malignancies and their perspectives on symptom management based on patient-reported outcomes during follow-up care.

METHODS

This qualitative descriptive study used semi-structured telephone interviews conducted from May 2022 to February 2023. A purposeful sample was recruited, with participants invited consecutively. Participants were adults ≥18 years diagnosed with a chronic hematological malignancy and participating in a symptom management intervention. Reflexive thematic analysis, as described by Braun and Clarke, was used to perform an inductive analysis of the interview data.

RESULTS

A total of 19 telephone interviews were conducted with 17 participants. Participants had nuanced perspectives on managing life with a chronic and uncommon hematological malignancy reflected in the following themes: not allowing the disease to dominate, struggling to understand and manage the disease, navigating everyday life with the disease, and evaluating impact and tailoring of patient reported outcome-based symptom management.

CONCLUSION

This study emphasizes the ambiguity of living with a chronic hematological malignancy. Participants strive to prevent the disease from dominating their lives, despite their struggles to understand and manage the disease. The use of patient-reported outcomes in dialogue and targeted symptom management helped participants navigate daily life challenges. These findings underscore important considerations for enhancing follow-up care for patients with chronic hematological malignancies.

The Perspective of Cancer Patients in Palliative Care on Unmet Needs: A Qualitative Synthesis Using Meta-Ethnography

BACKGROUND

As cancer patients approach the end of life, their needs become more complex, increasing the demand for palliative care. Advanced-stage cancer patients encounter increasing unmet psychological, physical, autonomy, and communication needs, reflecting the difference between patients' perceived requirements and the support from health care professionals. The objective of this study was to synthesize qualitative evidence on unmet needs in palliative cancer care among inpatient and outpatient adults.

METHODS

We conducted a meta-ethnographic review according to Noblit and Hare's framework and the operationalized guidelines developed by Sattar. The eMERGe Reporting Guidance was followed. A literature search was conducted in Cinahl, Embase, Medline, Scopus, Web of Science, PsycINFO and Google Scholar for gray literature. For all the studies, direct quotes from the participants and authors' results were identified, coded and analyzed in NVivo 1.7.1 and extracted as I and II order constructs from which higher third-order themes originated.

RESULTS

Eight studies were included. Four new themes emerged, representing areas where palliative cancer care patients expressed a need for help: the need for comprehensive, patient-centered care, the need for maintaining a sense of autonomy and dignity, the need for attentive support to patients' soul and the need for accessible and timely care.

CONCLUSIONS

Palliative care patients require a secure, suffering-free end-of-life journey with informed decision-making and team support. Ensuring continuity of care, validating their suffering, and allocating sufficient time are crucial aspects of care. This involves maintaining a consistent care plan, respecting patients' emotions and experiences, and providing services tailored to individual needs.

The Role of Caregivers in Promoting Connectedness in Youth with Mental Health Concerns

BACKGROUND/OBJECTIVES

Mental health concerns among youth represent a critical global public health issue. Research has found that youth with mental health concerns are often reliant on their caregivers while being isolated from peers. Guided by the recovery model of mental health care, this study investigates the often-overlooked role of caregivers in fostering 'connectedness' in youth; Methods: Semi-structured interviews were conducted with nine caregivers of youth with mental health issue; Results: Thematic analysis underscored three tasks in the role of caregivers in promoting connectedness in youth: (a) understanding the nature and quality of social networks, (b) supporting readiness to engage in social relationships, and (c) promoting their youth's social problem solving and self-efficacy; Discussion: These tasks highlight the complex dialectics faced by caregivers in supporting youth recovery. The findings hold key implications for developing interventions, resources and policies designed for caregivers.

A new model for the diagnostic assessment services trajectory for neurodevelopmental conditions

Purpose

The Canadian province of Québec faces several issues regarding the accessibility and quality of diagnostic assessment and the efficiency and continuity of evaluation, support, and intervention services for children with neurodevelopmental conditions (NDCs). To address these issues, the Ministry of Health and Social Services mandated a research team to initiate the development of a reference trajectory, i.e., a proposed model pathway based on national and international best practices and research, for the diagnostic assessment of NDCs in children aged 0-7 years.

Methods

The present study focused on the development of a logic model to operationalize the diagnostic services trajectory using a community-based participatory research approach and informed by implementation science. This involved representatives from multiple stakeholder groups (e.g., parents, professionals, physicians, administrators, researchers). Project steps included an analysis of best practices from a literature review on diagnostic trajectories, focus groups and interviews with stakeholders, and a validation process to ensure the appropriateness of the final model.

Results

The integration of existing research and stakeholder input resulted in a logic model for a new diagnostic services trajectory for children aged 0-7 years suspected of NDCs and identified key ingredients that should be present in its future implementation.

Conclusion

The proposed model for a diagnostic services trajectory is expected to address several systemic issues identified previously. Its implementation will need to be evaluated to ensure its sustained focus on the needs of families and its ability to promote their quality of life, well-being, and involvement.

Perceived Physical Activity Levels and Objective Measures: A Mixed-Methods Study of Residents Aged 65 and Above in Assisted Living Homes in Australia

Background and Purpose: Communities face a mounting social, economic and health burden as the global population of older adults continues to grow. Regular physical activity is consistently reported as an effective means of maintaining health and independence in older adults, yet engagement in activity remains low. This study assesses the activity levels of adults aged over 65 years residing in Australian assisted living homes, and extended to examine their perception of their activity and explore possible factors that hinder or promote their engagement in physical activity. Methods: Thirty-five older adults were recruited to this mixed-methods study from four separate assisted living homes. Objective activity data from five consecutive days of accelerometer wear were collected in combination with data from standardised and demographic questionnaires, and semistructured interviews. Qualitative data from interview transcripts were thematically analysed using NVivo software to develop themes relating to physical activity levels of older adults. Quantitative data from accelerometers and questionnaires were descriptively analysed, and associations between variables were examined using STATA software. Results and Discussion: Findings indicated that females were more active than males, and those who were younger and those with lower body mass index (BMI) displayed higher activity levels. Additionally, residents in assisted living facility (number 4) and those who did not need ambulatory assistance are more active. Conversely, those utilising support services and those with more comorbidities demonstrated lower activity levels. Marital status and cognitive function did not show any association with activity levels of older adults. During the interviews, many older adults acknowledged the importance of physical activity, and some believed they were active. However, objective results contradicted this perception. Conclusion: This study provides valuable insight into the demographic and health factors contributing to higher levels of activity, and the perceptions of activity among older adults vulnerable to health conditions associated with inactivity.

Financial toxicity of total cancer care immunotherapy patients and caregivers: impacts of COVID-19 pandemic and inflation

PURPOSE

Financial toxicity, cancer-treatment-related financial harm, is associated with expensive treatments like immunotherapy. The purpose of this study was to explore financial toxicity among advanced cancer patients receiving immunotherapies and their caregivers and, secondarily, to study how recent inflation and the COVID-19 pandemic impacted these experiences.

METHODS

Advanced cancer patients receiving immunotherapies and their caregivers were recruited to participate in semi-structured interviews about supportive care needs from 2022 to 2023. The Comprehensive Score for Financial Toxicity was collected. Guided by Jones et al.'s cancer financial toxicity model, the content analysis was conducted by two trained coders using NVIVO R1.

RESULTS

Sixteen patients and 10 caregivers (including 7 dyads) across 5 states participated in interviews in 2022-2023. Participants averaged 63.43 years (SD = 12.75), and patients received an average of 14.6 months of immunotherapy (SD = 9.415). The majority lived in non-metropolitan areas (67%) and were white (95%). Three theory-driven themes were developed: (1) Sources of Financial Toxicity, (2) Buffers of Financial Toxicity, and (3) Consequences of Financial Toxicity. Inflation was added to financial toxicity for non-metropolitan dwelling participants due to increased prices of gas and accommodation. Social support systems buffered the impact of financial toxicity. Material and psychological impacts of financial toxicity disproportionately affected younger and privately insured participants.

CONCLUSION

While immunotherapy patients face high medical costs of treatment, the burdens of accessing treatment for people living at a distance from the cancer center can exacerbate financial toxicity. Clinicians and researchers should also consider external financial pressures such as national economic impacts that compound the financial toxicity of treatment.

Experience of neurofeedback and methylphenidate in children with ADHD

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. ADHD is commonly treated with medication, such as methylphenidate, but some families and practitioners prefer psychosocial interventions as first line treatments. Many studies have investigated neurofeedback as a potential non-pharmacological treatment for ADHD yielding contradictory findings regarding its efficiency. Qualitative research on neurofeedback in ADHD is limited and can add valuable information on the acceptability and perceived efficacy among service users. This study aimed to explore the perceptions and experiences of children and adolescents with ADHD regarding the use of neurofeedback and methylphenidate. Eleven interviews with children and their parents explored their subjective experiences and perceived changes. Overall, neurofeedback was negatively experienced by those families: the intervention did not meet their expectations, and they reported minimal observed changes. The treatment with methylphenidate, however, was more manageable for families and was perceived to be more efficient despite its side effects.

