Interviews and focus groups in qualitative research: an update for the digital age

Predictors of willingness to uptake orthodontic treatment and qualitative insights into the reasons for its postponement in young adults

OBJECTIVES

To investigate the predictors of willingness to uptake orthodontic treatment and to explore the reasons for postponing its initiation in young adults.

MATERIALS AND METHODS

Students, aged 18-30 years old, were randomly approached at the Central Library of the Aristotle University of Thessaloniki Campus and invited to complete the study tool anonymously and voluntarily. The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) and the esthetic component of the Index of Orthodontic Treatment Need (IOTN-AC) were used to evaluate students' psychosocial impact of dental esthetics and severity of malocclusion, whereas the rationale for postponing the initiation of orthodontic treatment was recorded through an open-ended question, analyzed using thematic content analysis.

RESULTS

In total, 270 students, 55.2% female, participated. The single statistically significant factor predicting willingness to uptake orthodontic treatment was the PIDAQ-Psychological Impact subscale (OR: 1.24; 95% CI: 1.11-1.37, P < .001). Gender and age were not associated with willingness to pursue treatment. Seven main themes emerged regarding reasons for postponement: fear of the procedure, embarrassment regarding appearance during treatment, low prioritization of esthetics, insufficient information, high cost of treatment, prolonged duration of treatment, and residential mobility.

CONCLUSIONS

The findings suggest that psychological impact of dental esthetics constitutes the main driver to pursue orthodontic treatment. A patient-centered orthodontic approach should address the possible barriers to its initiation. Increasing young adults' oral health literacy could be key in empowering them to make better informed decisions regarding their oral health-related quality of life.

Beyond Bouncing Back: Exploring Undergraduate Dental Professional Students' Perceptions of Resilience

INTRODUCTION

The first signs of mental health issues in dentistry manifest as early as undergraduate training, thus it is essential to delve into the concept of resilience to equip those studying and working in dentistry with the resources to cultivate a positive mindset.

MATERIALS AND METHODS

A focus group was conducted with a homogenous purposive sample of eight undergraduate dental profession students from all 3 years of study at the University of Portsmouth Dental Academy (UPDA). The six-phase Braun and Clarke's thematic analysis was adopted to interpret patterns in data.

RESULTS

Four themes of: 'definition of resilience'; 'factors enhancing resilience'; 'factors challenging resilience' and 'developing resilience in dentistry'; and 23 subthemes were identified. Students defined resilience as an ability to bounce back from adversity and perceived it as a dynamic and contextual phenomenon that fluctuated due to an interplay of personal, social and environmental factors.

CONCLUSION

The findings of this study showed undergraduate dental profession students' perceptions of resilience, factors influencing it and strategies to develop it. These findings may inform the curriculum of resilience training programmes targeted towards this population.

The Need for Organisational Structure and Leadership Support: A Qualitative Study on Nurse Mentors' Perspectives on the Prerequisites for Effective Mentoring

BACKGROUND

Research consistently underscores the importance of mentoring and a supportive work environment for nurse retention and well-being. Previous research on nurse mentoring has primarily focused on mentees' perspectives. Research is scarce on the prerequisites for mentoring from the perspective of mentors-experienced registered nurses who guide and support their new colleagues, mentees.

AIM

To explore nurse mentors' perspectives on the prerequisites for mentoring, following their participation in a mentoring intervention.

DESIGN

Qualitative study design with an inductive approach using focus group interviews as a data collection method.

METHODS

A total of 19 experienced registered nurses, appointed as mentors, were interviewed in four focus groups and one individual interview, in May and June 2022, following the conclusion of the intervention period. Focus groups consisted of three to six participants. The transcribed interview data were analysed using qualitative content analysis.

RESULTS

The main theme identified in the results was that mentors needed organisational structure and leaders' support to facilitate the mentoring process. Participants underscored the necessity of a comprehensive support system that spans the entire mentoring process, as described in three themes: creating foundations for mentoring; navigating mentoring challenges in everyday work routines; and post-mentoring reflection and learning.

CONCLUSIONS

This study underscores the importance of integrating mentoring into daily healthcare routines by addressing barriers and facilitators, such as organisational structure and support from first line leaders. Key results highlight the need for pre- and post-mentoring phases to create a sustainable, continuous learning process. Further research should focus on developing sustainable frameworks for implementing mentoring.

IMPLICATIONS FOR THE PROFESSION

Policies should explicitly support the dual role of experienced registered nurses as both caregivers and mentors, acknowledging the demands on their time and responsibilities. Policymakers should integrate mentoring frameworks into nursing roles. This could play a critical role in stabilising the work environment.

IMPACT

What problem did the study address? Mentoring plays a critical role in helping newly qualified nurses transition into their professional roles, contributing to their retention and overall well-being. Although there is limited research on mentoring from the perspective of mentors. What were the main findings? Mentors needed organisational structure and leaders' support to facilitate the mentoring process. We identified that mentoring structures should include clear responsibilities, pre-mentoring preparation and post-mentoring reflections to ensure full implementation of the mentoring process. Where and on whom will the research have an impact? The findings of this study can support organisations in creating sustainable mentoring structures for registered nurses, in which both mentors and mentees collaborate within a community of practice. The mentoring findings can also be applicable to other contexts and professions.

REPORTING METHOD

Reporting of this study was guided by the Standards for Reporting Qualitative Research (SRQR).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Pictorial art for gaining informed consent in low-literacy settings

OBJECTIVE

Gaining informed consent for research in low-literacy setting is challenging. This study explores the creation and use of pictorial art in information and consent form in Sierra Leone (SL).

METHODS

A pictorial 'information and consent' (PIC) sheet was developed with an illustrator (co-author) and local colleagues for a national oral health survey involving school children in SL. Evaluation included 500 participants (children and parents) who received a feedback form to assess their satisfaction with pictures and also their effectiveness in aiding understanding of the research process, using a visual five-point Likert scale. Data were descriptively analysed using STATA v.18.

RESULTS

Feedback was received from 360 children (aged 12 and 15 years) and 14 parents of 6-year-olds. The average rating, out of five, for the question about liking pictures on the PIC sheet was 4.83 (S.D. = 0.62), while rating for how well pictures helped them understand the survey was 4.87 (S.D. = 0.54). Although most feedback was positive, a small minority expressed negative views.

CONCLUSION

Overall, participants appreciated that the pictorial aids had helped in understanding the research process.

PRACTICAL IMPLICATIONS

Pictorial aids show potential to improve comprehension and informed consent in low-literacy settings, indicating a promising approach for future research in similar contexts.

Experiences and reflections on living with a personal assistance service: a qualitative study of people with neuromuscular disease or spinal cord injury

PURPOSE

To investigate how people with neuromuscular disease or spinal cord injury experience living with a personal assistance service.

MATERIALS AND METHODS

Qualitative study using the Interpretive Description methodology with Aaron Antonovsky's theory of sense of coherence as a theoretical framework. The method was semi-structured individual interviews (n = 3) and focus group interviews (n = 5). In all, 19 adults with neuromuscular disease (n = 13) or spinal cord injury (n = 6) participated. The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.

RESULTS

Three themes were identified to understand living with personal assistance and how this affected everyday life: 1) Making meaning of a personal assistance service, 2) Managing a personal assistance service, and 3) Living with a personal shadow. Our findings provide an understanding of living with assistance and how it, among other things, is influenced by the legislation and the local authorities' administration of the service. Participants explained this by an experience of a sense of coherence.

CONCLUSION

For people with NMD and SCI, there are complex nuances associated with living with a personal assistance service. The findings illustrate that despite personal challenges of managing assistance services, it can meaningfully contribute to one's life by enhancing one's sense of coherence.

Clinical education during a crisis lived experiences of nursing students in Sweden during the COVID-19 pandemic

BACKGROUND

Nursing education entails extensive training across varying settings where nursing students can practice their theoretical knowledge and practical skills for their future profession. Skills in evidence-based practice are pivotal competences for nurses and need to evolve from novice to expert skills. During the COVID-19 pandemic, Sweden had a unique approach to restrictions. The conditions for nursing students to apply their practical skills changed, as the COVID-19 pandemic influenced nursing education. Previous studies lacked focus on the clinical and practical aspects of the nursing education during the COVID-19 pandemic. Such experiences can provide valuable knowledge for nursing education, especially in preparing for future crises as well as understanding the needs of the nurses who were educated during the pandemic. The aim of this study is therefore to highlight the essence and understanding of the experiences of nursing students undertaking nursing education in Sweden during the COVID-19 pandemic.

METHODS

A qualitative interview study of nine nursing students recruited through a convenience sample. The data was analyzed through a phenomenological hermeneutic approach, chosen for two of the opportunity to use the researcher's preunderstanding. The result is presented in three main themes; Being disappointed yet accepting the situation, Feelings of uncertainty and the covid-19 pandemic provided new insights, the two latter are further divided into a total of eight subthemes.

RESULTS

The COVID-19 pandemic affected nursing students' experience with clinical learning and contributed to their unique experiences. Compared to students who began their nursing education during the COVID-19 pandemic, those who started before the outbreak faced more significant adjustments in their learning. It was seen as positive for the student's future profession that a great focus was placed on how to prevent the spread of infection. The students experienced loneliness in the lack of support from other students, and fear of infecting or being infected. Furthermore, there was a lack of clinical placement and training hours, leading to worries of not being prepared. Opinions differed between the students on whether the clinical knowledge they acquired during the training was sufficient. Whilst the vast majority wanted more time for practical elements and training, they emphasized that this was not solely caused by the impact of the COVID-19 pandemic but an effect of the design of the education.

