Finnish emergency medical services managers' and medical directors' perceptions of collaborating with patients concerning patient safety issues: a qualitative study

OBJECTIVES

This study aimed to describe emergency medical services (EMS) managers' and medical directors' perceptions of collaborating with patients concerning patient safety issues in the EMS.

DESIGN

The study used a descriptive qualitative approach. Five focus groups and two individuals were interviewed using a semi-structured guide with open-ended questions. The data were analysed using reflexive thematic analysis. Consolidated criteria for Reporting Qualitative research was used to guide the reporting of this study.

SETTING

EMS organisations from Finland's five healthcare districts.

PARTICIPANTS

EMS medical directors (n=5) and EMS managers (n=14). Purposive sampling was used.

RESULTS

Two main themes, 'Patient safety considered an organisational responsibility' and 'EMS patients' opportunities and obstacles to speaking up', were generated from the data. Under the main theme, 'Patient safety considered an organisational responsibility', were three subthemes: patient safety considered part of the quality in EMS, system-level models for handling and observing patient safety in EMS, and management's ability to find a balance when using patients' feedback for patient safety development. Under the other main theme were four subthemes: 'social and feedback skills of EMS personnel and management', 'managements' assumptions of patients' reasons for not speaking up', 'EMS organisations' different but unsystematic ways of collecting feedback' and 'management's openness to develop patient participation'.

CONCLUSIONS

The nature of the EMS organisations and EMS assignments could affect a patient's participation in developing patient safety in EMS. However, EMS managers and medical directors are receptive to collaborating with patients concerning patient safety issues if they have sufficient resources and a coherent way to collect patient safety concerns. The management is open to collaborating with patients, but there is a need to develop a systematic method with enough resources to facilitate the management's collaborating with patients.

Elective egg freezers' disposition decisions: a qualitative study

OBJECTIVE

To explore the factors that influence elective egg freezers' disposition decisions toward their surplus-frozen oocytes.

DESIGN

Qualitative.

SETTING

Not applicable.

PATIENT(S)

Thirty-one participants: 7 past; 6 current; and 18 future oocyte disposition decision-makers.

INTERVENTION(S)

Not applicable.

MAIN OUTCOME MEASURE(S)

Qualitative thematic analysis of interview transcripts.

RESULTS

Six inter-related themes were identified related to the decision-making process which are as follows: decisions are dynamic; triggers for the final decision; achieving motherhood; conceptualization of oocytes; the impacts of egg donation on others; and external factors affecting the final disposition outcome. All women reported a type of trigger event for making a final decision (e.g., completing their family). Women who achieved motherhood were more open to donating their oocytes to others but were concerned about the implications for their child and felt responsibility for potential donor children. Women who did not achieve motherhood were unlikely to donate to others due to the grief of not becoming a mother, often feeling alone, misunderstood, and unsupported. Reclaiming oocytes (e.g., taking them home) and closure ceremonies helped some women process their grief. Donating to research was viewed as an altruistic option as oocytes would not be wasted and did not have the "complication" of a genetically-linked child. There was a general lack of knowledge around disposition options at all stages of the process.

CONCLUSION(S)

Oocyte disposition decisions are dynamic and complex for women, exacerbated by a general lack of understanding of these options. The final decision is framed by: whether women achieved motherhood, dealing with grief if they did not achieve motherhood, and considering the complexities of donating to others. Additional decision support through counseling, decision aids, and early consideration of disposition when eggs are initially stored may help women make informed decisions.

Considerations for Using Alternative Technologies in Nutrient Management on Cape Cod: Beyond Cost and Performance

Mitigating non-point source nitrogen in coastal estuaries is economically, environmentally, logistically, and socially challenging. On Cape Cod, Massachusetts, nitrogen management includes both traditional, centralized wastewater treatment and sewering as well as a number of alternative technologies. We conducted semi-structured interviews with 37 participants from governmental and non-governmental organizations as well as related industries to identify the barriers and opportunities for the use of alternative technologies to mitigate nitrogen pollution. The interviews were recorded, transcribed, and then analyzed using content analysis and rhetorical analysis. Cost and technical capacity to reduce nitrogen were the most discussed considerations. Beyond those, there were a slew of additional considerations that also impacted whether a technology would be installed, permitted, and socially accepted. These included: maintenance and monitoring logistics, comparisons to sewering, co-benefits, risk/uncertainty, community culture, extent of public engagement, permitting/regulatory challenges, and siting considerations. The insights about these additional considerations are valuable for transferring to other coastal areas managing nutrient impairments that may have not yet factored in these considerations when making decisions about how to meet water quality goals.

Interventions targeting psychological well-being for motor neuron disease carers: A systematic review

OBJECTIVES

This systematic review considers interventions designed to improve the psychological well-being (PWB) of carers of people with motor neuron disease (MND) using quantitative, qualitative, or mixed-methods studies, and aimed to (1) summarize current research, (2) assess the quality of evidence, and (3) evaluate the effectiveness of interventions.

METHOD

Mixed-methods systematic review (MMSR) was conducted based on Joanna Briggs Institute methodology for quantitative, qualitative, and mixed-methods reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

Thirteen papers met the inclusion criteria, including 12 studies (six mixed-methods, four quantitative, and two qualitative). Four studies described randomized controlled trials, seven detailed uncontrolled longitudinal studies with a single treatment group and a pre-post design, and one was an observational survey. Critical appraisal of the studies revealed a wide range of weaknesses in the quantitative and/or qualitative methodologies. Due to the heterogeneity of interventions, outcomes, and measurements, a narrative and convergent approach to data synthesis was employed. While a minority of studies demonstrated some benefits to hedonic and eudaimonic aspects of PWB, the interpretability of these data was limited by methodological problems.

SIGNIFICANCE OF RESULTS

This MMSR highlighted a paucity of quality research regarding interventions for the PWB of MND carers. Although some benefits to PWB were demonstrated, most studies suffered from substantial methodological problems, rendering the overall evidence base low. High-quality and carefully designed studies are a priority to enable effective development and testing of much-needed interventions targeting the PWB for MND carers.

Health Care Providers Views on Identifying and Responding to South Asian Women Experiencing Family Violence: A Qualitative Meta Synthesis

Family violence (FV) is a universal public health problem in South Asia with negative-health outcomes for South Asian women. Health care providers (HCPs) play a pivotal role in identifying and supporting women experiencing FV, but little is known about their experiences with South Asian women. A systematic review was conducted to explore and address health care providers' views on identification and response to South Asian women experiencing FV. Nine online databases, reference lists were searched, and a priori inclusion and exclusion criteria were applied independently by two reviewers. A meta-synthesis approach was utilized to integrate findings from qualitative studies. Eight studies involving 250 participants met the inclusion criteria. Studies were published between 2007 and 2020 within South Asian countries (Pakistan, India, and Sri Lanka) and one study from the USA and UK. The meta-synthesis identified three themes: Context of societal norms and attitudes towards women in South Asia; Influence of family honor, Privacy and shame; and Concern about health care provider's personal safety. Findings revealed that FV is often perceived as a normal routine issue and is considered a "private issue" in South Asian society. Family honor and values play a pivotal role in silencing women experiencing FV as disclosure is considered shameful and disgrace to family honor. Furthermore, health care providers avoid intervening in FV cases due to risk for their personal safety. Finally, this review provides the evidence to support a specific framework for FV interventions among south Asian women for policy makers and practitioners.

"Honestly, this problem has affected me a lot": a qualitative exploration of the lived experiences of people with chronic respiratory disease in Sudan and Tanzania

BACKGROUND

Over 500 million people live with chronic respiratory diseases globally and approximately 4 million of these, mostly from the low- and middle-income countries including sub-Saharan Africa, die prematurely every year. Despite high CRD morbidity and mortality, only very few studies describe CRDs and little is known about the economic, social and psychological dimensions of living with CRDs in sub-Saharan Africa. We aimed to gain an in-depth understanding of the social, livelihood and psychological dimensions of living with CRD to inform management of CRDs in Sudan and Tanzania.

METHOD

We conducted 12 in-depth interviews in 2019 with people with known or suspected CRD and 14 focus group discussions with community members in Gezira state, Sudan and Dodoma region, Tanzania, to share their understanding and experience with CRD. The data was analysed using thematic framework analysis.