Healthcare compassion interventions co-design and feasibility inquiry with clinicians and healthcare leaders in Aotearoa/New Zealand

Compassion in healthcare is valued by patients, healthcare professionals (HCPs), and leads to improved outcomes. Notwithstanding reports of systemic failings in the provision of compassionate care, research regarding ways to intervene remains limited. The aim of this study is to clarify compassion intervention needs in a diverse HCP workforce in public secondary healthcare in Aotearoa New Zealand (NZ) by utilising a co-design process. The co-design process involved a series of workshops with clinicians followed by in-depth interviews with healthcare leaders to derive input regarding feasibility and implementation. Reflexive thematic analysis was used to analyze the data. There was a great deal of interest in compassion interventions from healthcare professionals and leaders. However, for compassion interventions to be acceptable, feasible, and effective, compassion interventions design should be reimagined and reflected at each step of interventional design and implementation and span across organizational levels. Namely, the results of the study showed the preference for non-individual focused multi-level interventions to build bridges and connections. The desired compassion intervention components included practising connecting with others' humanity, improving compassion knowledge and relational and reflective skills, and cultural safety and anti-racism training. Experiential training embedded in models of cultural dialogue was the preferred interventional modality. Prioritising leadership as an intervention site was suggested to improve leadership's buy-in of compassion interventions and possibly serve as a starting point for transforming the broader culture, reviving interconnectedness in a healthcare system described as fragmented, disconnected, and alienating with compassion also acting as an equalizer of power.

Implementing palliative care in the intensive care unit: a systematic review and mapping of knowledge to the implementation research logic model

PURPOSE

The importance and effectiveness of palliative care (PC) in intensive care units (ICU) are known. Less is known about the implementation and integration of ICU-based PC interventions. This systematic review aims to use a modified implementation research logic model (IRLM) to identify, map, and synthesise evidence on implementation of ICU-PC (primary and/or specialist) interventions.

METHODS

This systematic review used an adapted Smith's IRLM to understand relationships between implementation factors-determinants (barriers and facilitators), strategies, and mechanisms-and report intervention characteristics and outcomes. Searches up to 2nd December 2023, of MEDLINE, Embase, Cochrane, CINAHL, and PsycINFO, combined PC, intensive care, and implementation terms.

RESULTS

84 studies (8 process evaluations, 76 effectiveness studies) were included. Published evidence on ICU-PC interventions is substantial, but reporting on implementation factors is variable and often lacking, especially for patient and family-related determinants and for all aspects of mechanisms. Main facilitators for implementation are adequate resources and collaboration between PC and ICU teams. Main barriers to implementation are lack of resources, negative perceptions of PC, and high ICU acuity. Implementation strategies include auditing resources, building stakeholder collaboratives, creating adaptable interventions, utilising champions, and supporting education. Mechanisms most commonly worked by facilitating collaborative working.

CONCLUSION

This review provides recommendations for ICUs when designing (stakeholder involvement, ICU-PC collaboration, assessment of culture and resources); implementing (targeted and adapted strategies, champions, and education); and evaluating/reporting (collect effectiveness and implementation data, including mechanisms) ICU-PC interventions. Use of implementation structures and patient/family involvement are both needed and important to be included.

"Sink or swim": mothers' experiences of extremely preterm infants after 15 years from birth

OBJECTIVES

To evaluate the experience of parenting a preterm infant from birth to adolescence and to raise awareness of the complexity of premature birth and the child's subsequent developmental journey for the entire family.

STUDY DESIGN

A phenomenological, qualitative approach using semi-structured interviews with open-ended questions was adopted to obtain retrospective, in-depth narratives. Seven mothers of adolescents born preterm with extremely low birth weight (ELBW) and admitted to a neonatal intensive care unit (NICU) participated in the study. Interviews were conducted by a trained researcher in qualitative methods, and independent coders performed data analysis.

RESULTS

Three phases and eight core themes, chronologically organized, emerged from the thematic analysis: starting from preterm birth (panic, fear and uncertainty; hope and a positive attitude to the future; altered parental role), transitioning to life after hospitalization (fatigue and worry about an uncertain future; need of support), and extending into adolescence (adolescents' fragility; overprotection; post-traumatic personal growth).

CONCLUSIONS

The birth of a preterm baby has significant repercussions for the entire family, not only in the period immediately following birth but also for many years afterwards, as the traumatic event is retraced with memories that remain both painful and vivid. These findings should be acknowledged by professionals working in the NICU to foster the development of targeted interventions that help parents build resilience, including from a personal growth perspective.

Automation tools to support undertaking scoping reviews

OBJECTIVE

This paper describes several automation tools and software that can be considered during evidence synthesis projects and provides guidance for their integration in the conduct of scoping reviews.

STUDY DESIGN AND SETTING

The guidance presented in this work is adapted from the results of a scoping review and consultations with the JBI Scoping Review Methodology group.

RESULTS

This paper describes several reliable, validated automation tools and software that can be used to enhance the conduct of scoping reviews. Developments in the automation of systematic reviews, and more recently scoping reviews, are continuously evolving. We detail several helpful tools in order of the key steps recommended by the JBI's methodological guidance for undertaking scoping reviews including team establishment, protocol development, searching, de-duplication, screening titles and abstracts, data extraction, data charting, and report writing. While we include several reliable tools and software that can be used for the automation of scoping reviews, there are some limitations to the tools mentioned. For example, some are available in English only and their lack of integration with other tools results in limited interoperability.

CONCLUSION

This paper highlighted several useful automation tools and software programs to use in undertaking each step of a scoping review. This guidance has the potential to inform collaborative efforts aiming at the development of evidence informed, integrated automation tools and software packages for enhancing the conduct of high-quality scoping reviews.

A survey of practicum training practices in clinical neuropsychology

Objective: While previous survey research has focused on various training constituencies such as trainees, and postdoctoral/internship supervisors, no previous survey research has examined the needs and perspectives of practicum level supervisors and training programs. This study was designed to address this limitation. These results were used in forming the North American Association of Practicum Sites in Neuropsychology (NAPSN). Method: A 41-item survey was developed and distributed to practicum supervisors across the United States and Canada via listserv. A total of 142 supervisors completed the survey; the majority were employed at academic medical centers (62%) and located in the U.S. (93%). Most participants evaluated adults (61%), while a minority evaluated children (27%), or patients across the lifespan (12%). Results: Most respondents supervise one (44%) or two (26%) students per year and prefer advanced trainees (>90%). The majority (78%) indicated students see one case per week. The number of clinical contact hours and reports varied based on location (U.S. vs. Canada) and population (adult vs. pediatric). Supervisors found professional papers and publicly available didactics to be the most helpful resources. Commonly endorsed needs included help with policies and procedures (53%), supervising trainees from underrepresented groups (49%) and nontraditional backgrounds (44%), and access to didactics (49%). Conclusions: The survey provided insights into current practices and the needs of practicum supervisors. These findings will inform NAPSN's development of materials and policies to support trainees and supervisors and can guide other professionals in supporting their practicum trainees as they navigate training in neuropsychology.

Use and impact of clinical pathways across various healthcare settings: A protocol for an umbrella review of global evidence

AIM

The proposed umbrella review aims to assess the use and impact of clinical pathways on professional practice, patient outcomes, length of hospital stay, hospital costs, patient satisfaction, and hospital staff satisfaction through a synthesis of existing systematic reviews and meta-analyses.

METHODS

Following PRIOR guidelines, a systematic search will be conducted in MEDLINE, Epistemonikos, and the Cochrane Library to identify relevant systematic reviews and meta-analyses, from inception till March 2024. Two reviewers will independently screen titles and abstracts, with a third resolving any disagreements. Full-text articles considered potentially relevant will be assessed for eligibility by the same process. The data extraction form will cover information about the review methods, characteristics of the included primary studies, the types of interventions evaluated, and the reported outcomes. This standardized data extraction form will be piloted by the review team on five to ten articles to ensure all relevant information is recorded. The quality of included systematic reviews and meta-analyses will be evaluated using AMSTAR 2. PROSPERO registration number is CRD42024529371.

RESULTS

The study will present a narrative synthesis of the findings, addressing the clinical and methodological heterogeneity and assessing the impact of clinical pathways on various healthcare outcomes.

CONCLUSION AND IMPLICATIONS

This umbrella review will provide evidence-based insights into the effectiveness, challenges, and best practices of clinical pathways, guiding healthcare decision-making and identifying areas for future research. Results will be disseminated widely to inform policy and improve healthcare service delivery.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution, as this paper is a protocol of an umbrella review.