CONCLUSIONS

The study showed that, through the shared experiences of nursing students who studied during the COVID-19 pandemic, education and the acquisition of clinical skills were affected. The students experienced feelings of loneliness in their isolation and fear of infecting or being infected throughout their education. However, the majority found themselves with a sense of acceptance of the situation, while there were also experiences of pausing the education because of the pandemic. Being a part of the group of nursing students participating in education during the COVID-19 pandemic gave new insights into the nursing profession regarding hygiene routine and hindering factors in communication with patients. Nursing students who have gone through their education during the COVID-19 pandemic have unique experiences such as preparedness of coming pandemics and the importance of reflection surrounding clinical education that are worthy of sharing. These experiences could be helpful when developing nursing education in the future and preparing for possible future crisis situations.

Investigating perspectives towards online content that promotes road safety: A qualitative study across three age groups

INTRODUCTION

Social media is an ideal platform for displaying online material that promotes road safety and discourages road rule violations. However, limited research has investigated the impact of online material promoting road safety on attitudes and behavior, and whether different age groups are influenced by such content.

METHOD

The qualitative study explored: (a) opinions and attitudes towards online material/content that promotes road safety/discourages illegal driving behavior; (b) whether participants believe this content can influence attitudes/behavior; and (c) whether these opinions differed across age groups. Sixty-six licensed Queensland drivers participated in a focus group. Three age groups were included: young drivers (17-25 years; n = 21), middle-aged drivers (26-49 years; n = 22), and older drivers (50 + years; n = 23).

RESULTS

The data were analyzed using reflexive thematic analysis, resulting in four themes: (1) Metrics behind a persuasive message, (2) Diverse and compelling content, (3) Demographics matter, (4) Each to their own.

CONCLUSIONS

There is the potential for social media to help promote road safety messages. Therefore, these findings have important implications for road safety messaging strategies and future research.

PRACTICAL APPLICATIONS

Future research could benefit by exploring ways to increase exposure to online material promoting road safety and determining which social media platforms are more likely to promote road safety material, with consideration to online algorithms.

Metacognitive strategies improve self-regulation skills in expert sports coaches

Self-regulation is linked to the ability to learn successfully, adapt to change, and project one's future behavior. This study aims to evaluate the impact of metacognitive strategies on self-regulation skills in the creation of educational content. Nine expert sports coaches participated in the research, and a mixed-methodology research plan was used to conduct the research. The results highlight the transformative effects of metacognitive strategies on self-regulation skills and sports coaches' experiences. The use of metacognitive strategies had a positive effect on the improvement of self-regulation skills. The facilitation program based on metacognitive questioning significantly affected the expert sports coaches' self-reported self-regulation skills. The results of the thematic analysis revealed that coaches' behavior was characterized by greater freedom in organizing their professional activities. Development of self-regulatory skills through changing educational practices encourages coaches' curiosity and openness to innovation, recognition of otherness, broadening of horizons, understanding of complexity, and disclosure of connections.

Development and Preliminary Validation of a Novel Instrument to Assess Re-Injury Associated Anxiety Following Traumatic Orofacial and Dental Injury in Young Boxers

BACKGROUND/AIM

An injury sustained during sports activity can lead to the development of reinjury anxiety and hamper performance. Although tools exist to assess re-injury anxiety, a domain of interest in the field of sports medicine, research in the psychological impact of an orofacial injury is rudimentary. The present study envisaged to develop an instrument to assess the presence of reinjury anxiety following orofacial and dental injury in boxers aged between 10 and 16 years.

METHODS

In Phase 1, items were generated following literature search and focus-group discussions (FGD). In Phase 2, a group discussion was conducted with three experienced boxing coaches to assess face validity, followed by two rounds of scrutiny by expert groups to assess the content validity through the content-validity-index (CVI), respectively. In Phase 3, the modified tool was pre-tested on an independent sample of young boxers. Finally, in Phase 4, to determine dimensionality, the modified tool was administered to 183 young boxers and their responses were subject to an exploratory factor analysis through Principal component analysis, followed by Promax rotation to determine the factor loading. Internal consistency reliability was measured through calculation of Cronbach's-alpha.

RESULTS

From the 29-items devised initially, the tool was sequentially modified. Analysis of the responses by the second expert group, an average Scale-level-CVI of 0.9 and Universal agreement of 0.526 was obtained, which resulted in the inclusion of 20 items for the final phase of the study. From the factor analysis, the items were found to fit to a five-factor structure, which explained 56.4% of the variance in the constructs. Internal consistency of the tool was measured to be 0.74.

CONCLUSION

A 10-item oral re-injury anxiety scale for young boxers (ORAS-YB) tool was developed. It was found to have high face and content validity, and acceptable reliability. Further research with a larger sample is required to confirm the factor structure and determine test-retest reliability of the developed tool.

Recruiting participants for focus groups in health research: a meta-research study

BACKGROUND

Focus groups (FGs) are an established method in health research to capture a full range of different perspectives on a particular research question. The extent to which they are effective depends, not least, on the composition of the participants. This study aimed to investigate how published FG studies plan and conduct the recruitment of study participants. We looked at what kind of information is reported about recruitment practices and what this reveals about the comprehensiveness of the actual recruitment plans and practices.

METHODS

We conducted a systematic search of FG studies in PubMed and Web of Science published between 2018 and 2024, and included n = 80 eligible publications in the analysis. We used a text extraction sheet to collect all relevant recruitment information from each study. We then coded the extracted text passages and summarised the findings descriptively.

RESULTS

Nearly half (n = 38/80) of the studies were from the USA and Canada, many addressing issues related to diabetes, cancer, mental health and chronic diseases. For recruitment planning, 20% reported a specific sampling target, while 6% used existing studies or literature for organisational and content planning. A further 10% reported previous recruitment experience of the researchers. The studies varied in terms of number of participants (range = 7-202) and group size (range = 7-20). Recruitment occurred often in healthcare settings, rarely through digital channels and everyday places. FG participants were most commonly recruited by the research team (21%) or by health professionals (16%), with less collaboration with public organisations (10%) and little indication of the number of people involved (13%). A financial incentive for participants was used in 43% of cases, and 19% reported participatory approaches to plan and carry out recruitment. 65 studies (81%) reported a total of 58 limitations related to recruitment.

CONCLUSIONS

The reporting of recruitment often seems to be incomplete, and its performance lacking. Hence, guidelines and recruitment recommendations designed to assist researchers are not yet adequately serving their purpose. Researchers may benefit from more practical support, such as early training on key principles and options for effective recruitment strategies provided by institutions in their immediate professional environment, e.g. universities, faculties or scientific associations.

Facilitators and barriers to AI adoption in nursing practice: a qualitative study of registered nurses' perspectives

BACKGROUND

Integrating Artificial Intelligence (AI) in nursing practice is revolutionising healthcare by enhancing clinical decision-making and patient care. However, the adoption of AI by registered nurses, especially in varied healthcare settings such as Saudi Arabia, remains underexplored. Understanding the facilitators and barriers from the perspective of frontline nurses is crucial for successful AI implementation.

AIM

This study aimed to explore registered nurses' perspectives on the facilitators and barriers to AI adoption in nursing practice in Saudi Arabia and to propose an extended Technology Acceptance Model for AI in Nursing (TAM-AIN).

METHODS

A qualitative study utilising focus group discussions was conducted with 48 registered nurses from four major healthcare facilities in Al-Kharj, Saudi Arabia. Thematic analysis, guided by the Technology Acceptance Model framework, was employed to analyse the data.

RESULTS

Key facilitators of AI adoption included perceived benefits to patient care (85%), strong organisational support (70%), and comprehensive training programs (75%). Primary barriers involved technical challenges (60%), ethical concerns regarding patient privacy (55%), and fears of job displacement (45%). These findings led to the development of TAM-AIN, an extended model that incorporates additional constructs such as ethical alignment, organisational readiness, and perceived threats to professional autonomy.

CONCLUSIONS

AI adoption in nursing practice requires a holistic approach that addresses technical, educational, ethical, and organisational challenges. The proposed TAM-AIN offers a comprehensive framework for optimising AI integration into nursing practice, emphasising the importance of nurse-centred implementation strategies. This model provides healthcare institutions and policymakers with a robust tool to facilitate successful AI adoption and enhance patient outcomes.

Voices from the field: exploring service providers' insights into service delivery and AAC use in Canada

Use of augmentative and alternative communication (AAC) often relies on the involvement of AAC service providers; however little is known about how AAC services are delivered across Canada. This study aimed to explore AAC service provision and factors influencing use of AAC from the perspectives of service providers across Canada who are involved in providing and/or supporting use of AAC systems. The 22 participants from nine (of the 10) provinces participated in online focus groups. Participants were speech-language pathologists, occupational therapists, communicative disorders assistants, and a teacher. Transcripts of the audio recordings were analyzed using reflexive thematic analysis. Four themes were generated that reflect service-related factors contributing to the use of AAC in Canada: Support of Organizational Structures, Concordant Relationships and Goals, Making the Right Decisions, and Influence of Knowledge and Attitudes. These themes highlight how government systems, key stakeholders, assessment practices, and knowledge of AAC influence service provision and use of AAC. Voices from across Canada highlighted shared experiences of services providers as well as revealed variability in service delivery processes. The findings bring to attention a need for further research and development of service provision guidelines to support consistency, quality in practice, and equity in AAC services.

