A critical look to community wisdom: Applying the World Café method to health promotion and prevention

Components to include in a program to facilitate the transition of novice nurses in emergency departments: A descriptive qualitative study

AIM

To explore the insights of stakeholders regarding the components that should be included in a program to facilitate the transition of novice nurses in emergency departments.

BACKGROUND

Novice nurses working in emergency departments are routinely confronted with substantial workloads, recurrent traumatic events, interpersonal conflicts and psychosocial challenges. These nurses need specific knowledge, skills and attitudes to function optimally. Inadequate support can hinder the clinical progression and potential assimilation of novice nurses into emergency departments, having a negative impact on transition outcomes. Over time, inadequately supported novice nurses may experience emotional and mental pressures, leading to occupational stress, decreased job satisfaction and increased nurse turnover.

DESIGN

Descriptive qualitative study.

METHODS

We recruited participants from the emergency departments of three selected public hospitals in the Tshwane Central Health District, South Africa. The participants were selected via purposive, maximum variation and snowballing sampling using the following inclusion criteria: 1) trained emergency nurses, including managers, clinical facilitators and nurses providing direct patient care; and 2) had at least six months of working experience after obtaining a specialty qualification in emergency nursing. Twelve participants (n = 12) participated in the study. Data were collected via the World Café method and analyzed thematically.

RESULTS

The participants identified five components for inclusion in a program, namely, support systems, orientation, competencies, knowledge resources and reflective practice.

CONCLUSION

Novice nurses working in emergency departments need a comprehensive, formal program for successful transition. When adequately supported, novice nurses may develop positive perceptions of their working environment, increasing job satisfaction and retention.

Stakeholder Perspectives on Research, Policy and Practice Priorities to Increase Human Milk Feeding Rates in the United Kingdom

BACKGROUND

Human milk feeding rates in the United Kingdom are a public health concern. Changes to United Kingdom policy and practice are needed to improve lactation support. These should be informed by those with lived experience of human milk feeding and those who provide support.

RESEARCH AIM

The aim of this study was to identify research, policy, and practice priorities for increasing human milk feeding rates using insights from a wide range of stakeholders. A secondary aim was to evaluate the influence of a World Café on individual attendees and their interactions within the organizations and communities of which they are a part.

METHODS

The research employed a participatory qualitative design, incorporating a cross-sectional survey and World Café discussions. World Café is a novel approach to engaging stakeholders in discussion, resulting in consensus-building and participatory-driven recommendations. A pre-event survey was completed by a self-selected sample of 67 participants; 37 of these (55%) took part in World Café discussions or an online focus group. World Café discussions and the online focus groups were recorded and transcribed verbatim. Following the World Café, 12 participants (32%) completed a post-event survey, and eight (22%) completed an additional follow-up survey at 2 months.

RESULTS

Priority policy and practice changes were identified, including enhancing education, the need for dedicated funding for human milk feeding support, the need to include family within support provision, and the need to change policy regarding media representations of infant feeding. In addition, World Café methodology proved valuable for facilitating networking and instigating changes in relation to support.

CONCLUSION

World Café generated stakeholder agreed-on priorities for research and policy. Many of the recommendations from historical policy and guidance continue to be areas for further development.

A World Café Approach to Exploring Perspectives on Diabetes Stigma in the United Kingdom

INTRODUCTION

Research has found that a high percentage of people with diabetes experience stigma, with perceptions of stigma being significantly higher among people with Type 1 diabetes compared to those with Type 2 diabetes. These experiences of diabetes stigma can lead to psychological, behavioural and medical consequences. The aim of the current study was to explore the perceptions of diabetes stigma and propose strategies for addressing this from the perspective of key stakeholders.

METHODS

A mixed methods design was used, commencing with an online qualitative survey (n = 128) and followed by a World Café (n = 11), where attendees reflected on their own experiences with stigma and discussed the survey findings.

RESULTS

The survey indicated that 75% of those with Type 1 diabetes and 51% with Type 2 had experienced diabetes stigma. The World Café identified three main areas that participants felt impacted their experiences with stigma or had the potential to help improve stigma: healthcare interactions, public awareness and media representations.

CONCLUSIONS

The findings supported previous research showing that diabetes stigma is prevalent among people with diabetes. The World Café was an excellent means of sharing knowledge and experiences among stakeholders, the findings of which will inform strategies to bring about change.

PATIENT OR PUBLIC CONTRIBUTION

World Café is a collaborative method where stakeholders contribute to the production and analysis of data through rounds of discussion and feedback.

Exploring patients and caregivers needs and experiences in oncological physiotherapy: a call for collaborative care

PURPOSE

This study explores whether the full potential of physiotherapy is reaching cancer patients and their caregivers at all stages of the oncological process, aiming to identify gaps and opportunities for improving care.

METHODS

The World Cafe co-design methodology facilitated discussions among cancer patients and caregivers. This dynamic, inclusive, and engaging approach fostered diverse perspectives and deeper insights through collaborative and flexible discussions. Sessions were recorded, transcribed, and qualitatively analyzed.