Evaluating the implementation of weekly rifapentine-isoniazid (3HP) for tuberculosis prevention among people living with HIV in Uganda: A qualitative evaluation of the 3HP Options Trial

Three months of isoniazid-rifapentine (3HP) is being scaled up for tuberculosis (TB) preventive treatment (TPT) among people living with HIV (PLHIV) in high-burden settings. More evidence is needed to identify factors influencing successful 3HP delivery. We conducted a qualitative assessment of 3HP delivery nested within the 3HP Options Trial, which compared three optimized strategies for delivering 3HP: facilitated directly observed therapy (DOT), facilitated self-administered therapy (SAT), and patient choice between facilitated DOT and facilitated SAT at the Mulago HIV/AIDS clinic in Kampala, Uganda. We conducted 72 in-depth interviews among PLHIV purposively selected to investigate factors influencing 3HP acceptance and completion. We conducted ten key informant interviews with healthcare providers (HCPs) involved in 3HP delivery to identify facilitators and barriers at the clinic level. We used post-trial 3HP delivery data to assess sustainability. We used thematic analysis (inductive and deductive) to align the emergent themes with the RE-AIM framework dimensions to report implementation outcomes. Understanding the need for TPT, once-weekly dosing, shorter duration, and perceived 3HP safety enhanced acceptance overall. Treatment monitoring by HCPs and reduced risk of HIV status disclosure enabled DOT acceptance. Dosing autonomy enabled SAT acceptance. Switching between DOT and SAT as needed enabled acceptance of patient choice. Dosing reminders, reimbursement for clinical visits, and social support enabled 3HP completion; pill burden, side effects, and COVID-19-related treatment restrictions hindered completion. All HCPs were trained and participated in 3HP delivery with high fidelity. Training, care integration, prior TPT experience with daily isoniazid, and few 3HP-related serious adverse events enabled adoption, whereas initial concerns about 3HP safety among HCPs, and COVID-19 treatment disruptions delayed 3HP adoption. Refresher training and collaboration among HCPs enabled implementation whereas limited diagnostic facilities for adverse events at the clinic hindered implementation. SAT was modified post-trial; DOT was discontinued due to inadequate ongoing financial support beyond the study period. Facilitated delivery strategies made 3HP treatment convenient for PLHIV and were feasible and implemented with high fidelity by HCPs. However, the costs of 3HP facilitation may limit wider scale-up. Trial registration: ClinicalTrials.gov (NCT03934931); Registered 2nd May 2019; https://clinicaltrials.gov/study/NCT03934931?id = NCT03934931&rank = 1.

Intervention Development for Tailored Education for Aging and Cognitive Health (TEACH) for Dementia Prevention in Midlife Adults: Protocol for a Randomized Controlled Trial

BACKGROUND

A total of 12 modifiable risk factors account for 40% of dementia cases globally, yet population adherence to health behaviors associated with these factors is low. Midlife is a critical window for dementia prevention, as brain pathology often begins to accumulate years or decades before the onset of symptoms. Although multidomain behavioral interventions have been efficacious in reducing the risk of cognitive decline, adherence is low. Intrapersonal factors, such as health beliefs, are known mediators of the relationship between knowledge and health behavior.

OBJECTIVE

In keeping with stage I of the National Institutes of Health (NIH) Stage Model for Behavioral Intervention Development, this study will use mixed methods to (1) develop an enhanced health education intervention, including an explanatory method for communicating information about dementia risk and personal health beliefs, and (2) conduct a pilot randomized controlled trial (n=20 per intervention arm) over 8 weeks to assess the feasibility of delivering the enhanced intervention versus basic health education alone.

METHODS

Phase 1 will involve focus groups and individual qualitative interviews. Focus groups will be analyzed using (1) a descriptive framework matrix analysis and (2) interpretive data review by the research team. Individual qualitative interviews will be coded using applied thematic analysis using a phenomenographic approach. Phase 2 will involve a pilot randomized controlled trial. Proximal outcomes (measured at baseline, 4 weeks, and 8 weeks) include the perceived threat of Alzheimer disease, dementia awareness, and self-efficacy.

RESULTS

This project was funded in August 2022. Data collection began in 2023 and is projected to be completed in 2025.

CONCLUSIONS

Study findings will reveal the feasibility of delivering an 8-week multidomain health education intervention for primary prevention of dementia in midlife and will provide preliminary evidence of mechanisms of change.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05599425; https://clinicaltrials.gov/study/NCT05599425.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/60395.

Mapping the scientific literature on obstetric and perinatal health among sexual and gender minoritized (SGM) childbearing people and their infants: a scoping review

BACKGROUND

Evidence suggests sexual and gender minoritized (SGM) childbearing individuals and their infants experience more adverse obstetric and perinatal outcomes compared to their cisgender, heterosexual counterparts. This study aimed to comprehensively map obstetric and perinatal physical health literature among SGM populations and their infants and identify knowledge gaps.

METHODS

PubMed, Embase, CINAHL, and Web of Science Core Collection were systematically searched to identify published studies reporting obstetric and perinatal outcomes in SGM individuals or their infants. Study characteristics, sample characteristics, and outcome findings were systematically extracted and analyzed.

RESULTS

Our search yielded 8,740 records; 55 studies (1981-2023) were included. Sexual orientation was measured by self-identification (72%), behavior (55%), and attraction (9%). Only one study captured all three dimensions. Inconsistent measures of sexual orientation and gender identity (SOGI) were common, and 68% conflated sex and gender. Most (85%) focused on sexual minorities, while 31% addressed gender minorities. Demographic measures employed varied widely and were inconsistent; 35% lacked race/ethnicity data, and 44% lacked socioeconomic data. Most studies (78%) examined outcomes among SGM individuals, primarily focusing on morbidity and pregnancy outcomes. Pregnancy termination was most frequently studied, while pregnancy and childbirth complications (e.g., gestational hypertension, postpartum hemorrhage) were rarely examined. Evidence of disparities were mixed. Infant outcomes were investigated in 60% of the studies, focusing on preterm birth and low birthweight. Disparities were noted among different sexual orientation and racial/ethnic groups. Qualitative insights highlighted how stigma and discriminatory care settings can lead to adverse pregnancy and birth outcomes.

CONCLUSIONS

Frequent conflation of sex and gender and a lack of standardized SOGI measures hinder the comparison and synthesis of existing evidence. Nuanced sociodemographic data should be collected to understand the implications of intersecting identities. Findings on perinatal health disparities were mixed, highlighting the need for standardized SOGI measures and comprehensive sociodemographic data. The impact of stigma and discriminatory care on adverse outcomes underscores the need for inclusive healthcare environments. Future research should address these gaps; research on SGM perinatal outcomes remains urgently lacking.

TRIAL REGISTRATION

The review protocol was developed a priori in February 2023, registered on Open Science Framework ( https://doi.org/10.17605/OSF.IO/5DQV4 ) and published in BMJ Open ( https://bmjopen.bmj.com/content/13/11/e075443 ).

A thin line between consent and abuse - Reflections on sexual experiences among Swedish young adults with intellectual disabilities

Research shows that young adults with intellectual disabilities struggle to understand the social codes embedded in sexual situations. This may lead to an incomprehension of sexual consent, or when consenting to sex may lead to abuse. This qualitative study aimed to gain an in-depth understanding of sexual experiences and perceptions about sexual consent among Swedish young adults with intellectual disabilities. The data comprise 22 semi-structured interviews with young adults aged 18-35 with intellectual disabilities, thematically analyzed using sexual script theory as a theoretical framework. Four themes emerged from the analysis: Setting the sexual scene, Sexual self-awareness, Sexual communication and the necessity of clarification and Striving for a balance. The results show that the participants had a variety of sexual experiences and challenges associated with sexual consent, but also an agency that favors sexual situations. Further research is necessary to understand the complexities of sexual consent in this population.

Disclosure Patterns of Opioid Use Disorders in Perinatal Care During the Opioid Epidemic on X From 2019 to 2021: Thematic Analysis

BACKGROUND

In 2021, the United States experienced a 14% rise in fatal drug overdoses totaling 106,699 deaths, driven by harmful opioid use, particularly among individuals in the perinatal period who face increased risks associated with opioid use disorders (OUDs). Increased concerns about the impacts of escalating harmful opioid use among pregnant and postpartum persons are rising. Most of the current limited perinatal OUD studies were conducted using traditional methods, such as interviews and randomized controlled trials to understand OUD treatment, risk factors, and associated adverse effects. However, little is known about how social media data, such as X, formerly known as Twitter, can be leveraged to explore and identify broad perinatal OUD trends, disclosure and communication patterns, and public health surveillance about OUD in the perinatal period.