RESULTS

People with CRD in both contexts reported experiences under two broad themes: impact on economic wellbeing and impact on social and psychological wellbeing. Capacity to do hard physical work was significantly diminished, resulting in direct and indirect economic impacts for them and their families. Direct costs were incurred while seeking healthcare, including expenditures on transportation to health facility and procurement of diagnostic tests and treatments, whilst loss of working hours and jobs resulted in substantial indirect costs. Enacted and internalised stigma leading to withdrawal and social exclusion was described by participants and resulted partly from association of chronic cough with tuberculosis and HIV/AIDS. In Sudan, asthma was described as having negative impact on marital prospects for young women and non-disclosure related to stigma was a particular issue for young people. Impaired community participation and restrictions on social activity led to psychological stress for both people with CRD and their families.

CONCLUSION

Chronic respiratory diseases have substantial social and economic impacts among people with CRD and their families in Sudan and Tanzania. Stigma is particularly strong and appears to be driven partly by association of chronic cough with infectiousness. Context-appropriate measures to address economic impacts and chronic cough stigma are urgently needed as part of interventions for chronic respiratory diseases in these sub-Saharan African contexts.

Driving forces of GPs' migration in Europe: an exploratory qualitative study

BACKGROUND

The shortage of GPs is a worldwide phenomenon, which encourages the migration of GPs and consequently exacerbates the GP shortage. This shortage imposes a threat for the entire healthcare system.

AIM

To explore the driving forces of GPs' migration in Europe and their reasons to stay in the new country, to migrate further, or to return to their home country.

DESIGN & SETTING

An exploratory, qualitative study of European GPs who have migrated within Europe.

METHOD

Individual interviews were conducted until data saturation and audio-recordings were transcribed. Thematic analysis was performed using NVivo.

RESULTS

Fifteen interviews with GPs from eight different European countries were conducted. The reasons why European GPs migrate and decide to stay or to leave were grouped under the following three themes: professional development; personal reasons; and the situation in the home country or the organisation of health care. New professional challenges, better working environment, and higher quality training programmes were mentioned as the main reasons for migration. Personal reasons, such as family's satisfaction with the living environment, closeness to other family members, and financial considerations, seemed to influence the decision to stay or leave the most.

CONCLUSION

Migration caused by dissatisfaction with the working and living environment is something countries could potentially work on in order to retain their GPs. As some countries in Europe rely more and more on international recruitment to combat the GP shortage, which in turn worsens the situation in other countries, a more unified Europe-wide approach to GP shortage and migration is needed.

"Things Will Get Worse Before They Get Better": LGBTQ + People's Reactions to the 2020 US Presidential Election

Introduction

Previous research has found that political discourse over proposed legislation that impacts lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ +) people serves as a distal stressor which is associated with poorer mental and physical health. This study sought to document responses to the 2020 US Presidential election among LGBTQ + people living in the USA.

Methods

Nineteen LGBTQ + people ages 20 to 76 (M = 47.20; SD = 17.66) living across the USA were interviewed via Zoom video conferencing software between October and early December 2020. The modal participant was female (36.8%), identified as gay or lesbian (47.3%), and White (84.2%). Interviews were coded using Interpretative Phenomenological Analysis (Smith & Osborn, 2003).

Results

Seventeen codes emerged, which were grouped into three themes. Participants viewed specific political figures, namely then-President Trump and Supreme Court nominee Coney-Barrett, as symbolic of the potential loss of rights and disenfranchisement of LGBTQ + people. Participants exhibited uncertainty about the future; however, a Biden presidential win was viewed as potentially instilling complacency and leading to fracturing of the LGBTQ + community. While some participants avoided news, most were engaged with the political process as a means of coping with election uncertainty.

Conclusions

The findings have implications for better understanding the concerns of LGBTQ + folks as it relates to how they view political discourse and the future of the equality movement.

Policy Implications

Policies which beneficially impact and engage a diverse range of LGBTQ + people would facilitate mobilization of LGBTQ + political communities.

Teaching vulval anatomy in the twenty-first century: The Australian experience

Anatomy has often been regarded as an immutable discipline where everything that needs to be known is known. This article focuses on the teaching of vulval anatomy, the diversification of gender in contemporary society, and the increasing popularity of the Female Genital Cosmetic Surgery (FGCS) industry. The binary language and singular structural arrangements contained in lectures and chapters on "female genital anatomy" are nowadays rendered exclusive and incomplete. A series of 31 semi-structured interviews with Australian anatomy teachers identified barriers and facilitators for teaching vulval anatomy to contemporary student cohorts. Barriers included lack of connection to contemporary clinical practice, time and technical difficulty involved in regularly updating online presentations, the crowded curriculum, personal sensitivity to teaching vulval anatomy, and reluctance to introduce inclusive terminology. Facilitators included lived experience, regular use of social media, and institutional initiatives toward inclusivity including the support of queer colleagues.

Perspectives on reasons for suicidal behaviour and recommendations for suicide prevention in Kenya: qualitative study

BACKGROUND

Little is known about the reasons for suicidal behaviour in Africa, and communities' perception of suicide prevention. A contextualised understanding of these reasons is important in guiding the implementation of potential suicide prevention interventions in specific settings.

AIMS

To understand ideas, experiences and opinions on reasons contributing to suicidal behaviour in the Coast region of Kenya, and provide recommendations for suicide prevention.

METHOD

We conducted a qualitative study with various groups of key informants residing in the Coast region of Kenya, using in-depth interviews. Audio-recorded interviews were transcribed and translated from the local language before thematic inductive content analysis.

RESULTS

From the 25 in-depth interviews, we identified four key themes as reasons given for suicidal behaviour: interpersonal and relationship problems, financial and economic difficulties, mental health conditions and religious and cultural influences. These reasons were observed to be interrelated with each other and well-aligned to the suggested recommendations for suicide prevention. We found six key recommendations from our thematic content analysis: (a) increasing access to counselling and social support, (b) improving mental health awareness and skills training, (c) restriction of suicide means, (d) decriminalisation of suicide, (e) economic and education empowerment and (f) encouraging religion and spirituality.

CONCLUSIONS

The reasons for suicidal behaviour are comparable with high-income countries, but suggested prevention strategies are more contextualised to our setting. A multifaceted approach in preventing suicide in (coastal) Kenya is warranted based on the varied reasons suggested. Community-based interventions will likely improve and increase access to suicide prevention in this study area.

Primary health care during the COVID-19 pandemic: A qualitative exploration of the challenges and changes in practice experienced by GPs and GP trainees

BACKGROUND

The COVID-19 pandemic has rapidly changed general practice in the UK. Research is required to understand how General Practitioners (GPs) and GP trainees adjusted to these changes, so that beneficial changes might be sustained, and Primary Health Care (PHC) can be prepared for future challenges. This study explored the experiences and perspectives of GP and GP trainees during the pandemic.

METHODS

Remote, semi-structured interviews (n = 21) were conducted with GPs (n = 11) and GP trainees (n = 10), recruited from across the UK using convenience and purposive sampling. Interviews were audio-recorded and transcribed verbatim. Interview data were analysed with an inductive thematic approach.

RESULTS

Five overarching themes were identified: (1) 'Thrown in at the deep end'; (2) Telemedicine: 'it needs to be a happy balance'; (3) Delayed referrals and 'holding' patients; (4) The Covid Cohort-training in Covid; (5) Suggestions and lessons for the future of general practice'. GPs reported a turbulent and uncertain time of major changes to PHC. They described the benefits of technology in general medicine, particularly telemedicine, when used in a balanced manner, highlighting the need for accompanying teaching and guidelines, and the importance of patient preferences. Key tools to help GPs manage patients with delayed referrals to Secondary Care were also identified.

CONCLUSION

Several key changes to general practice occurred as a result of the COVID-19 pandemic, including a rapid uptake of telemedicine. The pandemic exposed the strengths and limitations of normal general practice and highlighted the importance of workplace camaraderie. These findings contribute to the evidence base used to adapt PHC infrastructures as we emerge from the pandemic.

A qualitative study exploring the perceived effects of veterinarians' mental health on provision of care

Introduction

Veterinary medicine is a rewarding, yet demanding profession with a myriad of occupational stressors that can impact the mental health of veterinarians. Stress, mental health outcomes, and associated risk factors amongst veterinarians have been well-researched. Much less research has investigated how high stress and/or poor mental health can impact veterinarians' provision of care.

Methods

One-on-one research interviews were conducted with 25 veterinarians at a Canadian veterinary conference in July 2016 and verbatim transcripts were produced from the audio recordings. The research team collaboratively analyzed the interviews using thematic analysis.