Culture, community, and cancer: understandings of breast cancer from a non-lived experience among women living in Soweto

BACKGROUND

Individual perceptions, socio-cultural beliefs and health system factors are key determinants of people's health seeking behavior and are widely cited as the causes of delayed breast cancer diagnosis among women from structurally vulnerable settings. Asking: "how do women with a non-lived experience of cancer understand the disease and, what informs their health seeking behaviors?", we qualitatively explored, individual, sociocultural and health system elements from a conceptual model derived from the Socioecological, Health Belief and Cancer Stigma Frameworks, to understand perspectives of breast cancer in a South African urban community setting.

METHODS

Using a deductive approach and allowing new themes to emerge inductively, we investigated phenomenologically, breast cancer perceptions among 34 women from Soweto, Johannesburg (aged 35-74 years) in 6 Focus Group Discussions. We then conducted 20 follow-up semi-structured in-depth interviews to explore novel themes and suggestions for increasing breast cancer screening.

RESULTS

Findings revealed some awareness of breast and other cancers, but confusion and gaps in understanding of the disease, resulting in socio-culturally influenced misperceptions of risks, causes, and outcomes following treatment of breast cancer. This fueled perceptions of profound fear and stigma against people with breast and other cancers. These findings together with participant perceptions of primary healthcare providers being unwelcoming, under-resourced, and insufficiently trained to deal with breast cancer, resulted in women reporting being reluctant to participating in screening/early detection care seeking behavior. Women only accessed primary care when experiencing extreme pain or ill-health. Participants suggested as solutions for future interventions, the need for sustained community engagement, harnessing existing clinic and community stakeholders and resources to provide clear and understandable breast cancer information and encouragement for screening uptake.

CONCLUSIONS

Health literacy gaps surrounding breast cancer fuels socio-culturally influenced misperceptions, fear, stigma, and fatalism among women from Soweto. Women perceive primary care providers of having insufficient knowledge, skills, and resources to provide effective breast cancer screening services. Participants suggested the need for greater community engagement involving primary clinics and existing community stakeholders working collaboratively. Clear, understandable, and consistent information about breast cancer must be regularly disseminated and communities must be regularly encouraged to utilize breast cancer screening services.

Stakeholder views on addressing challenges to the implementation of social prescribing in the United Kingdom

Objectives

This study aimed to understand the key barriers to successfully implementing Social Prescribing (SP) initiatives from different perspectives.

Methods

An in-depth process evaluation using a multi-method qualitative design was conducted. Qualitative data was collected via semi-structured interviews (N = 23) and Focus Group Discussion (FGD' N = 4). Twenty-three stakeholders took part in the study, including community support providers (n = 7), SP link workers (n = 6), service users (n = 6), NHS employees/referrals, and those who were involved in SP leadership and coordination (n = 4). MAXQDA Version 20.0 was used for management and data analysis.

Results

We identified eight themes representing challenges for a successful implementation of a SP programme. The themes included (i) financial issues and sustainability, (ii) human resources challenges, (iii) partnership working challenges, (iv) inadequate and inconsistent implementation, (v) information system challenges, (vi) referral system issues, (vii) training and knowledge gaps, and (viii) accessibility and privacy concerns.

Conclusion

Study findings provide insight for commissioners, providers, and link workers to guide the delivery of appropriate SP services by identifying a range of factors that hinder the successful implementation of the programme. Future policy, service development, and research should consider tackling these challenges and generating different ideas for potential solutions to address the root causes of problems.

Clinicians' perspectives on remote patient management: A qualitative exploration of physiotherapists using the DiAL (Direct Access Line) programme

BACKGROUND

In response to the COVID-19 pandemic, face-to-face consultations within healthcare settings were suspended. Remote consultations became crucial for managing musculoskeletal conditions alongside Patient Initiated Follow-ups, leading to the development of the DiAL programme at a large National Health Service Community Trust. Previous research has focused on quantitative data, little is known about staff experiences with this programme.

OBJECTIVES

To explore the perceptions and opinions of physiotherapy staff using DiAL, in order to highlight the benefits and challenges of this service with identification of areas for future development.

DESIGN

Qualitative focus groups.

METHODS

Two virtual focus groups were conducted via Microsoft Teams, involving a purposive sample of physiotherapy staff in the musculoskeletal services known to have used DiAL. Thematic analysis was conducted.

RESULTS

Ten clinicians participated in the study, generating two main themes: Clinician Autonomy and Institutional Needs. These themes encompassed several subthemes.

CONCLUSIONS

Clinicians reported higher job satisfaction and improved accessibility for patients, attributing these positive outcomes to the autonomy and flexibility provided by the platform. While the programme met National Health Service targets for Patient Initiated Follow-ups, there was a desire for ongoing improvements and a recognition that previous audits failed to capture all the benefits. DiAL serves as a treatment choice, supporting evidence on the advantages of remote consultations and contributing to the National Health Services' goal of reducing its carbon footprint. There is a collective desire for the platform to continue with future recommendations including expanding its use and exploring additional audit metrics.

Challenges and Alternatives to Evaluation Methods and Regulation Approaches for Medical Apps as Mobile Medical Devices: International and Multidisciplinary Focus Group Discussion

BACKGROUND

The rapid proliferation of medical apps has transformed the health care landscape by giving patients and health care providers unprecedented access to personalized health information and services. However, concerns regarding the effectiveness and safety of medical apps have raised questions regarding the efficacy of randomized controlled trials (RCTs) in the evaluation of such apps and as a requirement for their regulation as mobile medical devices.

OBJECTIVE

This study aims to address this issue by investigating alternative methods, apart from RCTs, for evaluating and regulating medical apps.

METHODS

Using a qualitative approach, a focus group study with 46 international and multidisciplinary public health experts was conducted at the 17th World Congress on Public Health in May 2023 in Rome, Italy. The group was split into 3 subgroups to gather in-depth insights into alternative approaches for evaluating and regulating medical apps. We conducted a policy analysis on the current regulation of medical apps as mobile medical devices for the 4 most represented countries in the workshop: Italy, Germany, Canada, and Australia. We developed a logic model that combines the evaluation and regulation domains on the basis of these findings.

RESULTS

The focus group discussions explored the strengths and limitations of the current evaluation and regulation methods and identified potential alternatives that could enhance the quality and safety of medical apps. Although RCTs were only explicitly mentioned in the German regulatory system as one of many options, an analysis of chosen evaluation methods for German apps on prescription pointed toward a "scientific reflex" where RCTs are always the chosen evaluation method. However, this method has substantial limitations when used to evaluate digital interventions such as medical apps. Comparable results were observed during the focus group discussions, where participants expressed similar experiences with their own evaluation approaches. In addition, the participants highlighted numerous alternatives to RCTs. These alternatives can be used at different points during the life cycle of a digital intervention to assess its efficacy and potential harm to users.

CONCLUSIONS

It is crucial to recognize that unlike analog tools, digital interventions constantly evolve, posing challenges to inflexible evaluation methods such as RCTs. Potential risks include high dropout rates, decreased adherence, and nonsignificant results. However, existing regulations do not explicitly advocate for other evaluation methodologies. Our research highlighted the necessity of overcoming the gap between regulatory demands to demonstrate safety and efficacy of medical apps and evolving scientific practices, ensuring that digital health innovation is evaluated and regulated in a way that considers the unique characteristics of mobile medical devices.

Patients' and stakeholders' experiences of a personalized self-management SUPport program (P-SUP) for patients with type 2 diabetes mellitus and/or coronary heart disease: a qualitative process evaluation : Maximilian Scholl

BACKGROUND

Chronic diseases such as type 2 diabetes mellitus and coronary heart disease cause medical, social, and economic burdens worldwide. Disease management programs in Germany mostly lack components to improve patients' self-management and health-promoting lifestyles despite clear guideline recommendations. Therefore, a Personalized Self-Management Support Program (P-SUP) was developed, which includes: (1) peer support groups; (2) telephone coaching; (3) feedback reports and, (4) a web portal. This study aims to explore patients' and implementing stakeholders' experiences in the implementation of P-SUP to identify barriers and facilitators to the implementation of the intervention.

METHODS

A qualitative study was conducted using face-to-face focus group interviews with participating patients and telephone-based one-to-one expert interviews with implementing stakeholders, involved in the delivery of the intervention. The transcribed interview reports were analyzed using qualitative content analysis, and the contents were categorized according to Donabedian's Structure-Process-Outcome framework.

RESULTS

A total of six themes among patients (N = 35) and five themes among implementing stakeholders (N = 32) represent the experiences. The patient themes were: (1) technical conditions, (2) indoor facilities, (3) group composition, (4) acceptance of digital components, (5) supervision and feedback and (6) impact on lifestyle behavior. The themes among the implementing stakeholders were: (1) multiprofessional approach, (2) human resources, (3) patient acceptance, (4) supervision and feedback and (5) impact on lifestyle behavior.