OBJECTIVE

The objective is 3-fold: first, we aim to identify key themes and trends in perinatal OUD discussions on platform X. Second, we explore user engagement patterns, including replying and retweeting behaviors. Third, we investigate computational methods that could potentially streamline and scale the labor-intensive manual annotation effort.

METHODS

We extracted 6 million raw perinatal-themed tweets posted by global X users during the opioid epidemic from May 2019 to October 2021. After data cleaning and sampling, we used 500 tweets related to OUD in the perinatal period by US X users for a thematic analysis using NVivo (Lumivero) software.

RESULTS

Seven major themes emerged from our thematic analysis: (1) political views related to harmful opioid and other substance use, (2) perceptions of others' substance use, (3) lived experiences of opioid and other substance use, (4) news reports or papers related to opioid and other substance use, (5) health care initiatives, (6) adverse effects on children's health due to parental substance use, and (7) topics related to nonopioid substance use. Among these 7 themes, our user engagement analysis revealed that themes 4 and 5 received the highest average retweet counts, and theme 3 received the highest average tweet reply count. We further found that different computational methods excel in analyzing different themes.

CONCLUSIONS

Social media platforms such as X can serve as a valuable tool for analyzing real-time discourse and exploring public perceptions, opinions, and behaviors related to maternal substance use, particularly, harmful opioid use in the perinatal period. More health promotion strategies can be carried out on social media platforms to provide educational support for the OUD perinatal population.

Pain Resilience and Coping Behaviors in Individuals in a Collectivist Social Context

BACKGROUND/OBJECTIVES

Pain resilience (PR) may be associated with different coping skills, resulting in differences in pain outcomes. This study aimed to understand the role of PR in dictating the choice of coping methods.

METHODS

This study completed a preliminary validation of the Mandarin Chinese version of the Pain Resilience Scale (PRS-C) with online survey data (n = 46). Further, we conducted interviews with individuals with chronic low back pain (n = 24).

RESULTS

The PRS-C psychometric properties were assessed using a confirmatory factor analysis. The interviews explored pain history, treatment experiences, and coping strategies and were analyzed thematically. The validated PRS-C (10 items) demonstrated satisfactory psychometric properties. The interview results showed that participants who scored lower were more likely to adopt disengagement rather than engagement coping strategies. Qualitative data revealed three themes explaining why and how participants in this collectivist social framework chose their coping methods.

CONCLUSIONS

The findings suggest that while participants tried to understand their pain and treatment experiences, the cognitive appraisal construct in PR influenced some of the coping experiences. However, deeply influenced by Confucianism and Buddhism, participants also expressed factors beyond the scope of individual fortitudes, such as the relationship with a higher power that significantly influenced their coping behaviors.

Stepped-Care Web-Based Parent Support Following Congenital Heart Disease: Protocol for a Randomized Controlled Trial

BACKGROUND

Early neurodevelopmental risks, compounded with traumatic medical experiences, contribute to emotional and behavioral challenges in as many as 1 in 2 children with congenital heart disease (CHD). Parents report a strong need for supports; yet, there remains a lack of accessible, evidence-based behavioral interventions available for children with CHD and their families. I-InTERACT-North is a web-based stepped-care mental health program designed to support family well-being and reduce behavioral concerns through positive parenting for children with early medical complexity. In previous pilot studies, the program was effective in increasing positive parenting skills and decreasing child behavior problems, with high parent-reported acceptability. This paper presents the protocol for the first randomized study of stepped-care parent support for families of children with CHD.

OBJECTIVE

This study will involve a single-site, 2-arm, single-blind randomized controlled trial to evaluate (1) the feasibility and acceptability of a web-based stepped-care parent support program (I-InTERACT-North) and (2) the effectiveness of the program in enhancing positive parenting skills and reducing behavioral concerns among families of children with CHD.

METHODS

Families will be randomized (1:1) to either receive treatment or continue with care as usual for 12 months. Randomization will be stratified by child's sex assigned at birth and baseline parent-reported child behavior intensity. Primary outcomes include positive parenting skills and child behavior at baseline, 3 months, 6 months, and 12 months. Secondary outcomes include parental mental health, quality of life, service usage, and feasibility including program reach and adherence. A sample size of 244 families will provide >95% power to detect an effect size of d=0.64. Based on attrition data from pilot studies, a target of 382 families will be enrolled. Parent reports of acceptability, adoption, and suggested adaptability of the program will be examined using cross-case thematic analyses. Primary efficacy analysis will be conducted using an intent-to-treat approach. Generalized estimating equations will be used to examine changes in positive parenting. Child behavior, quality of life, and parent mental health will be tested with repeated-measures analyses. Additional sensitivity and replication analyses will also be carried out.

RESULTS

Recruitment began in February 2024, and recruitment and follow-up will continue until January 2029. We anticipate results in late 2029.

CONCLUSIONS

This study aims to test the effectiveness of I-InTERACT-North web-based stepped-care parent support in improving positive parenting skills and reducing child behavior problems in families of children with CHD compared with a care as usual control group. Results will inform future clinical implementation and expansion of this program among families of children with early medical conditions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06075251; https://clinicaltrials.gov/study/NCT06075251.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/64216.

Exploration of oral hygiene practices, oral health status, and related quality of life of individuals residing in the Rorya district of Tanzania, East Africa

Introduction

Oral health substantially impacts individuals' quality of life, making it an important target for global health interventions. This research describes oral health status, practices, and beliefs within the Rorya district of Tanzania to understand barriers to care.

Methods

To quantify physical oral health status, intraoral examinations were conducted on adults, noting the Decayed Missing and Filled Teeth (DMFT) and Comprehensive Periodontal Inflammatory Burden Index (CPBI). Oral Health-Related Quality of Life (OHRQoL) and semi-structured interviews were conducted to understand oral hygiene behaviors and beliefs. Data was analyzed via two-sample t-tests, Pearson's statistics, and NVIVO.

Results

A purposive sample (n = 139) of participants self-reported to reside in either Burere (n = 32), Nyambogo (n = 52), or Roche (n = 55) were assessed. A two-sample t-test revealed females (n = 67; x¯ = 7.1; SD = 5.4; p < 0.05) have a significantly higher DMFT score than males (n = 72; x¯ = 3.7; SD = 3.9). Moreover, the OHRQoL score of females (n = 67; x¯ = 12.10; SD = 14; p < 0.05) were significantly higher than males (n = 72; x¯ = 10.16; SD = 3). In contrast, males have significantly higher CPBI scores (x¯ = 3.8; SD = 1.5; p=<0.05) than females (x¯ = 3.0; SD = 1.3). Additionally, older age groups presented higher GI and PISA scores, while the younger group (20-30 years) displayed the highest mean DMFT score. The themes that emerged from semi-structured interviews were "pearls of laughter guarded by wisdom teeth," "whispered tales of oral tides and communal echoes," and "tales of the tooth fairy."

Discussion

In this community, proper oral health maintenance techniques are vital yet frequently disregarded, mainly due to disparities in access to resources, reflected in oral health scores. Addressing this is a crucial intervention, presenting an opportunity to uplift overall well-being. Moreover, gender and age disparities in oral health highlight the urgent need for tailored interventions.

Site-level factors affecting nursing home implementation of a personalized music intervention: Qualitative analyses from Music & Memory: A Pragmatic Trial for Nursing Home Residents with Alzheimer's Disease (METRIcAL)

BACKGROUND

Non-pharmacological interventions (NPIs) are preferred alternatives to using antipsychotic medications to manage disruptive behaviors in nursing home (NH) residents living with dementia. However, the implementation of these interventions is often complex in the NH environment. In this qualitative analysis of data from an embedded pragmatic clinical trial (ePCT) of a personalized music intervention, we describe NH-level implementation barriers and facilitators.

METHODS

In a 54-facility trial, we randomized 27 NHs from four US corporations to the personalized music intervention. In this qualitative analysis, we analyzed barriers and facilitators at 9 of the 27 intervention NHs, using (1) routinely collected data collector observations and (2) semi-structured interviews with NH staff. We iteratively developed codes to best describe these data and generated themes.

RESULTS

We found five qualitative themes related to the variation of intervention implementation across NHs: (1) turnover and institutional changes interfered with implementation; (2) consistent with pragmatic implementation, delivery strategies varied across NHs; (3) family members influenced residents' participation; (4) non-clinical program champions needed clinical buy-in, which was challenging and required demonstrating the intervention's clinical benefits; and (5) technological barriers among staff and residents impeded implementation.

CONCLUSIONS

Qualitative results from nine facilities participating in a NH ePCT of personalized music intervention highlight the importance of identifying an intervention's key components to ensure fidelity, while allowing the flexibility necessary for pragmatic implementation. Engaging family caregivers may improve the implementation of NPIs in the NH setting. Results may be helpful to other researchers implementing NPIs to manage neuropsychiatric symptoms for people living with dementia in NHs.