Results

Five themes described the perceived impacts of high stress and/or poor mental health: perceived negative impacts on interactions with (1) co-workers and (2) clients; (3) reduced concentration; (4) difficulty in decision making; and (5) reduced quality of care.

Discussion

These results highlight the perceived impacts of self-reported high stress and/or poor mental health on veterinary team dynamics, the potential to impact case outcomes, and possibly endanger patient safety. Interventions to help mitigate the impacts of high stress and poor mental health are discussed.

[Motives, goals and anticipated barriers as experienced by employees engaged in an initiative promoting sustainability at a general hospital - A qualitative analysis]

BACKGROUND

As a consequence of the climate crisis, a drastic reduction of greenhouse gas emissions and a transformation towards a sustainable economy are indispensable for the health care sector.

METHODS

For the present study, barriers and facilitators in implementing a transformation towards more sustainability were evaluated in qualitative interviews with members of an initiative attempting to establish more sustainability at a general hospital.

RESULTS

In 12 interviews, the interviewees were asked about the necessary personal characteristics for their commitment, short- and long-term ideas about how to reduce green house gas emissions, as well as barriers and facilitators of the organization's structure and of the societal context.

CONCLUSION

The methods for implementing more sustainability at a general hospital are mostly known. However, more knowledge is needed about the capacity to withstand both organizational barriers and feelings of hopelessness and impotence in order to preserve one's ability to act.

Women's beliefs of pain after childbirth: Critical insight for promoting behavioral strategies to regulate pain and reduce risks for maternal mortality

OBJECTIVE

Promoting behavioral strategies to better regulate pain and decrease the use of prescription pain medications immediately after childbirth is an attractive approach to reduce risks for adverse outcomes associated with the maternal mortality crisis. This study aimed to understand women's beliefs and experiences about pain management to identify important insights for promoting behavioral strategies to control postpartum pain.

METHODS

N = 32 postpartum women participated in a semi-structured interview about beliefs/experiences with managing postpartum pain. Higher- and lower-order themes were coded; descriptive statistics were used to summarize results.

RESULTS

Major trends emerging from the data were: (1) most women used a combination of medications (e.g., oxycodone and acetaminophen) and behavioral strategies (e.g., physical activity) in the hospital (94 %) and at discharge (83 %); (2) some women reported disadvantages like negative side effects of medications and fatigue from physical activity; and (3) some women reported they would have preferred to receive more evidence-based education on behavioral strategies during prenatal visits.

CONCLUSION

Our findings showed that most women were prescribed medications while in the hospital and at discharge, and used non-prescription, behavioral strategies.

PRACTICAL IMPLICATIONS

Future research is needed to test behavioral strategies in randomized clinical trials and clinical care settings to identify impact on reducing adverse maternal health outcomes.

Delivering a psychosocial program for older people living in retirement homes during the Covid-19 pandemic: A process evaluation and recommendations for community interventions

The Covid-19 pandemic lockdown regulations caused retirement homes to temporarily ban in-person visitation potentially increasing the mental health risks of older people. An opportunity arose for a multistakeholder community collaboration to design a mental health program for older people. To evaluate the process of delivering a 12-week psychosocial program aimed at preventing loneliness, countering boredom, and providing older people in restricted settings with education about Covid-19 during the lockdown, in Durban, South Africa. A qualitative retrospective design was used. Data from two focus groups and six semistructured individual interviews conducted with stakeholders (volunteers, social workers, and residents) postproject were analyzed using reflexive thematic analysis. Stakeholders had varied experiences of the project, in terms of content, processes of engagement, and implementation, resulting in five themes. The study concluded with recommendations. A strong need exists for multistakeholder community collaborations when implementing a program where the context restricts physical access.

Support Experiences for Novice Nurses in the Workplace: A Qualitative Analysis

Introduction

Since novice nurses need support at the beginning of their work, knowing workplace support resources can help them to experience fewer challenges at the beginning of their work and improve the quality of patient care.

Objectives

The present qualitative study aimed to explore novice nurses' experiences of supporting the workplace at the beginning of their work.

Design

This qualitative study was performed using a content analysis method.

Methods

This qualitative study was conducted with 14 novice nurse participants using the conventional content analysis method, unstructured in-depth interviews were used to collect data. All data were recorded, transcribed, and analyzed based on the Graneheim and Lundman method.

Results

Two major categories and four subcategories were extracted during data analysis as follows: (1) An intimate work environment with subcategories of cooperative work atmosphere and empathetic behaviors, (2) Educational support available for improvement contains subcategories conducting orientation courses and holding retraining courses.

Conclusion

The present study showed that such experiences as an intimate work environment, and educational support help novice nurses to have a supportive workplace and improve their performance. A welcoming and supportive atmosphere should be created for newcomers to ease their anxiety and frustration. Furthermore, they can improve their performance and provide quality care by giving themselves the motivation and spirit of improvement.

Relevance to Clinical Practice

This research highlights the need for new nurses to have support resources in the work environment, and healthcare managers can improve the quality of care by allocating sufficient support resources to this group of nurses.

Design, development, utility and usability testing of the EMPOWER-SUSTAIN Self-Management Mobile App© among primary care physicians and patients with metabolic syndrome

Objective

This study aimed to design, develop, assess and refine the EMPOWER-SUSTAIN Self-Management Mobile App© among primary care physicians (PCP) and patients with metabolic syndrome (MetS) in primary care.

Methodology

Using the software-development-life-cycle (SDLC) iterative model, storyboard and wireframe were drafted; and a mock prototype was designed to illustrate the content and function graphically. Subsequently, a working prototype was developed. Qualitative studies using the 'think-aloud' and cognitive-task-analysis methods were conducted for the utility and usability testing. Topic guide was based on the 10-Nielsen's-Heuristic-Principles. Utility testing was conducted among PCP in which they 'thought-aloud' while performing tasks using the mobile app. Usability testing was conducted among MetS patients after they were given the app for 3 weeks. They 'thought-aloud' while performing tasks using the app. Interviews were audio- and video-recorded, and transcribed verbatim. Thematic content analysis was performed.

Result

Seven PCP and nine patients participated in the utility and usability testing, respectively. Six themes (efficiency of use, user control and freedom, appearance and aesthetic features, clinical content, error prevention, and help and documentation) emerged. PCP found the mobile app attractive and relevant sections were easy to find. They suggested adding 'zoom/swipe' functions and some parts needed bigger fonts. Patients commented that the app was user-friendly, has nice interface, and straightforward language. It helped them understand their health better. Based on these findings, the mobile app was refined.

Conclusion

This app was produced using a robust SDLC method to increase users' satisfaction and sustainability of its use. It could potentially improve self-management behaviour among MetS patients in primary care.

Socio-demographic characteristics associated with perceived social support among parents of children aged 0-7 years: the CIKEO study

BACKGROUND

Social support has been associated with numerous positive outcomes for families' health, wellbeing and empowerment. This study examined which socio-demographic characteristics are associated with perceived social support among parents of children aged 0-7 years.

METHOD

Cross-sectional data of 1007 parents of children aged 0-7 years, gathered in the CIKEO cohort study in the Netherlands, were analysed. Social support was assessed with the Multi-dimensional Scale of Perceived Social Support (MSPSS). Linear regression models were used to examine associations between socio-demographic characteristics and perceived social support.

RESULTS

The mean age of the participants was 34.1 years (SD = 5.1); 92.9% were mothers. The multivariable regression model showed that fathers (β: -0.15, 95% CI: - 0.22, - 0.08), parents with a low educational level (β: -0.12, 95% CI: 0.18, - 0.06), parents with a low income (β: -0.10, 95% CI: - 0.19, - 0.01), unemployed parents (β: -0.14, 95% CI: - 0.20, - 0.07), and parents of older children (β: -0.07; 95% CI: - 0.13, 0.00) perceived lower levels of social support. Interaction analyses showed that parents with a migration background and a low educational level were particularly susceptible to perceiving lower levels of support (β: -0.34, 95% CI: - 0.52, - 0.15).

CONCLUSION

Fathers, parents with a low educational level, parents with a low income, unemployed parents, parents of older children, and parents with both a migration background and a low educational level are at increased risk of perceiving lower levels of social support.

IMPLICATIONS

We recommend to develop, implement and evaluate intervention strategies to strengthen perceived social support among the abovementioned subgroups of parents, in order to improve families' health, wellbeing and empowerment.