RESULTS

Sixteen participants were involved (eight cancer survivors and eight caregivers). The mean age of cancer survivors was 63.8 years, while the average age of caregivers was 59.3 years. Breast cancer was the most prevalent diagnosis among patients, and most caregivers had lost their family members to cancer. Analysis revealed two primary themes: "feeling cared for" and "the role of physiotherapy in the oncological process." Key findings highlight the need for more humanized healthcare, with professionals providing support through effective communication and empathy. Significant gaps were detected in both systematic referrals to physiotherapists and their integration into care teams. Testimonies highlighted the lack of knowledge about the full potential of physiotherapy in oncology, hindering access. There was also a demand for recognizing specialized oncological physiotherapists.

CONCLUSIONS

These findings highlight significant gaps in physiotherapy care for cancer survivors and caregivers, including unmet needs due to the lack of information, resources, and effective communication. Future efforts should focus on increasing the visibility of physiotherapy, integrating specialized physiotherapists into oncology teams, and enhancing the emotional education of healthcare professionals to provide more humanized care.

Experiences of dialogue in advance care planning educational programs

BACKGROUND

Advance care planning (ACP) is a process in which adults engage in an ongoing dialogue about future medical treatment and care. Though ACP is recommended to improve the quality of end-of-life care, the details of the dialogue experience in ACP are unknown.

OBJECTIVE

To explore participants' experiences of dialogue in an ACP educational program that encouraged them to discuss the value of a way of life.

RESEARCH DESIGN

This qualitative descriptive study used the focus group interview method. Data were analyzed using qualitative content analysis.

PARTICIPANTS AND RESEARCH CONTEXT

A dialogue-based ACP educational program was conducted in four regions in Japan for local citizens to discuss the value of their way of life. A total of 66 individuals (mean age = 55.5 ± 17.2 years; 50 women and 16 men) participated in focus group interviews.

ETHICAL CONSIDERATIONS

This study was approved by the Ethical Review Committee of Tokyo Women's Medical University (no. 4723) and Kyoto University (no. R2099).

FINDINGS

Five main themes were extracted: discussing one's thoughts with others in a considerate manner, reflecting on one's way of life through others, feeling a sense of connection with others through storytelling, realizing the difficulties of talking about "what if" topics, and turning one's eyes toward the future through the dialogue. These themes were interrelated and illustrated the complexity of the experience of discussing values.

CONCLUSIONS

The results suggest that dialogue in ACP is useful in clarifying values. They also indicated the need for dealing with the ethical challenges of discussing value and the importance of caring for the interlocutor to have a safe dialogue. In the ACP process, safety in dialogue may improve readiness in ACP, and health practitioners who support ACP need to address the ethical challenges entailing dialogue about values.

Scanning European Needs and Expectations Related to Livestock Biosecurity Training by Using the World Café Method

The European Union Animal Health Law (2016/429) emphasizes disease prevention, underpinned by livestock biosecurity, surveillance, and traceability, as key aspects to minimize the risk of animal diseases. An important element of biosecurity is the training of key actors involved in implementing it. However, their needs and expectations regarding this training are poorly known. Under the COST action BETTER (CA20103), a World Café was organized to identify the needs and expectations of biosecurity training for farmers, veterinary practitioners, veterinary students, and other actors. A total of 78 participants distributed in four groups participated in the World Café. Needs and expectations were identified and ranked in decreasing order of importance. For farmers, the most important aspects were training focusing on practical aspects, the planning of training sessions in the day to accommodate workload, the need to prepare multiple reminders of upcoming training, and the short duration of events. For veterinary practitioners, it was considered that a mixed approach, including a theoretical and a practical part where people are invited to create a biosecurity plan and a follow-up report, were the most important features of training. For veterinary students, creating a good knowledge of the main principles of biosecurity was found as an essential element of training. Regarding other actors, gaining an understanding in the spread of pathogens and the repercussions on the cost of animal products that diseases might have (consumers), training on good/best practices of cleaning and disinfection and the development of clear protocols (transporters), and a mixture of formal and informal training and training on communication skills (other actors) were considered important. The World Café was a useful method to have a first identification, discussion, and differentiation on livestock biosecurity training needs and expectations of the key actors, although additional follow-up research involving more participants from more diverse countries with different coverage of cultures and education would be beneficial. These needs and expectations are relevant and should be considered when designing new training courses.

Inclusive and intersectoral: community health improvement planning opportunities to advance the social determinants of health and health equity

BACKGROUND

Community health improvement plans (CHIPs) are strategic planning tools that help local communities identify and address their public health needs. Many local health departments have developed a CHIP, yet there is a lack of research on the extent to which these plans address root causes of health disparities such as the social determinants of health. This study aims to inventory the social determinants of health included in 13 CHIPs and examine facilitators and challenges faced by local health departments and partners when trying to include the social determinants of health.