Highlights

This was a real-world trial of a personalized music for nursing home (NH) residents with dementia.Pragmatic adaptations to intervention delivery may have compromised fidelity.Family caregivers are important to the success of behavioral interventions in NHs.

Exploring Latino cultural factors from the perspective of sexual minority men in the USA

Existing research on Latino cultural factors mainly focuses on gender and nationality, often overlooking sexual orientation and giving limited attention to the experiences of Latino sexual minority men in the United States of America (USA). This study addressed this gap by exploring how sexual minority men identify, describe and experience Latino cultural factors. Between April and December 2019, semi-structured interviews were conducted with 28 men (ages 18-40, 43% non-US-born) in the greater Miami, Florida area to explore their engagement in HIV prevention and behavioural health services. Secondary qualitative analysis examined five Latino cultural factors (personalismo, machismo, familismo, fatalismo and curanderismo), informed by the existing literature for initial coding and supplemented by the use of an inductive approach, yielding 14 subthemes. Findings revealed that although participants often described cultural factors in their traditional interpretations within the Latino community at large, they also highlighted unique experiences, particularly for relationship-oriented factors like personalismo, machismo and familismo. Sexual orientation stigma shaped participants' experiences of these cultural factors. Study findings enhance knowledge about Latino sexual minority men's lived experiences in the USA, underscoring how cultural factors are perceived both traditionally and uniquely, and emphasises the need for nuanced, culturally tailored assessments in future research.

Factors Influencing the Translation of Evidence Into Clinical Practice for Hospital Allied Health Professionals in Terms of the Domains of Behaviour Change Theory: A Systematic Review

This systematic review provides an overview of the unique challenges allied health professions face in the translation and implementation of evidence into practice, which remain relatively under reported and uninformed by a theoretical basis of behaviour change. MEDLINE, EMBASE, CINAHL and Scopus databases from 2010 to 2022 were searched for primary study designs resulting in 21 articles included in this review (PROSPERO: 2022 CRD42022314996). Allied health disciplines reported in the review were mainly from occupational therapy, physiotherapy, dietetics, and speech pathology. The most frequently reported implementation determinants across the Theoretical Domains Framework were identified as 'environmental context and resources', and 'knowledge'. The results also identified a greater influence of 'social influences' and 'beliefs about consequences' in implementation. Implementing evidence into clinical practice is a multifaceted, complex process, and the use of the Theoretical Domains Framework provided a systematic approach to understanding the drivers behind the target behaviours. However, there is a paucity of studies across the allied health professions that describe implementation strategies used and their impact. Many of the studies focused on implementation by the individual clinician rather than the role organizations can play in the translation of evidence into practice.

Exploring the impact of perceived early marriage on women's education and employment in Bangladesh through a mixed-methods study

Child marriage negatively affects women's socio-economic empowerment, particularly in education and employment. This study aimed to explore women' perspectives on the timing of their marriages, considering their educational and employment status at the time. It also sought to identify factors influencing early married women's perception of their marriages as timely. We analyzed both quantitative and qualitative data. The quantitative data included a sample of 5,596 women aged 15-24 from the 2017/18 Bangladesh Demographic and Health Survey. Additionally, we collected qualitative data through six in-depth interviews, two focus group discussions, and 13 key informant interviews. We used a multilevel mixed-effects Poisson regression model to examine the relationship between women's formal employment, education, and child marriage. Thematic analysis was employed for the qualitative data. Around 62% of the total women analysed reported their married occurred early with the mean age at marriage was 15.2 years. Approximately 55% of the total early married women believed their marriages occurred at the right time, especially among those who were employed at the time of their marriage. Among this subset, we also noticed a higher likelihood of discontinuing work and education following marriage. Qualitative findings revealed reasons behind this perception, such as escaping poverty, safety concerns, limited job prospects, and the impact of non-marital relationship and societal norms. While many early-married women perceived their marriage as timely, particularly those initially employed, this decision often coincides with a subsequent withdrawal from work and education. This underscores the pressing need for policies and programs aimed at educating women about the legal age for marriage and the negative consequences associated with early marriage while also equipping them with knowledge and resources for informed decision-making.

Application of the behaviour-centred design to understand facilitators and deterrents of hand hygiene among healthcare providers: findings from a formative phase of a cluster randomised trial in the Kampala Metropolitan area

BACKGROUND

Hand hygiene is known to reduce healthcare-associated infections. However, it remains suboptimal among healthcare providers. In this study, we used the Behaviour-centered Design approach to explore the facilitators and deterrents to hand hygiene among healthcare providers in the Kampala Metropolitan area, Uganda.

METHODS

We conducted a formative qualitative study as part of a cluster randomised trial in 19 healthcare facilities (HCFs). The study used 19 semi-structured and 18 key informant interviews to collect data on hand hygiene status and facilitators and deterrents of hand hygiene. Research assistants transcribed verbatim and used a thematic framework aided by Nvivo 14.0. to undertake analysis. We used thick descriptions and illustrative quotes to enhance the credibility and trustworthiness of our findings.

RESULTS

About 47.4% of the HCFs had sufficient hand hygiene infrastructure, and 57.9% did not report total compliance with hand hygiene during patient care. The physical facilitator for hand hygiene was the presence of constant reminders such as nudges, while the biological included the frequency of patient contact and the nature of clinical work. The only biological deterrent was the heavy workload in HCFs. The executive brain facilitators included knowledge of workplace health risks, infection prevention and control (IPC) guidelines, and a positive attitude. A negative attitude was the executive brain deterrent to hand hygiene. Recognition, rewards, and fear of infections were the only motivated brain facilitators. Behavioural setting facilitators included proximity to functional hand hygiene infrastructure, the existence of active IPC committees, good leadership, and the availability of a budget for hand hygiene supplies. Behavioural setting deterrents included the non-functionality and non-proximity to hand hygiene infrastructure and inadequate supplies.

CONCLUSIONS

The study revealed low compliance with hand hygiene during the critical moments of patient care and inadequacy of hand hygiene infrastructure. The deterrents to hand hygiene included a heavy workload, negative attitude, inadequate supplies, non-functionality, and long distance to hand washing stations. Facilitators included constant reminders, fear of infections, frequency of patient contact and nature of clinical work, positive attitude, knowledge of IPC guidelines, recognition and reward, good leadership, availability of budgets for hand hygiene supplies, availability and proximity to hand hygiene supplies and infrastructure and active IPC committees.

TRIAL REGISTRATION

ISRCTN Registry with number ISRCTN98148144. The trial was registered on 23/11/2020.

'When age is not a barrier': an explorative study of nonagenarian patients' experiences of undergoing percutaneous coronary intervention

AIMS

The recent rise in the number of nonagenarians (age ≥ 90 years) undergoing percutaneous coronary intervention (PCI) has revealed gaps in research, in particular on patients' experiences. Therefore, the aim of the study was to explore and describe nonagenarians' internal resources and their experiences of the in-hospital pathway.

METHODS AND RESULTS

Nineteen nonagenarian patients (women n = 9), mean age 91 years, 9 acutely, and 10 electively treated, were consecutively enrolled from a tertiary university hospital from June 2021 to February 2023. In-depth interviews were conducted during hospitalization, audiotaped and transcribed. The interviews were analysed using qualitative content analysis. Three sub-themes emerged from the nonagenarians' experiences with the PCI treatment trajectory: (i) Taking lifelong responsibility for own physical and mental health describes a population striving to live a healthy life and to stay independent. Physical and mental activities including healthy food choices had been an integral aspect of their lives from early childhood. (ii) Individual internal resources influenced the PCI pathway describes how their internal resources were used, from actively engaging in the decision-making process to withstanding discomfort during the PCI procedure. (iii) The post-PCI pathway was multifaceted describes a short stay at the cardiac ward with individual post-procedural experiences, close monitoring, and preparation for discharge including cardiac rehabilitation.

CONCLUSION

Nonagenarians undergoing PCI demonstrated a personal incentive to stay healthy and independent. Their internal resources of independence, stoicism, and resilience were used during their in-hospital stay contributing to a successful PCI procedure. Individual cardiac rehabilitation strategies were highlighted after discharge from hospital.