TRIAL REGISTRATION

NTR7607 in the Netherlands trial registry.

Development of a conceptual framework for a new patient-reported outcome measure for pain in women following mesh surgery for pelvic floor disorders: a qualitative study

Introduction and hypothesis

The Australasian Pelvic Floor Procedure Registry (APFPR) collects both clinical and health-related quality of life (HRQoL) data on women undergoing surgery using a prosthesis such as mesh for pelvic organ prolapse (POP) and stress urinary incontinence (SUI). The registry lacks a suitable instrument to assess pain in women following mesh surgery for SUI and POP. This qualitative study describes the views on pain following mesh surgery in women and clinicians through the development of a conceptual framework, which may inform the development of a new instrument for the APFPR.

Methods

We conducted semi-structured interviews with women following mesh surgery for POP and SUI (n=17) and clinicians (n=6) in Victoria, Australia. We sought to reveal aspects of any sort of pain after a pelvic floor procedure. Interviews covered sensation, region, continuity of pain, triggers, and the mode and method of administration for a new pain-specific patient-reported outcome measure. Data were analysed using thematic analysis.

Results

We identified the important components of pain felt by women with POP and SUI after surgery using mesh. From the seven themes outlined, a conceptual framework was developed compiling related components of pain into six specific domains.

Conclusions

This study identifies the important components of pain felt by women following mesh surgery. It is hoped that the development of a pain-specific PROM, as supported by clinicians, will assist in the timely and appropriate diagnosis and management of POP and SUI.

Counselling challenges associated with donor conception and surrogacy treatments - time for debate

Fertility counselling services have had to respond to significant developments in fertility treatments in recent years, prompting increasingly complex personal and professional ethical challenges. This Commentary focuses on those rising from donor conception and/or surrogacy. The profile of those seeking such treatments has changed to include growing numbers of same sex couples, single people, people who are transitioning or have done, people seeking posthumous use of gametes, and people using cross-border services. Alongside, awareness has grown of life-span implications, the impact of commercial DNA testing, and the need for 'later-life' support. Responses vary internationally and the time for debate is overdue. Who should provide fertility counselling and how? Should specialist qualifications, training, continuing professional development, and regulation be required? Should counsellors play a role in assessing suitability to parents? What aspects of different contractual arrangements and conflicts of interest need attention? Has the time come for counselling to be mandatory as part of pre-treatment pathways? What should be the relationship between fertility counsellors and multi-disciplinary clinic teams? How might fertility counsellors be represented nationally and internationally? What should be their relationship to 'later life' professional support? What place should professional knowledge hold in the evidence base?

Equity-Promoting Strategies in Online Grocery Shopping: Recommendations Provided by Households of Low Income

OBJECTIVE

To explore barriers and facilitators of online grocery shopping and identify community-driven strategies to promote equity in online food access.

DESIGN

This qualitative study used a purposive recruitment strategy to conduct 11 focus groups and 5 in-depth interviews between November 2020 and March 2021.

SETTING

Data collection was conducted virtually with participants residing in diverse (majority urban) regions of Maryland.

PARICIPANTS

44 primary household food purchasers with young children (aged < 8 years) eligible for the Supplemental Nutrition Assistance Program (SNAP).

PHENOMENON OF INTEREST

Barriers and facilitators of online grocery shopping and strategies elicited by the community to leverage SNAP and online food retailer services to reduce inequities in healthy food access.

ANALYSIS

We coded and analyzed transcripts on the basis of the Socioecological Model, Theory of Planned Behavior, and an Equity-Oriented Framework.

RESULTS

Overall, we identified 10 themes across all socioecological levels, all of which reflected both barriers and facilitators to online shopping: (1) individual: trust of shoppers, technology, (2) interpersonal: spousal/children needs, (3) community: safety and security, (4) organizational: retail experience and food quality, and (5) policy: SNAP and structural inequities. Participant recommendations included improving food access and communication with hired shoppers, implementing more payment/cost-saving options, and offering educational programming for SNAP participants on using benefits online.

CONCLUSIONS AND IMPLICATIONS

Households of low-income identified barriers and facilitators of online grocery shopping across the socioecological levels, emphasizing the need for a multilevel approach to equity promotion. We recommend future work to explore the suggested actionable pathways, which involve delivery providers, grocery stores, nutrition educators, and policymakers leveraging online grocery features (ie, meal planning support) and policies (ie, expansion of the SNAP Online Purchasing Pilot to more retailers) to reducing deterrents (ie, delivery fees waived) for an equity-promoting online grocery environment.

The changing face of HR professionals' expectations amidst COVID-19: a comparison in between Sri Lanka and foreign context

The COVID-19 has brought significant transformation to organizations throughout the world in expediting the sudden transition to digital business operations for business continuity. Thus, businesses need to examine the expectations of Human Resource (HR) professionals to adapt to the unexpected changes aroused by the novel COVID-19 pandemic. The study aimed to compare HR professionals' expectations from the workplace in Sri Lanka and foreign countries during the COVID-19 pandemic. The researchers utilized the qualitative research method and applied the thematic analysis in order to analyze the gathered data from 28 semi-structured interviews. According to the findings, HR professionals in Sri Lanka anticipate returning to work at office premises, and if this work transition continues in the future, they expect more incentives and strategies for work-life balance. In contrast, HR professionals in foreign countries anticipate a hybrid work culture with employee wellbeing sessions. Accordingly, the study implies that organizations should facilitate the expected requirements to continue work in the current and future crises. The HR policymakers will be able to carry out more precise planning activities in the future when developing policies related to managing HR functions in crises.

Nursing Care Delivery Models and Intraprofessional Collaborative Care: Canadian Nurse Leaders' Perspectives

Introduction

There are many different types of nursing care delivery models used to organize and provide care in hospitals. These models are comprised of different organizational structures and staffing skill mixes.

Objective

The aim of this study was to explore how nursing care delivery models promote intraprofessional collaborative care in acute care hospitals from the perspectives of nurse leaders.

Methods

A qualitative descriptive approach was used for this study. Telephone interviews were conducted between January 2021 and August 2021 using an interview guide comprised of semi-structured and structured questions. Using a purposeful sampling technique, ten leaders from nine hospital systems, representing both urban and rural hospitals in the province of Ontario, Canada, participated in the study. Content analysis was conducted resulting in two overarching themes.

Results

The first theme, Fluidity of the Model addresses the flexibility of the models and the impact of contextual factors such as changes in nurses' scope of practice, government funding changes, staffing mix, and organizational policies and rules. The second theme, Tools of the Trade describes the resources that hospitals implement to promote intraprofessional collaboration that indirectly impacts on patient safety.

Conclusion

Nursing care delivery models need to be flexible and adaptable. All nursing care delivery models in this study used various tools to promote intraprofessional collaborative care.

Succession management and corporate sustainability in Ghana: a leadership succession paradox

Purpose

A core responsibility of organizational leaders in a world of increasing competition for best talents is positioning right persons and plans for sustainable growth and progress of their respective organizations. However, attracting top talents for key positions is meaningless if it is not backed by winning retention or succession strategies. This paper aims to assess succession management techniques in the Nzema East District (NED) of Ghana to determine incumbent reliability on its own succession knowledge, practice and sustainability.

Design/methodology/approach

Through a cross-organizational investigation, this study used qualitative approaches to explore succession knowledge and practice as they relate to effective management and sustainability of selected NED organizations. In all, 60 purposively selected participants were involved in the study.

Findings

This study revealed not only that most NED organizational leaders have no succession plans but also that some senior management officials of these organizations, much as their subordinates, lack knowledge and practice of the concept altogether. It also emerged that a leadership succession paradox, where management expressed profound interest in succession planning (SP) learning and practice, adopting SP as a strategic tool and in using SP as insurance for sustainability of NED firms, but presides over the contrary, characterized much of NED management activity.

Research limitations/implications

As a case study, this research is limited in terms of generalizability, but its implications are quite limitless.

Originality/value

The originality of this study lies in an emerging leadership succession paradox where business executives advocate what, in practice and theory, they are themselves opposed to. Contrary to the logic that we practice what we learn, succession management in NED organizations is not only unethical but also paradoxical. This study has not been published and is not being considered for publication anywhere else.