METHODS

We conducted a comparative plan evaluation by scoring 13 CHIPs on their inclusion of equity orientation, inclusive planning processes, and five social determinants of health: health care access and quality, the neighborhood and built environment, economic stability, social and community context, and education access and quality. To supplement the plan evaluation, we conducted 32 in-depth interviews with CHIP leaders and stakeholders to understand the factors contributing to the inclusion and exclusion of the social determinants of health in the planning process.

RESULTS

CHIPs received an average score of 49/100 for the inclusion of the social determinants of health. Most plans addressed health care access and quality and the neighborhood and built environment, but they often did not address economic stability, the social and community context, and education access and quality. Regarding their overall equity orientation, CHIPs received an average score of 35/100, reflecting a relative lack of attention to equity and inclusive planning processes in the plans. Interviews revealed that challenges engaging partners, making clear connections between CHIPs and social determinants, and a lack of capacity or public and partner support often led to the exclusion of the social determinants of health. Recommendations to improve planning processes include improving data infrastructure, providing resources for dedicated planning staff and community engagement incentives, and centering equity throughout the planning process.

CONCLUSIONS

Although local health departments can leverage CHIPs to improve population health and address health disparities, they face a range of challenges to including the social determinants of health in CHIPs. Additional resourcing and improved data are needed to facilitate broader inclusion of these determinants, and more work is needed to elevate equity throughout these planning processes.

Perspectives on menstrual policymaking and community-based actions in Catalonia (Spain): a qualitative study

BACKGROUND

Menstrual research and policymaking have become imperative worldwide. It is necessary that these are informed by women and people who menstruate (PWM) alongside expert professionals and activists.

METHODS

The main aim of this study was to identify and propose policies and community-based actions to address menstrual inequity and promote menstrual health in Catalonia (Spain). This study consisted of two qualitative studies: (a) 34 individual photoelicitation interviews with women and PWM, (b) a World Café study with 22 professionals and activists. Sampling for both studies was purposive and selective. Recruitment was conducted through healthcare centres, social media, key contacts, and snowball sampling techniques. Data were collected in December 2020-September 2022, and analysed using Framework Analysis.

RESULTS

Participants considered the implementation of menstrual policies that address the taboo and stigma of menstruation to be crucial. They stressed the need for menstrual education, which should be integrated into formal education curricula. Participants, and especially women and PWM, highlighted the need to improve the access and quality of healthcare services, so that the menstrual cycle and menstruation are seen as health indicators. Health professionals should encourage agentic informed decisions, hence why both participant groups considered menstrual health education amongst health professionals to be pivotal. Taking action to improve the access and affordability of menstrual products was also imperative for participants, especially for socioeconomically vulnerable populations. Participants agreed on guaranteeing fully equipped menstrual management facilities, and and professionals discussed gender-neutral and sex-segregated bathrooms. Workplace menstrual policies to accommodate and ensure menstrual self-care were also suggested.

CONCLUSIONS

Our study highlights the need for multi-dimensional menstrual policies. These should include actions to address menstrual taboo and stigma, to promote menstrual education that goes beyond the hegemonic biomedical prism, to improve the access and quality of menstrual health services, along with policies ensuring adequate menstrual management facilities in public spaces and the access to menstrual products. Policymaking should also focus on how to ensure menstrual management and care in workplaces. Menstrual policies and community-based actions should be framed within intersectionality, to consider how societal structures of power and oppression influence menstrual experiences.

Personalized online intervention based on a risk algorithm for the universal prevention of anxiety disorders: Design and development of the prevANS intervention

Objective

To describe the design and development of prevANS, a personalized online intervention for the universal prevention of anxiety disorders based on a predictive risk algorithm. A user-centered approach was followed, considering the feedback of potential users and mental health professionals.

Methods

The study had three phases: (a) designing the intervention based on existing scientific literature; (b) piloting and evaluating the beta version involving potential users and health professionals; and (c) refining the intervention based on participants' suggestions. This iterative process aimed to refine the prevANS intervention before testing in a randomized controlled trial.

Results

The prevANS intervention provides personalized anxiety risk reports and components tailored to individuals' needs. Participants at low risk receive psychoeducation had access to a set of tools enhance protective factors. Moderate/high-risk individuals also receive cognitive-behavioral training. Both groups have access to a reward system and forum. Results from the design evaluation indicate that the prevANS interface is attractive and user-friendly and the psychoeducational materials helpful and engaging. The cognitive-behavioral training module received positive feedback. Participants suggested changes related to usability, content clarity, attractiveness, and engagement, which were implemented afterwards.

Conclusions

This article describes the development of a personalized intervention for preventing anxiety disorders using a validated risk prediction algorithm. The prevANS intervention was designed based on current scientific literature by a team of experts employing a user-centered approach. Research on the effectiveness of information and communication technologies in mental health prevention interventions considering user needs and preferences is warranted.