Parents' and Children's Emotional Well-Being and Language Beliefs in Heritage Bilingual Families

The present study aimed to examine how parents' psychological characteristics and positive beliefs about multilingualism predict children's emotional well-being in 51 multilingual families with an immigrant background. Parents were interviewed to assess their beliefs about multilingualism and completed a battery of questionnaires assessing depression, anxiety, psychological distress, parental competence, quality of life, and acculturative stress. They also completed the Strengths and Difficulties Questionnaire (SDQ), which assessed their children's socio-emotional and behavioral characteristics. The results from regression analyses showed that parents' depressive symptoms were significant concurrent predictors of children's conduct problems. In contrast, higher acculturation stress was associated with more emotional problems and better prosociality in children, although the stronger predictor for the latter variable was parents' self-efficacy. Positive beliefs about bilingualism were not related to children's well-being. The discussion highlights the importance of targeting parents' depressive traits and acculturation stress as possible risk factors for children's emotional and behavioral problems. Conversely, fostering parental self-efficacy may promote children's prosociality.

I Didn't Want the Psychotic Thing to Get Out to Anyone at All: Adolescents with Early Onset Psychosis Managing Stigma

The impact of stigmatisation on adults with mental illnesses has been thoroughly demonstrated. However, little is known about experiences of stigmatisation among adolescents with mental illness. Through semi-structured interviews with 34 Danish adolescents (14-19 years) diagnosed with psychosis, this study explores adolescents' experiences of psychosis stigma. On the basis of phenomenological analysis, we find that stigmatisation is widely experienced, and psychosis is generally regarded as more stigmatising than co-morbid mental illnesses. The participants engage in different strategies to manage possible stigma, especially strategies of (non-)disclosure. Disclosure is experienced as both therapeutic and normative, but also bears the risk of stigmatisation, and is therefore associated with numerous considerations. Being understood when disclosing is central to the participants, and lack of understanding from others is a continuous challenge. Nevertheless, participants experience benefits when feeling understood by people they confide in and can to a degree create the grounds for this through centralising aspects of their experiences of psychosis and mental illness. We argue that disclosure is both a stigma management strategy and a normative imperative, and that being understood or not is a challenge transcending stigma definitions.Clinical trial registration: Danish Health and Medicines Authority: 2612-4168. The Ethics Committee of Capital Region: H-3-2009-123. ClinicalTrials.gov: NCT01119014. Danish Data Protection Agency: 2009-41-3991.

Risk factors and strategies for relapse prevention among individuals living with serious mental illness in South Africa: Qualitative inquiry from patients' and caregivers' perspectives

INTRODUCTION

Relapse among individuals with serious mental illnesses in resource-limited contexts, including South Africa, is a significant concern. To date, the risks for relapse among this population is well documented, but little is known about prevention strategies to reduce its occurrence in these resource-limited settings. Therefore, this qualitative study explores the risk factors and strategies for relapse prevention from the patients' and caregivers' perspectives.

METHODS

We conducted audio-recorded face-to-face in-depth interviews to capture the lived experience of relapse of inpatient study participants with serious mental illness (N = 24) at a public specialized psychiatry hospital in South Africa and their caregivers (N = 6). We conducted an inductive thematic analysis with two pre-specified themes (risk factors for relapse and strategies for prevention), with the codes devised from the data.

RESULTS

Six sub-themes were identified from the analysis within the two pre-specified themes(Risk factors and strategies for relapse prevention): personal-related, family-related, and health system-related risk factors and strategies for preventing relapse, respectively. To highlight some essential findings, the importance of motivation for drug adherence, family involvement, and availability of anti-psychotic drugs in public health care were noted. More importantly, this study identified important cultural complexities where traditional healers play a significant role in some cultural understanding and treatment of mental illness, affecting medication adherence.

CONCLUSION

This study calls for people-centered mental health care delivery in a public health system that listens to the voice of concern, including cultural challenges, and implements meaningful support that matters most to the patient and their family/caregivers.

Evaluating the implementation of weekly rifapentine-isoniazid (3HP) for tuberculosis prevention among people living with HIV in Uganda: A qualitative evaluation of the 3HP Options Trial

Three months of isoniazid-rifapentine (3HP) is being scaled up for tuberculosis (TB) preventive treatment (TPT) among people living with HIV (PLHIV) in high-burden settings. More evidence is needed to identify factors influencing successful 3HP delivery. We conducted a qualitative assessment of 3HP delivery nested within the 3HP Options Trial, which compared three optimized strategies for delivering 3HP: facilitated directly observed therapy (DOT), facilitated self-administered therapy (SAT), and patient choice between facilitated DOT and facilitated SAT at the Mulago HIV/AIDS clinic in Kampala, Uganda. We conducted 72 in-depth interviews among PLHIV purposively selected to investigate factors influencing 3HP acceptance and completion. We conducted ten key informant interviews with healthcare providers (HCPs) involved in 3HP delivery to identify facilitators and barriers at the clinic level. We used post-trial 3HP delivery data to assess sustainability. We conducted an inductive thematic analysis and aligned the emergent themes with the RE-AIM framework dimensions to report implementation outcomes. Understanding the need for TPT, once-weekly dosing, shorter duration, and perceived 3HP safety enhanced acceptance overall. Treatment monitoring by HCPs and reduced risk of HIV status disclosure enabled DOT acceptance. Dosing autonomy enabled SAT acceptance. Switching between DOT and SAT as required enabled acceptance for patient choice. Dosing reminders, reimbursement for clinical visits, and social support enabled 3HP completion; pill burden, side effects, and COVID-19-related treatment restrictions hindered completion. All HCPs were trained and participated in 3HP delivery with high fidelity. Training, care integration, and collaboration among HCPs enabled, whereas initial concerns about 3HP safety among HCPs delayed 3HP adoption and implementation. SAT was maintained post-trial; DOT was discontinued due to inadequate ongoing financial support beyond the study period. Facilitated delivery strategies made 3HP treatment convenient for PLHIV and were feasible and implemented with high fidelity by HCPs. However, the costs of 3HP facilitation may limit wider scale-up.

Pilot testing the Engaging Generations (eGen) Program to address social well-being among lower-income older adults

Introduction

Throughout the COVID-19 pandemic, the need to address digital inclusion and social well-being for older adults was particularly apparent for those from disadvantaged communities. This pilot program provided access to technology and intergenerational mentorship to older adult participants interested in receiving and learning how to utilize an iPad. Pre/post-changes were examined for social well-being in the areas of quality of life, social isolation, and loneliness.

Methods

This study conducted pre- and post-surveys with older participants (n = 145) from five disadvantaged communities in the United States utilizing standardized measures. One-on-one interviews were conducted post-program (n = 98) to examine participants' perceptions of the program and evaluate its impact on social measures.

Results

The study sample included older adults (Mean age = 72.3) who were mostly lower income (82.3%) and self-reported as Black (13.6%), Hispanic (21.7%), and White (56.5%). Significant differences were identified in participant pre/post-survey scores for social isolation, loneliness, and a global measure of quality of life. Qualitative analyses suggest improvements in various aspects of social well-being. Themes showed that participants believed the program contributed to (1) enhanced mood and mental health, (2) improved quality of life, (3) sense of purpose and feelings of being less alone, (4) ability to use video calling to connect with others; and (5) ability to more freely use email, texting, and messaging to communicate with others.

Discussion

This research demonstrates that this pilot program seemed to contribute to reduced social isolation and loneliness for participants, and participants stated more positive social well-being following program participation. However, future research with larger samples is needed to expand upon these findings. Future studies will examine the pathways between technology improvements and social well-being and examine group differences.

Postoperative rehabilitation exercise experiences of geriatric patients with femoral neck fractures based on the perspective of medical staff: a qualitative study

BACKGROUND

The incidence of femoral neck fractures in older adults is increasing each year. Active and reasonable postoperative rehabilitation exercises can restore the activity of geriatric patients with femoral neck fractures to a great extent, while also avoiding bedridden complications and re-fractures. This study explores the perspectives, experiences, and recommendations of medical staff regarding the implementation status, existing problems, promoting factors, and hindering factors of post-surgical rehabilitation exercises for geriatric patients with femoral neck fractures. The ultimate goal is to further optimize rehabilitation exercise programs and to expedite this process for patients.

METHODS

A qualitative, descriptive phenomenological study was conducted. A total of 21 clinical medical staff were selected using the purposive sampling method for semi-structured interviews. A content analysis method was used to collate and analyze the collected interview data.

RESULTS

A total of 2 themes and 6 sub-themes were defined. The themes consisted of multiple obstacles occurring during the implementation of rehabilitation exercises and the scientific cognition of medical staff on these exercises. Respondents found that patient initiative during rehabilitation exercises was insufficient, that the comprehensiveness and continuity of exercises could not be guaranteed, and that unification between textbook theory and clinical practice was incomplete. Moreover, respondents believed that their professional quality should be excellent, but that staffing and organizational management required optimization, and that support was required for the implementation of rehabilitation exercises.