Understanding User Requirements for a Senior-Friendly Mobile Health Application

The advancement of mobile technologies has motivated countries around the world to aim for smarter health management to support senior citizens. However, the use of mobile health applications (mHealth apps) among senior citizens appears to be low. Thus, drawing upon user expectations, the present study examined user requirements for a senior-friendly mHealth application. A total of 74 senior citizens were interviewed to explore the difficulties they encounter when using existing mobile apps. This study followed Nielsen’s usability model to identify user requirements from five aspects, namely learnability, efficiency, memorability, error, and satisfaction. Based on the results, a guideline was proposed pertaining to usability and health management features. This guideline offers suggestions for mHealth app issues related to phrasing, menus, simplicity, error messages, icons and buttons, navigation, and layout, among others. The study also found that speech recognition technology can help seniors access information quickly. The proposed guideline and findings offer valuable input for software and app developers in building more engaging and senior-friendly mHealth apps.

The Human Capital Risk Reporting of Listed South African Companies: Exploring a Reporting Framework to Support Corporate Governance

Despite the importance and requirement of integrated reporting on human capital (HC), research indicates a lack of reporting frameworks and adequate disclosure in organization reports. Thus, a unique research opportunity is created for researchers to determine what is being presented in reports and how it correlates with human resource management. This article investigates HC reporting practices and proposes a risk reporting framework in support of corporate governance. A qualitative method utilizing qualitative document analysis was followed to analyze a purposive sample (n = 39) of Johannesburg Stock Exchange top 40 listed companies’ annual integrated reports of 2020. Overall, companies followed a widely accepted risk management approach, with inconsistencies in the phases and methods of reporting the risk management phases directed at HC. The magnitude of the risk to the companies is also not understood. The most commonly reported HC risks were employee growth and development, diversity and inclusion, career paths, and employee turnover and turnover intention. Employee work-related well-being was largely neglected. An interesting finding is that the reported risks were metrics-deprived. Current HC practices are backward-looking instead of forward-looking, and they are fragmented. Therefore, an HC reporting framework is suggested for future research that addresses the gaps in integrated reports.

Interdisciplinary clinicians' attitudes, challenges, and success strategies in providing care to transgender people: a qualitative descriptive study

BACKGROUND

Access to clinicians competent in transgender health remains a significant barrier and contributor toward health inequity for transgender people. Studies on access and barriers to care have predominantly evaluated transgender patients' perceptions, but scant research has included the perspectives of clinicians.

AIMS

We conducted a qualitative study to explore how clinicians (meaning physicians and advanced practice providers, in this paper) in the United States: (1) attain and utilize information, (2) perceive barriers and facilitators, and (3) understood gaps in their professional training, in regard to practicing transgender health care.

METHODS

A Qualitative Descriptive approach guided our conventional content analysis of field notes and interviews with clinicians within a parent study that explored health care access among transgender adults. Transcripts were coded into meaning units that were iteratively abstracted into themes. Standard measures were performed to promote the trustworthiness of the analysis and reduce bias.

RESULTS

Participants (n = 13) consisted of physicians (n = 8), physician assistants (n = 3), and nurse practitioners (n = 2). The majority were women (n = 11), identified as White (n = 9), cisgender (n = 13), and ages ranged from 31 - 58 years. Five main themes were identified: (1) Knowledge Acquisition: Formal and Informal Pathways to Competency; (2) Perceived Challenges and Barriers: I didn't know what I was doing; (3) Power to Deny: Prescriptive Authority and Gatekeeping; (4) Stigma: This is really strange, and I can't really understand it; (5) Reflections: Strategies for Success, Rewards, and Personal Motivations.

DISCUSSION

Clinicians gained a sense of comfort and competence with mentorship, self-directed learning, clinical experience, and person-centered, harm-reduction approaches. Stigma, bias, and structural-level factors were barriers to providing care. This study offers a unique perspective of clinicians' motivations and strategies for providing gender-affirming care and elucidates how stigma impacts the delivery of gender-affirming care.

Exploring the Experiences of Pharmacy Students and Their Transition to Online Learning during COVID-19

Due to the heavy focus on development of communication skills, compounding laboratories and many practical workshops, undertaking a registerable pharmacist qualification in an online format is typically not an option for students. COVID-19 presented on-campus pharmacy students with the opportunity to experience online learning. The aim of this study was to explore the experiences of on-campus pharmacy students who were required to move their studies to online learning during the COVID-19 pandemic. An interpretive phenomenological methodology was adopted, and semi-structured interviews were conducted with pharmacy students who were originally enrolled in on-campus learning and had to transition to online learning. Data were analyzed using a hermeneutic phenomenological approach whereby themes were identified to aid in the development of the phenomena guided by 'lived experience'. Seven interviews were conducted with pharmacy students. Four emergent themes resulted from the interviews: (1) life as an on-campus pharmacy student, (2) preconceived ideas of online learning, (3) learning differences as an online pharmacy student and (4) the future of online pharmacy programs. Students were initially hesitant to transition to online learning due to preconceived ideas and expectations that may have tainted their overall experience. Pharmacy students preferred face-to-face learning due to their sociable personality and heavy dependence on peer and teacher support. All participants reported that they preferred face-to-face learning and acknowledged that fully online programs were not suited to their learning style or to the discipline of pharmacy. After their experience of online learning, participants believed that there was a place for online learning components in pharmacy courses. Lectures and some discussion workshops could be delivered online, but some aspects, such as compounding; dispensing; counselling; and demonstration of medication delivery devices, such as asthma inhalers and injectable diabetes products, should be delivered on campus.

Mississippi INBRE Outreach Scholars program: adapting a summer scholars program to the virtual world amidst the COVID-19 pandemic

The Mississippi IDeA Networks of Biomedical Research Excellence (INBRE) supported by the National Institute of General Medical Sciences (Grant P20GM103476) launched the new Mississippi INBRE Outreach Scholars (MIOS) summer research program in 2019. The program was designed to offer students community outreach and research experiences related to the study of behavioral and health disparities life sciences. The program was adapted in early 2020 to offer the program in a fully online format in the summer of 2020. This article details the program adaptations and discusses program evaluation data related to scholars' perceptions of program benefits and expectations and their confidence in research-related skills. The program evaluation was a mixed-method approach that included a qualitative postprogram survey and a pre-post quantitative survey. Scholars identified technical and communication skill building and resilience as areas of personal growth. Overall, the program met scholars' expectations for the program and significantly improved their confidence on 8 of the 19 (with confidence interval estimated differences from 0.3 to 2.56, where a difference of 1 is an improvement across 1 anchor on a Likert-type scale) various research-related tasks/skills after completion of the program. The analyses presented demonstrated that a combined qualitative and quantitative analysis approach is useful for examining the extent to which programs such as Mississippi INBRE are meeting goals of providing a rich research experience in health disparities for a diverse student body. Future longitudinal data may be examined to explore the long-term impact of MIOS on career preparation and choices and graduate education.NEW & NOTEWORTHY The Mississippi INBRE Outreach Scholars program is a summer research program for Mississippi college students that was successfully adapted to a fully online environment amidst the coronavirus-19 pandemic.

Exploring parents' perspectives on feeding their young children: a qualitative study using photo-elicitation in Chile

OBJECTIVE

Childhood obesity is considered one of the most important public health problems around the world. Chile is currently one of the Latin American countries with a high prevalence of childhood obesity. Given that parents' food parenting practices shape their children's lifelong eating habits, addressing those practices is key to curbing later problems of obesity. However, studies of the influences on Chilean parents' food parenting practices are scarce. Hence, this study explores factors that influence food parenting practices of preschool-aged children in Chile.

DESIGN

Qualitative research, using interviews with the photo-elicitation technique.

SETTING

Metropolitan Region, Chile.

PARTICIPANTS

Twenty-five parents from families recruited from public childcare centres.

RESULTS

Through a thematic analysis with an inductive approach, we identified five themes that influence food parenting practices: (1) parents' previous experiences and how they determine their current goals and beliefs; (2) responses to the child's characteristics; (3) the influences of other family members, especially grandparents; (4) parents' nutritional knowledge; and (5) living contexts, especially limited budgets and lack of time.

CONCLUSIONS

The study reveals multilevel influences, which converge at the family level, on food parenting practices. A family-centrerd approach that addresses the mentioned influences is necessary to improve the management of the childhood obesity problem in Chile.

Hospital security guard's well-being and repeated exposure to personal threats in the workplace: a qualitative study in an Australian hospital

Purpose

This study aimed to understand the effect of repeated exposure to personal threats on hospital security guards' well-being.