CONCLUSIONS

Multiprofessional interventions such as P-SUP appear to be valuable for patients and implementing stakeholders. Although infrastructural barriers made the implementation of peer support and digital patient education difficult, patients rated the exchange with peers and experts on health-related topics positively. The lack of supervision and feedback during the course of the intervention might be compensated by regular telephone coaching. The findings from this study can be used in future studies to guide researchers and implementing stakeholders and to improve the feasibility and effectiveness of complex interventions in different contexts.

TRIAL REGISTRATION

The P-SUP study was registered in the German Clinical Trials Register (DRKS) on 16/07/2020 under the registration number DRKS00020592.

Cultivating global antimicrobial stewardship: linguistic and cultural validation of the Australian National Antimicrobial Prescribing Survey appropriateness assessment definitions for Portugal

BACKGROUND

Antimicrobial resistance is driven by inappropriate antimicrobial prescribing. The National Antimicrobial Prescribing Survey (NAPS) is an Australian-developed auditing platform to assist in the assessments of antimicrobial quality by antimicrobial stewardship programmes using consensus-based definitions. The NAPS has demonstrated to be transferable to other countries. Its adaptation to Portugal could improve knowledge about the quality of antimicrobial prescribing in the country.

OBJECTIVES

To translate, culturally adapt, and validate the Australian Hospital NAPS appropriateness assessment definitions of antimicrobial prescribing for Portugal.

METHODS

International recommendations on translation and adaptation of instruments were followed. Two panels of experts participated in the process, using Zoom® for discussions and interviews, and Google Forms® for assessing vignettes. A native English-speaking person proficient in Portuguese conducted the back-translation. SPSS v.28 and Excel® were used for validity calculation.

RESULTS

The Portuguese version was well accepted, its implementation being perceived as desirable and feasible by the experts. Validation process showed a Fleiss' κ score of 0.483 (95% CI, 0.415-0.551, P < 0.005) for appropriateness, and an average agreement with the Australian NAPS team of 0.8 and 0.9, respectively, for appropriateness and reasons for inappropriateness.

CONCLUSIONS

The Portuguese version of the Australian Hospital NAPS appropriateness assessment definitions of antimicrobial prescribing, the first to be translated from English, was deemed non-inferior to the original, was well accepted, considered to be desirable and feasible, and could inspire other countries, particularly other Portuguese-speaking countries, to adapt and validate them in their own contexts, reinforcing the possibility of transferring NAPS use beyond Australia.

Barriers to healthy transitions between nursing homes and emergency departments

This study identifies barriers to healthy transitions between nursing homes and emergency departments by exploring current practices in both primary care (out-of-hours primary care and nursing homes) and specialist healthcare (ambulance services and emergency departments) organizations from the perspectives of healthcare professionals. The objective is to highlight areas where improvements to these transitions are most needed. NH residents frequently use acute healthcare services. Many have complex healthcare needs, requiring coordination across multiple providers and different healthcare settings. Transitions theory by Afaf Meleis inspired this study and helped identify barriers to healthy transitions between nursing homes and emergency departments. Eighteen qualitative interviews were conducted with healthcare professionals from nursing homes, ambulance services, out-of-hours primary care, and emergency departments. Three themes were identified from the interviews: 1: staff burden, 2: discontinuity of care, and 3: transitions taking a toll on the well-being of residents. This study identifies critical areas needed to improve transitions between nursing homes and emergency departments. Many of the barriers to healthy transitions are systemic, suggesting that micro, meso, and macro-level efforts are needed.

Clinical supervision, a reflective intervention to support new graduate nurses and midwives enhance their person-centredness: qualitative evaluation

Person-centred care is an international healthcare priority. Strategies are needed to support nurses and midwives to understand the meaning of person-centredness and support them to embed this philosophy into practice. Clinical supervision has been proposed as a strategy to support this but requires more evidence.The aim of this research was to evaluate a newly developed model of clinical supervision, underpinned by person-centred practice theory, to enhance the person-centred practices of new graduate nurses and midwives.

DESIGN

Qualitative study (embedded within a mixed methods study) using focus groupsMethods: Group, online clinical supervision (named C.A.R.E.) underpinned by the Person-centred Practice Framework was provided to 103 new graduate nurses and midwives once per month for one hour, over six months. The researchers used [Braun, V., & Clarke, V. (2022). Thematic analysis; A practical guide. SAGE]. Thematic Analysis to analyse data.

RESULTS

Twenty one participated in the qualitative evaluation. Four themes were identified (1) Person-centredness in Action (person-centredness experienced and delivered by the new graduates) (2) Enhancing the Transitioning Toolkit (professional and personal growth as an outcome of reflection and learning together) (3) The Transitioning Environment (care environment and C.A.R.E. environment) and (4) Challenges to C.A.R.E. (team and organisation, and personal).

CONCLUSION

This supportive safe space allowed new graduates to explore their and other's practices, in relation to person-centred practice theory. Through sharing their experiences, they increased their knowledge and confidence to incorporate new learning into their own practice. This clinical supervision model underpinned by the Person-centred Practice Framework provides person-centred benefits to the new graduates, patients and families. However, without organisational support the benefits will not be realised.

Exploring the facilitators and barriers in opioid deprescribing for non-cancer pain treatment experienced by general practitioners: A qualitative study

BACKGROUND

Guidelines recommend opioid deprescribing in patients on long-term opioid treatment for chronic non-cancer pain. This study aims to explore facilitators and barriers in opioid deprescribing among general practitioners in the Netherlands. In addition, this study aims to identify possibilities for improvement regarding opioid deprescribing in primary care.

METHODS

Focus group discussions with Dutch General practitioners were held by two skilled moderators. The focus group discussions were transcribed verbatim and analysed using MAXQDA software. Three independent reviewers searched for overarching themes using thematic analysis with an inductive approach. Discussions were organized until data saturation was reached.

RESULTS

Twenty-two general practitioners participated in four focus group discussions. Five main themes emerged from the data: (1) patient-centred care; (2) ensuring proper pain management (3) dilemmas and hardships in dealing with opioid use disorder; (4) the competency gap; (5) needs and possibilities to improve opioid deprescribing in primary care. The first theme addresses the main facilitators in opioid tapering. The following three themes emerged as main barriers in opioid deprescribing. The fifth theme identified possibilities for change.

CONCLUSIONS

This study indicates the importance of intrinsic motivation and a tailored approach to deprescribe opioids in patients with chronic pain on long-term opioid treatment. Identified barriers include struggles in pain management, challenges caused by opioid use disorder, insufficient capacities such as time constraints and lack of skills. Recommendations for improvement involve enhanced collaboration with healthcare professionals in primary and secondary care, provision of practical tools and assurance of sufficient time.

SIGNIFICANCE

This focus group study among 22 Dutch general practitioners elucidates the complexities of opioid deprescribing and reveals pivotal themes such as patient-centred care, pain management challenges, and competency gaps. The findings underscore the crucial role of intrinsic motivation and that of a tailored approach in opioid deprescribing, while demonstrating how a lack in effective pain treatments, practical capacities and challenges caused by opioid dependence, impede opioid deprescribing. By uncovering these complexities, this study aims to inform future deprescribing strategies.

User Needs and Factors Associated With the Acceptability of Audiovisual Feedback Devices for Chest Compression Monitoring in Cardiopulmonary Resuscitation

The use of audiovisual feedback devices to guide the quality of chest compressions during cardiopulmonary resuscitation has increased in recent years. Audiovisual feedback devices can be classified as integrated (eg, Zoll AED Plus defibrillator) or standalone (eg, CPRmeter). This study aimed to explore users' needs and factors affecting the acceptability of audiovisual feedback devices. Semistructured interviews were conducted with healthcare professionals involved in lifesaving activities. The Unified Theory of Acceptance and Use of Technology was used as a theoretical framework for the study. The Unified Theory of Acceptance and Use of Technology model has four constructs: performance expectancy, effort expectancy, social influence, and facilitating factors. Ten themes were identified under the four constructs. The performance expectancy constructs include three themes: perceived usefulness, outcome expectation, and applicability in diverse situations. The effort expectancy construct encompasses two themes: user-friendliness and complexity. The social influence construct has two themes: social and organizational factors. Lastly, the facilitating factors construct includes three themes: staff competence, perceived cost, and compatibility of devices. Exploring the needs and factors influencing the acceptability of audiovisual feedback devices used during cardiopulmonary resuscitation will inform healthcare providers, managers, manufacturers, and procurers on how to improve the efficiency and use of these devices.

Assessment of women's needs and wishes regarding interprofessional guidance on oral health in pregnancy - a qualitative study

BACKGROUND

Poor oral and dental health due to oral dysbiosis during pregnancy increases the risk for negative pregnancy outcomes. Communicating the importance of oral health is therefore essential in reducing the risk of adverse pregnancy outcomes. Professional guidance could substantially support women's positive perception of their own competence. Information on oral health should be provided by healthcare professionals such as midwives, obstetricians and dentists. The aim of this study was to assess the needs, wishes and preferences of pregnant women in Germany, regarding interprofessional collaboration and guidance on oral health during pregnancy.

METHODS

Sources of information, preferences regarding information supply as well as the need for interprofessional collaboration of involved healthcare professions were investigated in six online focus groups with pregnant women. In addition, three expert interviews with a midwife, an obstetrician and a dentist were conducted. The focus groups and interviews were analysed using qualitative content analysis according to Kuckartz.