CONCLUSION

This study investigated the opinions and experiences of medical staff during postoperative rehabilitation exercises in geriatric patients with femoral neck fractures. Collaborative efforts should fully engage hospitals, communities, and families, enhance the alignment of health education with patient needs, advance the scientific development of an integrated medical model by refining the curriculum and teaching system, and significantly elevate the level of medical science and technology. This study will serve as a valuable reference for the establishment of future professional, and personalized rehabilitation programs tailored for geriatric patients with femoral neck fractures.

'Breakdown and healing' - adaptation experiences of postpartum nurses returning to work: a descriptive phenomenological study

BACKGROUND

Promoting the work adaptation of nurses returning to work after childbirth is key to improving their physical and mental health and ensuring the quality of nursing care. Although postpartum nurses have reported high work stress and poor adaptation after returning to work, little is known regarding the experiences, problems and further needs. This study aimed to explore the adaptation experiences of postpartum nurses returning to work.

METHODS

This was a qualitative study with descriptive phenomenological approach. Individual semi-structured interviews were conducted between March and May 2023 in four tertiary hospitals in Changsha, mainland China, which were selected using convenience sampling. A total of 16 postpartum nurses returning to work within one year were recruited using purposive sampling and maximum variation sampling. The interviews were analysed using the Colaizzi's 7-step method.

RESULTS

'Breakdown and healing' is a strong thread in postpartum nurses' work adaptation. It links 13 subthemes in the interview data, which can be grouped under three overarching themes: (a) changes and challenges of multiple roles; (b) self-coping and social support; and (c) further needs after returning to work. The phrase 'breakdown and healing' reflects the mutual relationship between stress and coping among postpartum nurses. The changes and challenges associated with being required to fulfil multiple roles of mothers, wives and nurses make the subjects feel on the verge of 'breakdown'. When returning to work, most of them move slowly towards 'healing' through positive self-management and support from their partners, families, supervisors and colleagues. Moreover, their ongoing demands and unsolved problems - such as their desire for a workplace that is friendly and serves their needs - were generated by the constant process of 'breakdown and healing'.

CONCLUSIONS

Understanding how postpartum nurses returning to work perceive adaptation experiences is essential for nursing managers, who can use the findings to implement targeted measures to shorten postpartum nurses' maladaptation period after returning to work and promote their work adaptation. This study underscores the critical importance of personalized return-to-work training, flexible work arrangements, support from colleagues and managers, well-established maternal facilities and services, and targeted policy efforts in enhancing postpartum nurses' work adaptation.

The utility of website-based quality improvement tools for health professionals: a systematic review

As technology continues to advance, it is important to understand how website-based tools can support quality improvement. Website-based tools refer to resources such as toolkits that users can access and use autonomously through a dedicated website. This review examined how website-based tools can support healthcare professionals with quality improvement, including the optimal processes used to develop tools and the elements of an effective tool. A systematic search of seven databases was conducted to include articles published between January 2012 and January 2024. Articles were included if they were peer reviewed, written in English, based in health settings, and reported the development or evaluation of a quality improvement website-based tool for professionals. A narrative synthesis was conducted using NVivo. Risk of bias was assessed using the Mixed Methods Appraisal Tool. All papers were independently screened and coded by two authors using a six-phase conceptual framework by Braun and Clarke. Eighteen studies met the inclusion criteria. Themes identified were tool development processes, quality improvement mechanisms and barriers and facilitators to tool usage. Digitalizing existing quality improvement processes (n = 7), identifying gaps in practice (n = 6), and contributing to professional development (n = 3) were common quality improvement aims. Tools were associated with the reported enhancement of accuracy and efficiency in clinical tasks, improvement in adherence to guidelines, facilitation of reflective practice, and provision of tailored feedback for continuous quality improvement. Common features were educational resources (n = 7) and assisting the user to assess current practices against standards/recommendations (n = 6), which supported professionals in achieving better clinical outcomes, increased professional satisfaction and streamlined workflow in various settings. Studies reported facilitators to tool usage including relevance to practice, accessibility, and facilitating multidisciplinary action, making these tools practical and time-efficient for healthcare. However, barriers such as being time consuming, irrelevant to practice, difficult to use, and lack of organizational engagement were reported. Almost all tools were co-developed with stakeholders. The co-design approaches varied, reflecting different levels of stakeholder engagement and adoption of co-design methodologies. It is noted that the quality of included studies was low. These findings offer valuable insights for future development of quality improvement website-based tools in healthcare. Recommendations include ensuring tools are co-developed with healthcare professionals, focusing on practical usability and addressing common barriers to enhance engagement and effectiveness in improving healthcare quality. Randomized controlled trials are warranted to provide objective evidence of tool efficacy.

'We are all bringing, like a unique sort of perspective': The core elements of a strengths-based digital arts mentoring program for autistic adolescents from the perspective of their mentors

INTRODUCTION

While the adoption of strengths-based approaches to supporting autistic adolescents is growing in popularity, the application of this approach to a digital arts mentoring program has yet to be explored. This study reports on the core elements contributing to the success of a community digital arts mentoring program for autistic adolescents from the mentors' perspective. This paper presents an in-depth exploration of mentors' experiences, comprising a component of a broader line of research investigating a digital arts mentoring program for autistic adolescents emphasising positive youth development.

METHODS

The digital arts mentoring program spanned 20 weeks across two Australian school terms and was attended by two groups of autistic adolescents (N = 18) aged between 11 and 17 years. A qualitative approach was utilised in exploring the perspective of their mentors (N = 6). Qualitative data were collected at the end of each school term for each group with the mentors using an interpretive phenomenological approach and Colaizzi's seven-step analysis method. Thirteen individual interviews were conducted with six mentors.

CONSUMER AND COMMUNITY INVOLVEMENT

This research was conducted with a disability arts provider to provide a digital arts mentoring program to autistic adolescents. The mentors employed have lived experience with disorders such as attention deficit hyperactivity disorder (ADHD) and anxiety.

RESULTS

Five primary themes emerged from the data: positive connections, mentor knowledge and experience, mentoring approaches, autism education, program organisation, resources and environment. Subthemes underpinned the primary themes related to positive connections (three subthemes), mentoring approaches (four subthemes) and program organisation, resources and environment (three subthemes).

CONCLUSION

The findings suggest that prior experience, sufficient training, a supportive environment and a flexible and adaptable approach were essential for success. Understanding the core elements of a strengths-based digital arts program in occupational therapy provides a comprehensive framework for utilising clients' inherent strengths and creativity as therapeutic tool, creating an empowering environment, fostering meaningful outcomes for clients.

Livestock keeping, mosquitoes and community viewpoints: a mixed methods assessment of relationships between livestock management, malaria vector biting risk and community perspectives in rural Tanzania

BACKGROUND

Livestock keeping is one of the potential factors related to malaria transmission. To date, the impact of livestock keeping on malaria transmission remains inconclusive, as some studies suggest a zooprophylactic effect while others indicate a zoopotentiation effect. This study assessed the impact of livestock management on malaria transmission risks in rural Tanzania. Additionally, the study explored the knowledge and perceptions of residents about the relationships between livestock keeping and malaria transmission risks in a selected village.

METHODS

In a longitudinal entomological study in Minepa village, South Eastern Tanzania, 40 households were randomly selected (20 with livestock, 20 without). Weekly mosquito collection was performed from January to April 2023. Indoor and outdoor collections used CDC-Light traps, Prokopack aspirators, human-baited double-net traps, and resting buckets. A subsample of mosquitoes was analysed using PCR and ELISA for mosquito species identification and blood meal detection. Livestock's impact on mosquito density was assessed using negative binomial GLMMs. Additionally, in-depth interviews explored community knowledge and perceptions of the relationship between livestock keeping and malaria transmission risks.

RESULTS

A total of 48,677 female Anopheles mosquitoes were collected. Out of these, 89% were Anopheles gambiae sensu lato (s.l.) while other species were Anopheles funestus s.l., Anopheles pharoensis, Anopheles coustani, and Anopheles squamosus. The findings revealed a statistically significant increase in the overall number of An. gambiae s.l. outdoors (RR = 1.181, 95%CI 1.050-1.862, p = 0.043). Also, there was an increase of the mean number of An. funestus s.l. mosquitoes collected in households with livestock indoors (RR = 2.866, 95%CI: 1.471-5.582, p = 0.002) and outdoors (RR = 1.579,95%CI 1.080-2.865, p = 0.023). The human blood index of Anopheles arabiensis mosquitoes from houses with livestock was less than those without livestock (OR = 0.149, 95%CI 0.110-0.178, p < 0.001). The majority of participants in the in-depth interviews reported a perceived high density of mosquitoes in houses with livestock compared to houses without livestock.

CONCLUSION

Despite the potential for zooprophylaxis, this study indicates a higher malaria transmission risk in livestock-keeping communities. It is crucial to prioritize and implement targeted interventions to control vector populations within these communities. Furthermore, it is important to enhance community education and awareness regarding covariates such as livestock that influence malaria transmission.