Design/methodology/approach

A single site, qualitative study using a convenience sampling approach to recruit hospital security guards who attend code black (staff, patient or visitor exposed to a personal threat) calls.

Findings

Five interviews were held with eight hospital security guards. Seven of the eight participants were male. Seven were Caucasian. All had extensive experience in the industry. Six consistent themes emerged from the data covering well-being, coping and support; concerns about physical safety; compassion and compassion fatigue; effective communication is crucial; role/s; and training and equipment.

Research limitations/implications

This study used a convenient sampling approach to recruit security guards from one acute hospital in Australia, limiting the applicability of the findings to other contexts. Although the majority of hospital security guards were interviewed, the format of interviews varied between one-to-one interviews and focus groups, based on the availability of guards to participate and attend.

Practical implications

We recommend that the role of the hospital security guard in Code black situations is documented in policy and practice documents, and articulated in multidisciplinary aggression management training. There should be clear statements on the importance of strong communication and clinical leadership in code black situations. Hospital security guards should attend Mental Health First Aid training, which teaches on and off the job coping strategies. There is a need for debriefing and consideration should be given to supporting “time-out”. Hospital security guards require education on infection control and the risks associated with blood and body fluids.

Originality/value

Hospital security guards play an important role in the safety of patients and staff in code black situations. When they are well supported, they experience high levels of job satisfaction and are able to maintain their compassion towards people who are aggressive and violent towards them. However, repeated exposure to code black situations has the potential to erode the well-being of hospital security guards.

Identifying Potential Gamification Elements for A New Chatbot for Families With Neurodevelopmental Disorders: User-Centered Design Approach

BACKGROUND

Chatbots have been increasingly considered for applications in the health care field. However, it remains unclear how a chatbot can assist users with complex health needs, such as parents of children with neurodevelopmental disorders (NDDs) who need ongoing support. Often, this population must deal with complex and overwhelming health information, which can make parents less likely to use a software that may be very helpful. An approach to enhance user engagement is incorporating game elements in nongame contexts, known as gamification. Gamification needs to be tailored to users; however, there has been no previous assessment of gamification use in chatbots for NDDs.

OBJECTIVE

We sought to examine how gamification elements are perceived and whether their implementation in chatbots will be well received among parents of children with NDDs. We have discussed some elements in detail as the initial step of the project.

METHODS

We performed a narrative literature review of gamification elements, specifically those used in health and education. Among the elements identified in the literature, our health and social science experts in NDDs prioritized five elements for in-depth discussion: goal setting, customization, rewards, social networking, and unlockable content. We used a qualitative approach, which included focus groups and interviews with parents of children with NDDs (N=21), to assess the acceptability of the potential implementation of these elements in an NDD-focused chatbot. Parents were asked about their opinions on the 5 elements and to rate them. Video and audio recordings were transcribed and summarized for emerging themes, using deductive and inductive thematic approaches.

RESULTS

From the responses obtained from 21 participants, we identified three main themes: parents of children with NDDs were familiar with and had positive experiences with gamification; a specific element (goal setting) was important to all parents, whereas others (customization, rewards, and unlockable content) received mixed opinions; and the social networking element received positive feedback, but concerns about information accuracy were raised.

CONCLUSIONS

We showed for the first time that parents of children with NDDs support gamification use in a chatbot for NDDs. Our study illustrates the need for a user-centered design in the medical domain and provides a foundation for researchers interested in developing chatbots for populations that are medically vulnerable. Future studies exploring wide range of gamification elements with large number of potential users are needed to understand the impact of gamification elements in enhancing knowledge mobilization.

A scoping review of gestational diabetes mellitus healthcare: experiences of care reported by pregnant women internationally

BACKGROUND

Gestational diabetes mellitus (GDM) is a condition associated with pregnancy that engenders additional healthcare demand. A growing body of research includes empirical studies focused on pregnant women's GDM healthcare experiences. The aim of this scoping review is to map findings, highlight gaps and investigate the way research has been conducted into the healthcare experiences of women with GDM.

METHODS

A systematic search of primary research using a number of databases was conducted in September 2021. Studies were included if they had an explicit aim of focusing on GDM and included direct reporting of participants' experiences of healthcare. Key data from each study was extracted into a purposely-designed form and synthesised using descriptive statistics and thematic analysis.

RESULTS

Fifty-seven articles were included in the analysis. The majority of studies used qualitative methodology, and did not have an explicit theoretical orientation. Most studies were conducted in urban areas of high-income countries and recruitment and research was almost fully conducted in clinical and other healthcare settings. Women found inadequate information a key challenge, and support from healthcare providers a critical factor. Experiences of prescribed diet, medication and monitoring greatly varied across settings. Additional costs associated with managing GDM was cited as a problem in some studies. Overall, women reported significant mental distress in relation to their experience of GDM.

CONCLUSIONS

This scoping review draws together reported healthcare experiences of pregnant women with GDM from around the world. Commonalities and differences in the global patient experience of GDM healthcare are identified.

Underground Gamete Donation in Sunni Muslim Patients

This qualitative study focuses on the "underground" practices of Sunni Muslim physicians and patients who are performing and undergoing religiously prohibited third-party gamete donation. It is based on face-to-face interviews with two Sunni Muslim gynecologists and 25 Sunni Muslim women who underwent third-party gamete donation treatments and gave birth to a baby. The analysis of the interviews sheds light on patients' experiences regarding donation and explores the experiences of the gynecologists. The patients shared with us their inner conflict regarding childbearing using either donated sperm or a donated egg. They expressed a subversive attitude toward the religious authorities and the Islamic fatwa (religious ruling) that prohibits third-party gamete donation. The gynecologists provide fertility care involving third-party gamete donation despite Islamic religious prohibitions; in consequence, they suffer feelings of guilt for their actions. The study participants challenge accepted binary conceptions regarding the boundaries between religious laws and the desire to produce offspring, between what is allowed and what is forbidden, between guilt and happiness, and between the desire to maintain a marital relationship and the desire to comply with cultural-religious rules. Based on Gloria Anzaldua's theory of the borderlands, and the context-informed approach, this study underscores the importance of giving voice to Sunni Muslim patients who underwent third-party gamete donation treatments and contributes to a deeper understanding of their dilemma of finding a reproductive solution that does not run counter to religious values.

Motivation and Engagement of Final-Year Students When Using E-learning: A Qualitative Study of Gamification in Pandemic Situation

The COVID-19 pandemic has changed how the education system operates. The shift from face-to-face learning to online learning generated many problems, including decreasing students’ motivation and engagement. Gamification has been used as one of the solutions to overcome the problem of low motivation and engagement in learning. The current study aims to examine students’ behavioral change when using e-learning with gamification, investigate gamification elements that are important to students and how it influences students’ motivation and engagement, and investigate whether population characteristics may influence students’ motivation and engagement. Qualitative methods were employed to gather and analyze the data. The thematic analysis resulted in six main themes. The findings revealed that there were behavioral changes in students during gamification implementation, i.e., from negative to positive and from positive to negative. Four gamification elements were found to be the most important gamification elements to students, i.e., points, leaderboard, badges, and gamified test. The mechanism of how these elements influenced motivation and engagement was discussed. The population characteristics of final-year students also had an impact on gamification effectiveness. Despite gamification’s capabilities to influence motivation and engagement, there are some concerns related to negative impacts that must be addressed in the future.

Families' Experiences of Continuous Glucose Monitoring in the Management of Congenital Hyperinsulinism: A Thematic Analysis

Background and Aims

In patients with congenital hyperinsulinism (CHI), recurrent hypoglycaemia can lead to longstanding neurological impairments. At present, glycaemic monitoring is with intermittent fingerprick blood glucose testing but this lacks utility to identify patterns and misses hypoglycaemic episodes between tests. Although continuous glucose monitoring (CGM) is well established in type 1 diabetes, its use has only been described in small studies in patients with CHI. In such studies, medical perspectives have been provided without fully considering the views of families using CGM. In this qualitative study, we aimed to explore families' experiences of using CGM in order to inform future clinical strategies for the management of CHI.

Methods

Ten patients with CHI in a specialist centre used CGM for twelve weeks. All were invited to participate. Semi-structured interviews were conducted with nine families in whom patient ages ranged between two and seventeen years. Transcripts of the audio-recorded interviews were analysed using an inductive thematic analysis method.