RESULTS

25 pregnant women participated in focus groups. Pregnant women in all trimesters, aged 23 to 38 years, were included. Many women did not receive any or received insufficient information on oral health during pregnancy and wished for more consistent and written information from all involved healthcare providers. The extent of oral health counselling women received, heavily relied on their personal initiative and many would have appreciated learning about the scientific connection between oral health and pregnancy outcomes. An overall uncertainty about the timing and safety of a dental visit during pregnancy was identified. Interviews with experts provided additional insights into the working conditions of the involved healthcare professionals in counselling and emphasised the need for improved training on oral health during pregnancy in their respective professional education as well as thematic billing options in relation to this topic.

CONCLUSION

Guidance of women on oral health during pregnancy appears to be insufficient. Providing information adapted to the needs, wishes and preferences of women during pregnancy as well as the implementation of this topic in the education of involved healthcare professionals could contribute to an improved prenatal care for pregnant women and subsequently a reduced risk of negative pregnancy outcomes.

Experiences of racism in the U.S. - A perspective from Asian & Pacific Islander, Black, Latina, and Middle Eastern women

Introduction

Racism is a critical social determinant of health because it can have a direct impact on health and well-being, as well as infiltrate systems, policies, and practices. Few studies have explored the similarities and differences of experiences with racism and health between different minoritized groups. The objective of this paper is to examine how racism influences life experiences from the perspectives of Asian & Pacific Islander, Black, Latina, and Middle Eastern women.

Methods

Eleven online racially/ethnically homogeneous focus groups with a total of 52 participants were conducted in the U.S., with representation from the North, South, and West coast. The online focus groups were recorded, transcribed, and two were translated into English (from Vietnamese and Spanish). The data was coded through NVivo and analyzed through a series of team meetings to establish themes.

Results

Participants reported experiences of racism and discrimination, including physical and verbal personal attacks. They shared the role of microaggressions in their daily life, along with the ubiquitous anti-Black sentiment discussed in every group. Our participants discussed the complexities of intersectionality in their experience of discrimination, specifically regarding immigration status, language spoken, and gender. Participants also reported the role of direct racism and vicarious racism (e.g., the experiences with racism of friends or family, awareness of racist incidents via the news) in affecting their mental health. Some effects were fear, stress, anxiety, depression, and self-censoring. For participants in the Black and Latina focus groups, mental health stressors often manifested into physical issues.

Discussion

Understanding the nuances in experiences across racial/ethnic groups is beneficial in identifying potential interventions to prevent and address racism and its negative health impacts.

Exploring the experiences and expectations of trainee representatives in medical specialties: A qualitative study in the West Midlands, UK

Introduction

Despite its importance, there is a paucity of evidence describing the role and responsibilities of trainee representatives.

Aim

This study explored key stakeholders' experiences and expectations of the trainee representative role.

Method

All eligible individuals in the West Midlands Deanery's School of Medicine were invited to participate in an interview exploring their experiences and expectations of the trainee representative role. Recurring themes were identified through thematic analysis using NVivo12 software.

Results

Five themes-Support for trainee representatives, Deanery events for trainee representatives, Roles and responsibilities of trainee representatives, Representation and recruitment, and Benefits of being a trainee representative-were identified. Formalising appointments to such roles and providing induction and information on key responsibilities were highlighted as steps to minimise the gap.

Conclusion

Trainee representative positions allow trainees to explore leadership roles; however, further work is needed to improve the resources to support the professional development of trainee representatives.

Assessment of women's needs, wishes and preferences regarding interprofessional guidance on nutrition in pregnancy - a qualitative study

BACKGROUND

A healthy nutrition in pregnancy supports maternal health and fetal development, decreasing the risk for adverse pregnancy outcomes. Guidance by prenatal care professionals can increase women's awareness regarding the importance of nutrition in pregnancy and thereby contribute to a reduced risk for adverse pregnancy outcomes. The aim of this study was to assess the needs, wishes and preferences of pregnant women regarding the interprofessional guidance on nutrition in pregnancy.

METHODS

Using a qualitative approach and a purposive maximum variation sampling strategy, 25 pregnant women were recruited to participate in six semi-structured, guideline-oriented online focus groups. In addition, two semi-structured, guideline-oriented interviews, with a midwife and an obstetrician, were conducted. The focus groups and interviews were audio-recorded and transcribed. Transcripts were analysed using a systematic deductive-inductive approach to qualitative content analysis according to Kuckartz.

RESULTS

Focus group participants covered diverse perspectives in terms of their age, different models of prenatal care as well as dietary forms from omnivorous to vegan. The majority of women perceived the guidance on nutrition during pregnancy as insufficient. Involved healthcare professionals, namely midwives and obstetricians, should provide more consistent information, especially to avoid uncertainties exacerbated by the internet and social media. There is a need for individual nutrition information regarding dietary supplements and the specifics of different dietary forms during pregnancy, such as a vegan diet. The majority of participants supported the integration of a free-of-charge professional nutrition counselling in prenatal care. Interviews with experts identified time pressure and the complexity of nutrition as a topic as the main obstacles in consultation settings. Both midwife and obstetrician emphasised the need for improved professional education on nutrition in pregnancy in their respective studies.

CONCLUSION

Professional guidance for pregnant women on nutrition and uncertainties going along with certain forms of diet during pregnancy could alleviate the burden and overwhelming amount of web-based information. Additionally, information adapted to the needs, wishes and preferences of pregnant women would improve prenatal care through a more personalised approach. The quality of nutrition guidance in pregnancy should be improved by the implementation of this topic in the education of involved healthcare professionals.

Perceptions and beliefs of community gatekeepers about genomic risk information in African cleft research

BACKGROUND

A fundamental ethical issue in African genomics research is how socio-cultural factors impact perspectives, acceptance, and utility of genomic information, especially in stigmatizing conditions like orofacial clefts (OFCs). Previous research has shown that gatekeepers (e.g., religious, political, family or community leaders) wield considerable influence on the decision-making capabilities of their members, including health issues. Thus, their perspectives can inform the design of engagement strategies and increase exposure to the benefits of genomics testing/research. This is especially important for Africans underrepresented in genomic research. Our study aims to investigate the perspectives of gatekeepers concerning genomic risk information (GRI) in the presence of OFCs in a sub-Saharan African cohort.

METHODS

Twenty-five focus group discussions (FGDs) consisting of 214 gatekeepers (religious, community, ethnic leaders, and traditional birth attendants) in Lagos, Nigeria, explored the opinions of participants on genomic risk information (GRI), OFC experience, and the possibility of involvement in collaborative decision-making in Lagos, Nigeria. Transcripts generated from audio recordings were coded and analyzed in NVivo using thematic analysis.

RESULTS

Three main themes-knowledge, beliefs, and willingness to act-emerged from exploring the perspective of gatekeepers about GRI in this group. We observed mixed opinions regarding the acceptance of GRI. Many participants believed their role is to guide and support members when they receive results; this is based on the level of trust their members have in them. However, participants felt they would need to be trained by medical experts to do this. Also, religious and cultural beliefs were crucial to determining participants' understanding of OFCs and the acceptance and utilization of GRI.

CONCLUSIONS

Incorporating cultural sensitivity into public engagement could help develop appropriate strategies to manage conflicting ideologies surrounding genomic information in African communities. This will allow for more widespread access to the advances in genomics research in underrepresented populations. We also recommend a synergistic relationship between community health specialists/scientists, and community leaders, including spiritual providers to better understand and utilize GRI.

Perceptions of Students and Teachers Regarding the Impact of Cadaver-Less Online Anatomy Education on Quality of Learning, Skills Development, Professional Identity Formation, and Economics in Medical Students

Anatomy is one of the most important basic sciences in medical education and is the foundation for doctors to develop clinical skills. In the last few years, anatomy teaching has been transformed from hands-on practice into online modalities. In this study, we aimed to determine the perceptions of students and teachers about learning anatomy without using cadavers (cadaver-less) from a knowledge, technological, and humanistic perspective. The research was carried out in the Faculty of Medicine at Hasanuddin University, located in South Sulawesi, Indonesia, over a period from June to August 2021. A focus group discussion was extended to all medical students in their first year of study following their completion of online anatomy lessons. Furthermore, educators responsible for instructing anatomy in the initial year were sent an invitation to participate in a one-on-one interview with the principal investigator. In general, the results of the study complied with what has been known from the literature about the quality of online learning and its advantages and disadvantages. However, our discussions with students and interviews with teachers revealed that anatomy education without the use of cadavers is perceived as undesirable as it negatively impacts the identity formation of the future physician. It also takes away the opportunity for students to develop empathy for humanity.

Virtual counselling of tobacco cessation during the COVID-19 pandemic: A qualitative study on the experiences and perceptions of Malaysian dental undergraduates and their patients

INTRODUCTION

When dental institutions had to close down during the Movement Control Order (MCO) implementation due to the COVID-19 pandemic, dental students were faced with delays in completing their tobacco cessation schedule. An alternative was to allow students to conduct virtual counselling (VC) for smoking cessation for their patients to address their clinical requirements. This study aimed to explore Malaysian dental undergraduates' and patients' experiences undergoing smoking cessation counselling through virtual platforms.