Examining the experiences of vulnerably housed patients visiting Kingston, Ontario's emergency departments: a qualitative analysis

INTRODUCTION

Vulnerably housed individuals access emergency departments (EDs) more frequently than the general population. Despite Canada's universal public health care system, vulnerably housed persons face structural barriers to care and experience discrimination from healthcare providers. This study examines how vulnerably housed persons perceive their experience of care in the ED and Urgent Care Center (UCC) in Kingston, Ontario and aims to develop strategies for improving care for this group.

METHODS

As part of a larger mixed-methods study, narratives were collected from participants attending the ED/UCC as well as community-based partner organizations, asking them to describe an experience of a recent ED visit (< 24 months). Participants could identify as members of up to three equity-deserving groups (EDGs) (for example homeless, part of an ethnic minority, having a disability, experiencing mental health issues). Coding and thematic analysis were completed for the experiences of participants who identified as being vulnerably housed (n = 171). Results were presented back to individuals with lived experience and service providers working with clients with unstable housing.

RESULTS

Participants reported judgement related to a past or presumed history of mental health or substance use and based on physical appearance. They also often felt unheard and that they were treated as less than human by healthcare providers. Lack of effective communication about the ED process, wait times, diagnosis, and treatment led to negative care experiences. Participants reported positive experiences when their autonomy in care-decision making was respected. Furthermore, having a patient-centered approach to care and addressing specific patient needs, identities and priorities led to positive care experiences.

CONCLUSIONS

The ED care experiences of vulnerably housed persons may be improved through healthcare provider training related to trauma-informed and patient-centered care and communication strategies in the ED. Another potential strategy to improve care is to have advocates accompany vulnerably housed persons to the ED. Finally, improving access to primary care may lead to reduced ED visits and better longitudinal care for vulnerably housed persons.

Beyond the diagnosis of drug-resistant Tuberculosis in Norway: patients' experiences before, during and after treatment

BACKGROUND

This study aims to explore the varied experiences of patients with drug-resistant tuberculosis in Norway. The study emphasizes challenges and implications of being diagnosed with drug-resistant tuberculosis, including the impact on psychosocial health during the diagnosis, disease, treatment, isolation and recovery phases. Norway is a low endemic country of tuberculosis. Most patients are immigrants, and some of them have recently arrived in the country. Patients undergoing treatment for drug-resistant tuberculosis endure prolonged and demanding treatment that could affect their psychosocial health.

METHODS

This qualitative study conducted 16 in-depth interviews with individuals aged 18 years and above who were diagnosed with drug-resistant tuberculosis. All participants completed the treatment between 2008 and 2020. Fourteen participants were immigrants, and eight of them had resided in Norway for less than four years before diagnosis. Data analysis followed the six-phase reflexive thematic analysis framework, focusing on identifying patterns in participants' experiences, thoughts, expectations and attitudes.

RESULTS

The narratives of the participants highlighted the complexities of navigating the diagnosis of drug-resistant tuberculosis, treatment, side effects and life after treatment. Immigrants encountered additional challenges, including language barriers and adapting to new social environments. All participants reported experiencing physical health issues that additionally affected their mental health and social activity. Several participants had a delayed or prolonged diagnosis that complicated their disease trajectory. Participants with suspected or confirmed contagious pulmonary tuberculosis underwent hospital isolation for periods ranging from weeks to six months. The participants reported mental health issues, social isolation and stigma, however few were offered follow-up by a psychologist. Many participants had persistent problems at the time of the interviews. Three main themes emerged from the analysis: Delayed and prolonged diagnosis; Psychosocial impact of isolation during treatment; The life after tuberculosis.

CONCLUSION

This study highlights the enduring impact of drug-resistant tuberculosis on patients and the significance of timely diagnosis, psychosocial support and post-treatment follow-up. The participants universally faced serious implications of the disease, including stigma and isolation. Participants who experienced delayed diagnosis, reflected on missed early intervention opportunities. We recommend further research in low endemic countries to evaluate the international and local recommendations on psychosocial support.

Perspectives on Referral Pathways for Timely Head and Neck Cancer Care

Importance

Timely diagnosis and treatment are of paramount importance for patients with head and neck cancer (HNC) because delays are associated with reduced survival rates and increased recurrence risk. Prompt referral to HNC specialists is crucial for the timeliness of care, yet the factors that affect the referral and triage pathway remain relatively unexplored. Therefore, to identify barriers and facilitators of timely care, it is important to understand the complex journey that patients undertake from the onset of HNC symptoms to referral for diagnosis and treatment.

Objective

To investigate the referral and triage process for patients with HNC and identify barriers to and facilitators of care from the perspectives of patients and health care workers.

Design, Participants, and Setting

This was a qualitative study using semistructured interviews of patients with HNC and health care workers who care for them. Participants were recruited from June 2022 to July 2023 from HNC clinics at 2 tertiary care academic medical centers in Boston, Massachusetts. Data were analyzed from July 2022 to December 2023.

Main Outcomes and Measures

Themes identified from the perspectives of both patients and health care workers on factors that hinder or facilitate the HNC referral and triage process.

Results

In total, 72 participants were interviewed including 42 patients with HNC (median [range] age, 60.5 [19.0-81.0] years; 27 [64%] females) and 30 health care workers (median [range] age, 38.5 [20.0-68.0] years; 23 [77%] females). Using thematic analysis, 4 major themes were identified: the HNC referral and triage pathway is fragmented; primary and dental care are critical for timely referrals; efficient interclinician coordination expedites care; and consistent patient-practitioner engagement alleviates patient fear.

Conclusions and Relevance

These findings describe the complex HNC referral and triage pathway, emphasizing the critical role of initial symptom recognition, primary and dental care, patient information flow, and interclinician and patient-practitioner communication, all of which facilitate prompt HNC referrals.

Work Adjustments by Types of Occupations Amongst People with Multiple Sclerosis: A Survey Study

PURPOSE

To explore the occurrence of work adjustments for people with multiple sclerosis (MS) across types of occupations (managerial, office, and manual workers).

METHODS

All working-aged (20-50 years) residents in Sweden diagnosed with MS were invited to participate in a web-based survey in 2021. Responses were linked to individual-level nationwide registers. Descriptive analyses were conducted to compare sociodemographic and clinical variables across occupations as well as other responses. The odds ratio of having any adjustment at work was determined using multinomial logistic regression.

RESULTS

From all 4412 respondents (52% response rate), 3313 employees were included. The majority were women (72%) and had low (24.2%) or mild disease severity (44.7%). Nevertheless, different work adjustments across occupations were observed. Compared to the other occupations, office workers reported more invisible symptoms, more work adjustments and considered adapted schedules as the most important adjustment. On the contrary, more managers reported having no limiting symptoms and consequently, disclosed their diagnosis less often. They also reported having fewer work adjustments and more opportunities to modify their work than office and manual workers. Manual workers had a higher likelihood to report needing more support at work than office workers and managers. Further, a higher likelihood of having work adjustments was associated with progressive MS, higher MS severity, and invisible symptoms.

CONCLUSION

A more severe clinical profile of MS was associated with having work adjustments. The physical demands and responsibilities of an occupation play an important role when requesting and getting work adjustments amongst employees with MS.

Examining Inclusive Language in Clinical Narratives in Medical Biochemistry Textbooks to Model Equitable Patient-Centered Care in Preclinical Undergraduate Medical Education

Purpose

When healthcare professionals use biased or stigmatizing language to describe people or conditions, it can impact the quality of care or erode the patient-physician relationship. It is not clear where healthcare professionals acquire biased and stigmatizing language in practice. This study focuses on examining language in educational materials used in training of medical students. Specifically, medical biochemistry textbooks were examined as they are often a first exposure to clinical narratives and communication standards. The aim of this project is to investigate whether medical biochemistry textbooks, widely recommended in preclinical UME, model inclusive language communication in clinical narratives.

Methods

To determine if educational materials follow inclusive writing guidelines, we conducted a modified document analysis on a sample of medical biochemistry textbooks when clinical scenarios were described. Three independent researchers separately reviewed the textbooks, coded the language using NVivo, and generated themes.

Results

Our results show that medical biochemistry textbooks contain language which is not in alignment with the best practices for inclusive language. Our analysis mapped codes to two primary themes of language misalignment. The first theme, "clinical language" (n = 92), included the following codes: difficult patient, general negative descriptive language, patient as failure, and questioning patient credibility. The second primary theme, "identity-first labeling" (n = 251), included 21 codes.

Conclusion

This study provides early evidence that the language used in medical biochemistry textbooks to describe people and conditions is not in alignment with inclusive language recommendations. This can reinforce the way future healthcare professionals speak to and about their patients.