Results

Analysis revealed five core themes: CGM's function as an educational tool; behavioural changes; positive experiences; negative experiences; and design improvements. Close monitoring and retrospective analysis of glucose trends allowed for enhanced understanding of factors that influenced glucose levels at various times of the day. Parents noted more hypoglycaemic episodes than previously encountered through fingerprick tests; this new knowledge prompted modification of daily routines to prevent and improve the management of hypoglycaemia. CGM use was viewed favourably as offering parental reassurance, reduced fingerprick tests and predictive warnings. However, families also reported unfavourable aspects of alarms and questionable accuracy at low glucose levels. Adolescents were frustrated by the short proximity range for data transmission resulting in the need to always carry a separate receiver. Overall, families were positive about the use of CGM but expected application to be tailored to their child's medical condition.

Conclusions

Patients and families with CHI using CGM noticed trends in glucose levels which motivated behavioural changes to reduce hypoglycaemia with advantages outweighing disadvantages. They expected CHI-specific modifications to enhance utility. Future design of CGM should incorporate end users' opinions and experiences for optimal glycaemic monitoring of CHI.

Gender differences of health literacy in persons with a migration background: a systematic review and meta-analysis

OBJECTIVE

To investigate gender differences of health literacy in individuals with a migration background.

DESIGN

Systematic review and meta-analysis. OVID/MEDLINE, PsycINFO and CINAHL were searched in March 2018 and July 2020.

SETTING

Studies had to provide health literacy data for adult women and men with a migration background, collected with a standardised instrument, or report results that demonstrated the collection of such data. Health literacy data were extracted from eligible studies or requested from the respective authors. Using a random-effects model, a meta-analysis was conducted to assess standardised mean differences (SMDs) of health literacy in men and women. Two researchers independently assessed risk of bias for each included study using the Appraisal Tool for Cross-Sectional Studies.

RESULTS

Twenty-four studies were included in this systematic review. Thereof, 22 studies (8012 female and 5380 male participants) were included in the meta-analyses. In six studies, gender-specific health literacy scores were reported. The authors of additional 15 studies provided their data upon request and for one further study data were available online. Women achieved higher health literacy scores than men: SMD=0.08, 95% CI 0.002 to 0.159, p=0.04, I2=65%. Another 27 studies reported data on female participants only and could not be included due to a lack of comparable studies with male participants only. Authors of 56 other eligible studies were asked for data, but without success.

CONCLUSION

Men with a migration background-while being much less frequently examined-may have lower health literacy than women. As heterogeneity between studies was high and the difference became statistically insignificant when excluding studies with a high risk of bias, this result must be interpreted with caution. There is a paucity of research on the social and relational aspects of gender in relation to health literacy among people with a migration background, especially for men.

PROSPERO REGISTRATION NUMBER

CRD42018085555.

'It opened my eyes': Parents' experiences of their child receiving an anxiety disorder diagnosis

Anxiety disorders are the most common mental health disorders among children, however there is limited guidance on the process of assessing child anxiety disorders and sharing diagnostic outcomes with families. This study aimed to identify aspects of the diagnostic process that are helpful and/or unhelpful for families, and ways to mitigate any potential negative consequences of receiving a child anxiety disorder diagnosis. A qualitative study was conducted with parents of 11 children (aged 7-12 years) with a primary diagnosis of an anxiety disorder, identified through a child mental health service. We used an inductive thematic analysis approach. Elements of the diagnostic process considered helpful or less helpful for families related to four themes: clarity and insight, being heard, the anxiety label and access to support. Findings illustrate the importance of sharing diagnoses compassionately in the context of ensuing treatment, and the benefits of providing families with personalised verbal and written diagnostic information, that is tailored for both parents and children.

Living with and Breaking a Cycle of Illness: A Secondary Qualitative Data Analysis of Women’s Experiences with Long COVID

Long COVID is an emerging condition, with early evidence suggesting it impacts women at a greater rate than men. As we seek to understand long COVID, it is important to consider the holistic impacts of this condition. Therefore, a qualitative perspective was used to explore the experience of those living with long COVID. Eight people from Scotland, who presented as women and Caucasian, participated in this study. A thematic analysis, from a phenomenological perspective, was conducted on data collected during two semi-structured focus groups. Five central themes emerged including: (1) a prolonged, varied, and debilitating illness; (2) barriers to care; (3) predominantly negative experiences of care; (4) fighting to carry the burden; and (5) looking to the future. These themes are linked through an explanatory theory describing a cycle of illness, the work required to break the cycle, and participant’s aims to regain their health and advocate for their condition. The thematic results are consistent with two prior qualitative studies on long COVID, creating a relatively consistent picture of individuals’ experiences during the pandemic. Additionally, the developed theory shares commonalities with individuals living with chronic illness, providing further insight into participants’ experiences.

Suicide Prevention Outreach on Social Media Delivered by Trained Volunteers

Background: There is a need to develop new ways to reach and engage people at risk for suicidal behavior. Suicide prevention outreach on social media (SPOSM) represents a promising strategy, and trained volunteers could potentially provide the needed human resources. Aims: We aimed to investigate users' perception of SPOSM delivered by volunteers of the Israeli Sahar organization and its potential to promote help-seeking behavior. Methods: Outreach messages written by Sahar volunteers between July 2015 and June 2020 in response to suicidal posts on a social media site were screened. User responses were analyzed using inductive thematic analysis. Results: One hundred sixteen user responses were analyzed. Positive impact themes were identified in 69.8% of responses, while 16.4% of responses mentioned barriers to care and 10.3% were negative. Limitations: As the study is based on real-life data, the data are limited to users who chose to respond to outreach. Conclusion: The findings suggest that volunteer-based SPOSM is viewed positively by many users and may foster help-seeking behavior. The findings also outline challenges such as emotional barriers to care and privacy concerns.

Exploring the Utility and Personal Relevance of Co-Produced Multiplicity Resources with Young People

Multiplicity, the experience of more than one self in the body, is an under-researched area of young people's mental health. The aim of this study was to explore the perspectives of experts-by-experience within a community sample regarding two specific resources: a co-produced self-help guide about multiplicity for adolescents, and a set of guidelines for supporting someone who identifies as 'multiple'. 34 participants (Mage= 22.06, 2.26 SD; 15F, 1M, 18NBG) completed an online survey consisting of open-ended and Likert scale questions to assess the language, utility, transferability and therapeutic impact of the materials. Descriptive statistics and a Foucauldian-informed Narrative Analysis were employed to analyse responses, producing a summary of utility and two narrative chapters. The emergent chapters, 'Breaking the Stigma' and 'Recognising the Many', highlight the need for greater understanding and awareness of multiplicity, with psychoeducation materials viewed as helpful. Inclusive language can reduce stigma and normalise multiplicity as a response to trauma. With greater understanding, practitioners and researchers can collaborate with young people through trauma wise care, providing multiplicity sensitive language and support. Overall, the term 'parts' was viewed as problematic by the participants as it could imply the plural system is not coexisting as a whole. Additionally, opinions varied as to how much diagnostic language could and should be used to describe multiplicity; linguistically and conceptually. Importantly, compassion was seen as particularly essential for younger selves within the system; older in their years and presence, but often more vulnerable within the societies in which the system resides.

A framework for measuring the adoption factors in digital mobile payments in the COVID-19 era

Purpose

This study aims to identify the acceptance factors in the UAE for the digital mobile payment market, introduces a new hierarchical framework based on the continuation intention factors and prioritises the importance of the acceptance criteria and sub-criteria.

Design/methodology/approach

The measurement of acceptance factors in payment systems is a complex and unstructured topic involving many criteria and sub-criteria, which requires breaking the problem down into several components organised in a hierarchical multi-level form. The analytic hierarchy process (AHP) methodology manages the complexity of multi-criteria decision-making processes based on a new set of criteria connected to the adoption and continuance intention factors.

Findings

The AHP framework developed a ranking of 18 sustainability sub-factors based on evaluations by experienced payment professionals.

Research limitations/implications

The future directions of the research would be to investigate the impact of dynamic capabilities on the resilience of retail service networks, especially during COVID-19, where supply and demand are highly indeterminate.

Practical implications

Through successive stages of data collection, measurement analysis and refinement, the contribution of this research is a reliable and valid framework that can be used to conceptualise and prioritise sustainability strategies in payment management.

Originality/value

Given the lowest mobile payment products penetration rates of the UAE and the scarcity of literature on this topic, this study aims to contribute to the knowledge by including UTAUT, the IS success model and the impact of COVID-19 as adoption and continuance intention factor in the digital mobile payment case in the UAE.