MATERIALS AND METHODS

The study consisted of qualitative, semi-structured Focus Group Discussions (for students, n = 23) and in-depth interviews (for patients, n = 9); to phenomenologically describe the perceptions of participants involved in the VC. Each session was recorded with the participants' permission. The recorded session was transcribed verbatim and thematically analysed using the qualitative data analysis software, NVivo™.

RESULTS

The major themes that emerged were: (1) General opinions and experiences, (2) Content of VCs, (3) Remote access to counselling, (4) Patient-clinician relationships, (5) Technical issues, (6) Changes after VCs, and (7) Future application. Most students and patients were quite comfortable with VC as it is convenient, allowing students to be creative and avoid the hassle of transport and traffic. However, some of the students felt that it lacked the personal touch and guidance from lecturers who would normally be present during physical class.

CONCLUSION

Virtual counselling enables remote access to counselling, but it is also subjected to some limitations, especially regarding lack of clinical assessments, human touch and internet issues. Though participants were optimistic about adapting it in the future, multiple factors must be considered. Ultimately, the behavioural change will depend on the patient's motivation in making a difference.

Challenges Faced by Women With Neuromuscular Diseases When Having to Urinate Away From Home

The aim of this study was to investigate the challenges women with neuromuscular disease face when having to urinate when away from home. The design for this study was qualitative using the interpretive description methodology and the Sense of Coherence theory. The method was three semi-structured focus group interviews with 12 women (3 ambulant and 9 non-ambulant) with neuromuscular diseases at a specialized rehabilitation hospital. We found that physical and functional barriers hampered the opportunity to urinate when away from home due to lack of accessibility and impaired physical functioning. Psychosocial impacts were related to inconvenience and dependency on relatives, fear of stigmatization and impacted dignity, and the constant social sacrifices. The challenge of access to adequate and equitable sanitation for women with neuromuscular diseases is not at always met in society, and these women consequently often must resort to repressing the fundamental need to urinate.

Identifying the Active Ingredients of a Computerized Speech and Language Therapy Intervention for Poststroke Aphasia: Multiple Methods Investigation Alongside a Randomized Controlled Trial

BACKGROUND

Aphasia is a communication disorder affecting more than one-third of stroke survivors. Computerized Speech and Language Therapy (CSLT) is a complex intervention requiring computer software, speech and language therapists, volunteers, or therapy assistants, as well as self-managed practice from the person with aphasia. CSLT was found to improve word finding, a common symptom of aphasia, in a multicenter randomized controlled trial (Clinical and Cost Effectiveness of Computer Treatment for Aphasia Post Stroke [Big CACTUS]).

OBJECTIVE

This study provides a detailed description of the CSLT intervention delivered in the Big CACTUS trial and identified the active ingredients of the intervention directly associated with improved word finding for people with aphasia.

METHODS

We conducted a multiple methods study within the context of a randomized controlled trial. In study 1, qualitative interviews explored key informants' understanding of the CSLT intervention, how the components interacted, and how they could be measured. Qualitative data were transcribed verbatim and analyzed thematically. Qualitative findings informed the process measures collected as part of a process evaluation of the CSLT intervention delivered in the Big CACTUS trial. In study 2, quantitative analyses explored the relationship between intervention process measures (length of computer therapy access; therapists' knowledge of CSLT; degree of rationale for CSLT tailoring; and time spent using the software to practice cued confrontation naming, noncued naming, and using words in functional sentences) and change in word-finding ability over a 6-month intervention period.

RESULTS

Qualitative interviews were conducted with 7 CSLT approach experts. Thematic analysis identified four overarching components of the CSLT approach: (1) the StepByStep software (version 5; Steps Consulting Ltd), (2) therapy setup: tailoring and personalizing, (3) regular independent practice, and (4) support and monitoring. Quantitative analyses included process and outcome data from 83 participants randomized to the intervention arm of the Big CACTUS trial. The process measures found to be directly associated with improved word-finding ability were therapists providing a thorough rationale for tailoring the computerized therapy exercises and the amount of time the person with aphasia spent using the computer software to practice using words in functional sentences.

CONCLUSIONS

The qualitative exploration of the CSLT approach provided a detailed description of the components, theories, and mechanisms underpinning the intervention and facilitated the identification of process measures to be collected in the Big CACTUS trial. Quantitative analysis furthered our understanding of which components of the intervention are associated with clinical improvement. To optimize the benefits of using the CSLT approach for word finding, therapists are advised to pay particular attention to the active ingredients of the intervention: tailoring the therapy exercises based on the individual's specific language difficulties and encouraging people with aphasia to practice the exercises focused on saying words in functional sentences.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN68798818; https://www.isrctn.com/ISRCTN68798818.

'It becomes the new everyday life' - experiences of chronic pain in everyday life of people with limb-girdle muscular dystrophy

PURPOSE

To investigate experiences and reflections on challenges in everyday life of people living with limb-girdle muscular dystrophy (LGMD) and chronic pain in order to improve rehabilitation services.

MATERIALS AND METHODS

The design for this study was qualitative using the Interpretive Description methodology and the salutogenic theory of Sense of Coherence as the theoretical framework. Four semi-structured focus group interviews were conducted with 19 adults with LGMD from April to May 2021. The interviews were conducted online due to COVID-19.

RESULTS

Living with chronic pain and LGMD affected everyday life in terms of the participants' overall Sense of Coherence. Beneficial or unfavorable coping strategies were identified within four interrelated categorical themes: pain management, normality comprehension, affected emotional sentiment and altered identity.

CONCLUSION

Healthcare professionals should acknowledge possible chronic pain secondary to LGMD. Chronic pain appears to be a prevalent problem in people with LGMD with negative impact on everyday life, yet patients with LGMD did not receive sufficient information and necessary tools from health professionals to cope with chronic pain. Thus, adequate pain management appeared to be a difficult and self-taught process. Educating health professionals on how to support patients with LGMD and chronic pain is needed.IMPLICATIONS FOR REHABILITATIONHealth professionals should acknowledge and address the possibility of chronic pain secondary to limb-girdle muscular dystrophy (LGMD) and educate patients in pain management.Physiotherapy, energy management and engagement in meaningful activities may help patients gain some control of pain and limit the consequences of pain on everyday life.Supporting patients to accept pain and to shift focus towards their current capabilities may potentially improve pain management.Educating health professionals on how to support patients with LGMD and chronic pain is needed.

The impact of a changed writing environment on students' motivation to write

Introduction

The act of writing is widely acknowledged to be a complex and challenging activity, and in parallel, we know that student motivation to write is a predictor of writing performance. So understanding what characteristics of the writing classroom support or foster motivation remains a salient concern. Research has shown that UK teachers are more likely to see themselves as readers than writers, which may affect how they teach writing.

Methods

This paper reports on student focus group interview data from a study which sought to strengthen teachers' sense of themselves as writers, and to examine the impact of this on students' classroom experience of writing and their writing outcomes. The participant teachers experienced a creative writing residential, which established a writing community led by two professional writers, with the goal of changing teachers' professional practice in their own writing classrooms. The study was mixed methods, comprising a randomized controlled trial and a comprehensive qualitative dataset collating data from both the residential and the classroom. This paper presents the qualitative analysis of 32 interviews with 16 student focus groups, exploring their responses to their teachers' changed practices and how it connected with their motivation to write.

Results

The interview analysis shows how many students responded positively to new teaching practices which gave them greater autonomy and choice, and established a more collaborative way of working. This led to increased confidence in and motivation to write.

Discussion

The study highlights the importance of the classroom environment in supporting and sustaining motivation to write, and underlines that motivation is not simply an internal characteristic of an individual but is situated within the context of a community of writers.

Revolutionising dental technologies: a qualitative study on dental technicians' perceptions of Artificial intelligence integration

BACKGROUND

The integration of artificial intelligence (AI) in dentistry has the potential to revolutionise the field of dental technologies. However, dental technicians' views on the use of AI in dental technology are still sparse in the literature. This qualitative study aimed to explore the perceptions of dental technicians regarding the use of AI in their dental laboratory practice.

METHODS

Twelve dental technicians with at least five years of professional experience and currently working in Malaysia agreed to participate in the one-to-one in-depth online interviews. Interviews were recorded, transcribed verbatim and translated. Thematic analysis was conducted to identify patterns, themes, and categories within the interview transcripts.

RESULTS

The analysis revealed two key themes: "Perceived Benefits of AI" and "Concerns and Challenges". Dental technicians recognised the enhanced efficiency, productivity, accuracy, and precision that AI can bring to dental laboratories. They also acknowledged the streamlined workflow and improved communication facilitated by AI systems. However, concerns were raised regarding job security, professional identity, ethical considerations, and the need for adequate training and support.

CONCLUSION

This research sheds light on the potential benefits and challenges associated with the integration of AI in dental laboratory practices. Understanding these perceptions and addressing the challenges can support the effective integration of AI in dental laboratories and contribute to the growing body of literature on AI in healthcare.

Exploring stakeholders' perspectives on the quality of services provided through community pharmacies

INTRODUCTION

It is important to understand the factors impacting the quality of services provided through community pharmacies. Exploring how key stakeholders perceive good quality in these services is a logical first step. This could also inform the development of quality measures, such as quality indicators (QIs).

AIM

To identify key stakeholders' perspectives on the quality of services provided through community pharmacies in Norway, specifically by exploring their experiences and perceptions about what constitutes good service quality.

METHODS

A convenient sampling approach was used to recruit participants for five semi-structured focus groups from Facebook, pharmacy chains, and patient organizations. The interviews with twenty-six participants were conducted via Microsoft Teams. Interviews were transcribed verbatim, and an inductive thematic analysis with a reflexive approach was used.

RESULTS

Four main themes emerged from the analysis; 1) sufficient and substantively suitable information to cover individual needs, 2) communication skills and relationships with the pharmacy professionals, 3) customer satisfaction with knowledgeable employees and conveniently located pharmacies, and 4) factors that affect the pharmacy working environment.

CONCLUSION

This study has identified areas that pharmacy professionals and customers regard as essential to define good quality of community pharmacy services. Effective communication skills, appropriate provision of information, customer satisfaction, and working environment are all essential factors when developing quality metrics for community pharmacies.

The Experience of Home Parenteral Therapy: A Thematic Analysis of Patient Interviews

BACKGROUND

A limited number of studies have explored patients' experience with home parenteral (injectable) therapy (HPT) in the UK.

AIM

To explore the immediate-, short-, and long-term experience of patients with self-management of any home parenteral therapy with the intention for developing a guideline for service development in the United Kingdom.

METHODS AND DESIGN

An interview-based study of patients receiving HPT. Invitations were posted to all patients on the hospital HPT register. The sessions were conducted by telephone for all consenting patients. The interviews were recorded, transcribed, and analysed thematically. Participants completed the 'Health Education Impact Questionnaire' (heiQ) before and after the education session.

RESULTS

Of the 640 patients invited to participate in the study, 45 (7%) patients completed the interviews and the education session. An interview analysis revealed that the patients' experiences of HPT were generally positive, but the levels of training and support received showed wide individual variations. The patients had experienced periods of doubt and uncertainty, where they would have appreciated quick access to professional advice to alleviate their concerns. There was a reliable positive change (10.5-18.4%) from before and after the education sessions in six out of the eight domains on the heiQ questionnaire (health-directed behaviour, self-monitoring and insight, constructive attitudes and approaches, skill and technique acquisition, social integration and support, and emotional distress) and moderate change in two domains (5.3% in positive and negative engagement in life, and 2.6% in health services navigation).

CONCLUSION

Self-administered parenteral therapy at home is a valuable option, but training and preparation standards should be optimised across hospitals and the wider NHS.

Norwegian music students' perceptions and experiences of challenges and resources for health

Introduction

Music students in higher education experience health-related challenges linked to practice and performance, while an understanding of these challenges and access to resources to deal with them are required to promote the students´ health. Health literacy and health education are integral parts of health promotion and resources for health, which encompasses health-related knowledge and competence aiming to improve health. The aim of this study was to explore Norwegian music students' perceptions and experiences of resources and challenges for health and address the following research question: What health-related challenges do music students in higher music education meet, and what health promoting resources do they need and use to deal with these challenges and promote their health?

Methods

We conducted a qualitative study including three focus group interviews with 13 music students aged between 19 and 31 years studying classical, folk, jazz or rhythmic genres from five different music departments in Norwegian universities. The Salutogenic model of health was used as theoretical framework and a few questions regarding the concept of health literacy were included in the interviews. We used thematic network analysis to analyze the data.

Results

Main health challenges were related to performance pressure and difficulties implementing good health habits in the students` daily lives. Furthermore, the findings revealed several resources that promoted the students' health: (1) Personal resources included situational understanding, using adequate coping strategies, high motivation and participating in regular physical activity. (2) Social resources involved an understanding of the importance of social support from peers and teachers and synergy created between themselves and the audience through sharing of music. (3) Environmental resources were linked to access to good rehearsal rooms. The music students expressed a need for increased competence in health promoting routines during practice and performance and suggested that health-related topics should be an integrated part of education.

Learning loss and psychosocial issues among Thai students amidst the COVID-19 pandemic: the perspectives of teachers in the online classroom

BACKGROUND

The COVID-19 pandemic has had a broad influence on health and society across the globe, especially on the education sector as its educators have had to continue the provision of teaching and learning opportunities to their students online in the midst of pandemic. This has led to learning loss and psychological health issues among students, which is now being recognized worldwide. This study aims to explore the perceptions, perspectives, and experiences of teachers with regards to learning loss and psychological health issues among students during the COVID-19 pandemic in Thailand.

METHODS

Descriptive qualitative research was employed to gain a richer understanding of this interesting phenomenon. The experiences of twelve primary and secondary teachers were looked into by dividing them into several focus groups and interviewing them through video conferencing. All interviews were recorded, transcribed and analyzed through the use of content analysis.

RESULTS

The findings that include the perceptions, perspectives, and experiences among teachers focused on three main themes, which are teaching and Learning during the COVID-19 pandemic, learning loss caused by the COVID-19 pandemic, and support to deal with the psychosocial issues during the COVID-19 pandemic. These are then divided into fifteen sub themes.

CONCLUSIONS

Through these findings, this study is able to provide an understanding of the perceptions, perspectives, and experiences of teachers regarding learning loss and psychosocial issues among students during the COVID-19 pandemic in Thailand. It also highlights the psychological issues that were met, the social and family support offered, ways how learning loss among students could have been prevented in the midst of the pandemic, and finally suggests what the education administrators and healthcare or public health sector administrators can do to enhance the quality of education and resilience skills of the students during and after the pandemic.

The assessment and management of sesamoiditis: a focus group study of podiatrists in Aotearoa New Zealand

BACKGROUND

Sesamoiditis is a common inflammatory condition affecting the sesamoid bones at the plantar aspect of the first metatarsophalangeal joint (1MTPJ). However, there are currently no recommendations or clinical guidelines to support podiatrists in their assessment or management of sesamoiditis. The aim of this study was to explore the views of podiatrists in Aotearoa New Zealand on their approaches to the assessment and management of patients with sesamoiditis.

METHODS

This qualitative study included focus group discussions with registered podiatrists. Focus groups took place online via Zoom and were guided by a detailed focus group question schedule. The questions were designed to encourage discussion around assessment approaches used in the diagnosis of sesamoiditis and the treatment tools used to manage patients with sesamoiditis. Focus groups were audio-recorded and transcribed verbatim. Reflexive thematic analysis was used to analyse the data.

RESULTS

A total of 12 registered podiatrists participated in one of three focus groups. Four themes were constructed relating to the assessment of sesamoiditis: (1) obtaining a patient history; (2) recreating patient symptoms; (3) determining contributing biomechanical factors; and (4) ruling out differential diagnoses. Seven themes were constructed relating to the management of sesamoiditis: (1) consideration of patient factors; (2) patient education; (3) cushioning of the sesamoids to allow more comfortable weightbearing of the 1MTPJ; (4) pressure redistribution and offloading of the sesamoids; (5) immobilisation of the 1MTPJ and sesamoids; (6) facilitating efficient sagittal plane motion during gait; (7) referring to other health professionals to find different ways to treat or manage patient symptoms.

CONCLUSION

Podiatrists in Aotearoa New Zealand demonstrate an analytical approach in the assessment and management of patients with sesamoiditis based on their clinical experience and knowledge of lower limb anatomy. A range of assessment and management techniques are selected based on the practitioners personal preferences, as well as the patient's social factors, symptomology, and lower limb biomechanics.

'Baby mamas' in Urban Ghana: an exploratory qualitative study on the factors influencing serial fathering among men in Accra, Ghana

BACKGROUND

Biological fathering, especially in patrilineal societies, was traditionally acceptable only in the context of marriage to the mother of the child. Many men were polygynous, often staying in one household with all their wives and children. However, this phenomenon has been on the decline in recent times, mainly due to Christianity, which encourages monogamy while frowning on polygyny. The Ghanaian family has for the past few years been undergoing changes due to migration, urbanization, and industrialization. With an increase in non-marital births and the dissolution of marital unions, multi-partner fertility is likely to increase. Contemporary Ghanaian perspectives on the circumstances that lead men to engage in paternal multi-partner fertility, otherwise referred to in this study as serial fathering, are scanty, hence this study examines the factors that lead to serial fathering among Ghanaian men.

METHODS

The study employed the qualitative method, using in-depth interviews with twenty (20) serial fathers and a focus group discussion with seven (7) women.

RESULTS

It was found that factors such as the attitude of women in relationships, the duolocal post-marital residential pattern, and the age at first birth are some of the reasons why some men father children with multiple partners.

CONCLUSION

The study concludes that both situational and personal factors account for the phenomenon of serial fathering amongst men in Prampram, Ghana, and these factors bring about distinctions in serial fathering as occurring either within or outside of marriage.

Parental Perspectives on Adolescent Health-Related Confidentiality: Trust, Responsibility, and Disease Etiology as Key Themes

PURPOSE

As children progress through adolescence, they become more independent and more responsible regarding their health. This shift in responsibility from the parents to the adolescent poses a challenge for healthcare professionals who must consider both parties. Pediatricians and other healthcare professionals may encounter problems regarding consent and confidentiality. This study aimed to investigate the opinions of Belgian parents of adolescents concerning cases about confidentiality in adolescent health problems.

METHODS

A qualitative methodology with semi-structured interviews and a case-based approach was chosen to answer our study aim. Belgian parents of adolescents were recruited voluntarily; 20 parents were interviewed. Parents' opinions on four different cases regarding confidentiality were obtained. Interviews were audio- and video-recorded and transcribed verbatim. Independent coding of the transcripts was conducted.