The impact of working in academia on researchers' mental health and well-being: A systematic review and qualitative meta-synthesis

OBJECTIVE

To understand how researchers experience working in academia and the effects these experiences have on their mental health and well-being, through synthesizing published qualitative data.

METHOD

A systematic review and qualitative meta-synthesis was conducted to gain a comprehensive overview of what is currently known about academic researchers' mental health and well-being. Relevant papers were identified through searching electronic databases, Google Scholar, and citation tracking. The quality of the included studies was assessed and the data was synthesised using reflexive thematic analysis.

RESULTS

26 papers were identified and included in this review. Academic researchers' experiences were captured under seven key themes. Job insecurity coupled with the high expectations set by the academic system left researchers at risk of poor mental health and well-being. Access to peer support networks, opportunities for career progression, and mentorship can help mitigate the stress associated with the academic job role, however, under-represented groups in academia are at risk of unequal access to resources, support, and opportunities.

CONCLUSION

To improve researchers' well-being at work, scientific/academic practice and the system's concept of what a successful researcher should look like, needs to change. Further high-quality qualitative research is needed to better understand how systemic change, including tackling inequality and introducing better support systems, can be brought about more immediately and effectively. Further research is also needed to better understand the experiences and support needs of post-doctoral and more senior researchers, as there is a paucity of literature in this area.

TRIAL REGISTRATION

The review protocol was registered on PROSPERO (CRD42021232480).

Effect of Word-of-Mouth Communication and Consumers’ Purchase Decisions for Remanufactured Products: An Exploratory Study

In this study, we explored the interactive relationship between social media online word-of-mouth and offline word-of-mouth and its impact on consumers’ decision process for purchasing remanufactured products in China. This study adopted an exploratory approach, and we conducted semi-structured in-depth interviews with 30 Chinese consumers in Guangdong, China. As per our findings, it was determined that social media online word-of-mouth, offline word-of-mouth, and information source credibility are the main factors that affect Chinese consumers in the decision process for purchasing remanufactured products. In addition, offline word-of-mouth was noted to play a moderating role in the influence of social media online word-of-mouth in terms of purchase decisions. Information source credibility influences consumers’ purchase decisions and also plays a mediating role in the influence of offline word-of-mouth on the purchase decision. The result of our study provides managerial insights for Chinese remanufactured product enterprises to improve consumer awareness, influence purchase decisions, and cultivate habits toward remanufactured products.

Evaluating the Effects of Training to Improve Teaching Skills of Health Sciences Educators in Sudan

Purpose

This evaluation draws evidence on the outcome of learning and teaching courses that were offered to a number of teaching staff (referred to as trainers) of the Academies of Health Sciences, Midwifery Schools and Centre for Continuous Professional Development in Sudan.

Methods

The evaluation was a cross-sectional, institution-based study conducted from October 2017 to January 2018 involving qualitative design. It consisted of direct observations of teaching, focus group discussions with students and semi-structured interviews with managers of teaching institutions.

Results

The findings of direct observations revealed that the learning and teaching course has positive effects on the trainers' ability to have clear, well-stated learning objectives; their presentation skills; and their use of different teaching methods. Moreover, the observations showed that trainers who attended the learning and teaching course now encourage the students to ask questions and are providing them with timely feedback about their learning. As students were the main beneficiaries for improved teaching, focus group discussions have shown that students were generally satisfied with trainers' performance regarding the stated learning outcomes, curricula design, use of a range of teaching methods and assessment methods. During in-depth interviews, managers of training institutions expressed satisfaction with the trainers' performance regarding the development of training materials, learners' assessment, supervision, and evaluation of training.

Conclusion

Short courses on teaching and learning were a valuable investment for trainers, students, and the overall performance of health sciences training institutions. The evaluation revealed that trainers were able to apply what they have learnt. Moreover, students and managers noticed improvement in the performance of trainers in teaching, course delivery and assessment. It is recommended to expand, cascade and institutionalize the short courses on learning and teaching to all states to improve the capabilities of trainers, which would eventually contribute to the production of competent allied health professions in Sudan.

The Impact of Pre-Round Meetings on the Clinical Learning of Nurses and Doctors on Hospital Wards: A Qualitative Study

Introduction

The pre-round meeting is an interprofessional gathering conducted in conjunction with the ward round in many hospitals. Here, nurses, doctors and eventually allied health clinicians discuss clinical issues before attending to the patients. This study focused on the learning aspects of the pre-round meeting, and it is, to our knowledge, the first study to explore the impact of pre-round meetings on learning in a clinical setting.

Objectives

To improve our understanding of the impact pre-round meetings has on clinical learning among the nurses and doctors who attend them.

Method

A qualitative study. Focus group interviews were conducted. Participants comprised of 9 doctors and 13 nurses from two different hospitals in Norway. The participants represented both surgical and non-surgical departments

Results

This study showed that the pre-round meeting is an arena with a high learning potential. Learning takes place in the discussion that arises when different professions meet. Both nurses and doctors emphasized that the pre-round meeting is both a conscious learning arena and an arena where learning is a by-product. Several factors interfered with the utilization of its learning potential.

Conclusion

The pre-round meeting is an arena with high learning potential. However various factors can influence this potential. The study highlights the importance of being aware of the learning potential in the pre-round meeting, to achieve higher-level learning objectives. A collaborative environment, continuity, competence, and availability of the staff and structured pre-round meetings are essential elements for achieving higher-level learning objectives.

Scaling up community-based health insurance in Ethiopia: a qualitative study of the benefits and challenges

Background

Ethiopia has achieved impressive improvements in health outcomes and economic growth in the last decade but its total health spending is among the lowest in Africa. Ethiopia launched a Community-Based Health Insurance (CBHI) scheme in 2011 with a vision of reaching 80% of districts and 80% of its population by 2020. This study aimed to identify early achievements in scaling up CBHI and the challenges of such scale-up.

Methods

We interviewed 18 stakeholders working on health financing and health insurance in Ethiopia, using a semi-structured interview guide. All interviews were conducted in English and transcribed for analysis. We performed direct content analysis of the interview transcripts to identify key informants’ views on the achievements of, and challenges in, the scale-up of CBHI.

Results

Implementation of CBHI in Ethiopia took advantage of two key “policy windows”—global efforts towards universal health coverage and domestic resource mobilization to prepare countries for their transition away from donor assistance for health. CBHI received strong political support and early pilots helped to inform the process of scaling up the scheme. CBHI has helped to mobilize community engagement and resources, improve access to and use of health services, provide financial protection, and empower women.

Conclusion

Gradually increasing risk pooling would improve the financial sustainability of CBHI. Improving health service quality and the availability of medicines should be the priority to increase and sustain population coverage. Engaging different stakeholders, including healthcare providers, lower level policy makers, and the private sector, would mobilize more resources for the development of CBHI. Training for operational staff and a strong health information system would improve the implementation of CBHI and provide evidence to inform better decision-making.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07889-4.

Sustainable Utilization of Fishery Waste in Bangladesh—A Qualitative Study for a Circular Bioeconomy Initiative

Living marine resources are limited; therefore, utilizing them sustainably is essential. Not all resources obtained from the sea are used adequately, causing discards, on-board waste, and by-products and waste on land. Recognition of the limited marine resources and increasing environmental pollution has emphasized the need for better utilization of by-products. Waste may include particles of flesh, skin, bones, entrails, shells or liquid stick water. Unfortunately, no fishery waste and by-product management initiatives or projects exist in Bangladesh; by-products are generally thrown into dustbins, ponds, rivers, and the sea. Bangladesh’s fish-processing waste and fishery by-products could be exported, providing a source of foreign currency earnings. Primary and secondary data were collected through documentary analysis, a literature review, and in-depth interviews (n = 129) with fishers and other relevant stakeholders regarding the challenges of Bangladesh’s sustainable fishery by-products and fish-processing waste. The data were analyzed thematically, guided by the most meaningful stories, and show that fish waste, or fishery by-products, should not be considered less valuable than the fish itself but is a precious and profitable resource capable of bringing health, social, economic, and environmental benefits. Our results reveal that fishery waste can expand local communities’, especially fishers’ and other workers’, potential for jobs or alternative income-generating tasks during fishing ban seasons. Finally, suggestions for managing fishery waste and fishery by-products are made to ensure improved and sustainable utilization via a circular bioeconomy.