RESULTS

Parents' opinions differ considerably when asked if a physician has to maintain confidentiality toward the adolescent, depending on the content of the case. Opinions appear underpinned by three factors: trust, responsibility of the different parties, and the etiology of the problem.

DISCUSSION

This study shows that the nature, severity, and frequency of the medical issue at hand shape the opinions of parents toward patient confidentiality, on top of the trust and responsibility factors also highlighted in previous work. This is in contrast to the Belgian legislation, which focuses on maturity regardless of context.

"Ditch the white coats": What LGBTQ+ patients prefer in their primary care provider

BACKGROUND

Health disparities in lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (LGBTQ+) individuals are well documented, and there is a dearth of primary care providers (PCPs) with the knowledge, skills, and attitudes to sensitively care for this diverse population.

PURPOSE

The purpose of this research study was to ask LGBTQ+ patients what qualities they prefer in their PCP. The findings will be used to better prepare nurse practitioners (NPs) to care for this diverse community and inform the training of future NPs to provide patient-centered care to LGBTQ+ individuals.

METHODOLOGY

In this qualitative descriptive study, four focus groups were conducted remotely between December 2020 and January 2021 with self-identified LGBTQ+ patients of an LGBTQ+ health center in the northeast. Thematic analysis of the data elicited codes, categories, and themes. Strategies were implemented to promote trustworthiness of the results.

RESULTS

Twenty-eight participants shared the qualities they value in their PCP. Analysis revealed four themes: "Ditch the white coats"; "Meet me where I am"; "The relationship is key"; and "Be knowledgeable about and comfortable with LGBTQ+ people and their health care needs."

CONCLUSIONS

The focus groups elucidated important information on caring for the LGTBQ+ communities and insights into what NPs must do to provide patient-centered care to this diverse population.

IMPLICATIONS

These findings can improve practice through a better understanding of LGBTQ+ patients' perspectives. Additionally, this study demonstrates the feasibility of directly asking our patients what they want in their health care provider.

Necessity and relevance of qualitative research in pediatric dentistry. A literature review

Objectives

This review aims to understand the essence and relevance of qualitative research in pediatric dentistry and summarizes the most important information needed for a pediatric dentist before conducting a qualitative study.

Methods

An electronic search was conducted on studies published from December 2019 until December 2021 using PubMed, Scopus, and King Abdulaziz University Digital library. Several keywords were used to identify the studies for this review.

Results

Thirty-three studies involving qualitative methods in pediatric dentistry have been conducted on parents and dentists. Qualitative studies in pediatric dentistry are used to explore the perceptions of mothers and their children and to understand their behavior in different areas related to pediatric dentistry. Barriers to conducting qualitative studies with children include credibility, the influence of others on children's opinions, and differences that influence children's behavior while conducting the study.

Conclusion

Qualitative methods in pediatric dentistry have been conducted on parents and dentists; however, little is known about the credibility and trustworthiness of conducting qualitative research with children. Future studies are needed to investigate effective interview techniques with children and more research should be conducted to evaluate the credibility and trustfulness of using children as a source to collect data in qualitative research.

Orthodontic retention experience of university students: A qualitative study

Objective:

To explore university students’ experience of retention and identify potential barriers and facilitators to long-term adherence.

Design:

Cross-sectional qualitative study using virtual focus groups.

Setting:

University of Leeds.

Participants:

Dental and non-dental students from the University of Leeds, who had previously undergone orthodontic treatment and had received removable retainers.

Methods:

Students were invited to participate via email. Virtual focus groups were undertaken using Microsoft Teams. A topic guide was used to explore the experience of orthodontic retention including factors that influence long-term retainer wear. Focus groups were recorded and analysed using an inductive thematic approach.

Results:

In total, 23 students participated in four focus groups, including 13 dental students. The period since the end of orthodontic treatment varied from 9 months to 10 years. Of the 23 participants, 8 (35%) were no longer wearing their retainers. Four themes were identified: (1) experience of orthodontic treatment including knowledge of relapse; (2) experience of retainer wear, including motivators and barriers; (3) role of others; and (4) increasing adherence. Key factors influencing use of retainers were the importance placed on maintaining treatment outcomes, awareness of unwanted tooth movement and understanding of the role of the retainer, access to replacement retainers, and ongoing support to encourage retainer wear. Greater knowledge and dental awareness reported by dental students did not necessarily increase adherence.

Conclusion:

Adherence to removable retainer wear is an important aspect of orthodontic treatment but it is recognised that long-term retainer wear is highly variable. The understanding of relapse and retention is variable. Challenges in gaining access to replacement retainers are a common cause of cessation of retainer wear. Dental professionals are perceived to be important in encouraging and supporting retainer wear and individuals reported they would like more follow-up.

A qualitative enquiry into dental students' perceptions of dentistry as a career choice in the State of Qatar

BACKGROUND

Career choice is a complex, multifaceted process affecting all aspects of life. Motivational factors of aspiring dentists are crucial to inform institutions and aid with the admission process. The aim of this study was to explore undergraduate dental students' perceived motivation for their career choice in the first dental institution in the State of Qatar to bridge the gap in knowledge in this area.

METHODS

Homogeneous purposive sampling technique was employed to collect data from all year 2 and year 3 undergraduate dental students to gain a deeper insight into their motivation of career choice. An explorative qualitative method using face-to-face focus group sessions were utilized. All focus groups were conducted in English and contained a moderator and observer. A topic guide was used to ensure data collection standardization. Participants' views were recorded and filed notes obtained. Data was transcribed and analysis performed utilizing an inductive thematic approach.

RESULTS

A total of 34 students (89.5%) from year 2 and 3 participated in the focus groups. Data analysis revealed six main themes emerging from this study namely; altruism and patient care, family influence factors, childhood aspirations, hands-on practical skills, professional and social status, and the opportunity to reconsider and transfer. Based on frequency, altruism, opportunities to learn hands-on practical skills and professional status appeared to be the main drivers influencing students' choice of dentistry as a professional career.

CONCLUSION

This qualitative study presents the first national study providing insightful information regarding current undergraduate dental students' decision process in relation to their profession selection, and shows that opportunities to provide patient care seems to be the key to motivation. There was also a strong inclination towards performing hands-on practical tasks as a dentist, and developing a professional status. Interestingly, financial reward did not feature as a motivational factor in this study. The study highlights the influence of socio-cultural and economic factors on choosing dentistry as a career. This data could help dental institutions better understand future applicant's motivations to join dentistry and assist with the academic recruitment/admission process and targeting students with a potential to excel in the profession.

Considerations for conducting and reporting digitally supported cognitive interviews with children and adults

BACKGROUND

Cognitive interviewing is a well-established qualitative method used to develop and refine PRO measures. A range of digital technologies including phone, web conferencing, and electronic survey platforms can be leveraged to support the conduct of cognitive interviewing in both children and adults. These technologies offer a potential solution to enrolling underrepresented populations, including those with rare conditions, functional limitations and geographic or socioeconomic barriers. In the aftermath of the COVID-19 pandemic, the use of digital technologies for qualitative interviewing will remain essential. However, there is limited guidance about adapting cognitive interviewing procedures to allow for remote data capture, especially with children.

METHODS

Synthesizing the literature and our research experiences during the COVID-19 pandemic, we examine considerations for implementing digitally supported cognitive interviews with children, adolescents, and adults. We offer recommendations to optimize data quality and empirical rigor and illustrate the application of these recommendations in an ongoing cognitive interviewing study to develop and refine a new pediatric PRO measure.

RESULTS

Good research practices must address participant and researcher preparation for study-related procedures and should anticipate and pre-emptively manage technological barriers. Field notes should detail interview context, audio/video cues, and any impact of technological difficulties on data quality. The approaches we recommend have been tested in an ongoing cognitive interviewing study that is enrolling children/adolescents with cGVHD ages 5-17 and their caregivers [NCT04044365]. The combined use of telephone and videoconferencing to conduct cognitive interviews remotely is feasible and acceptable and yields meaningful data to improve the content validity of our new PRO measure of cGVHD symptom bother.

CONCLUSION

Digitally supported cognitive interviewing procedures will be increasingly employed. Remote data collection can accelerate accrual, particularly in multi-site studies, and may allow for interviewer personnel and data management to be centralized within a coordinating center, thus conserving resources. Research is needed to further test and refine techniques for remote cognitive interviewing, particularly in traditionally underrepresented populations, including children and non-English speakers. Expansion of international standards to address digitally supported remote qualitative data capture appears warranted.

Zooming into Focus Groups: Strategies for Qualitative Research in the Era of Social Distancing

Qualitative research methods are important and have become increasingly prominent in medical education and research. The reason is simple: many pressing questions in these fields require qualitative approaches to elicit nuanced insights and additional meaning beyond standard quantitative measurements in surveys or observatons. Among the most common qualitative data collection methods are structured or semistructured in-person interviews and focus groups, in which participants describe their experiences relevant to the research question at hand. In the era of physical and social distancing because of the novel coronavirus disease (COVID-19) pandemic, little guidance exists for strategies for conducting focus groups or semistructured interviews. Here we describe our experience with, and recommendations for, conducting remote focus groups and/or interviews in the era of social distancing. Specifically, we discuss best practice recommendations for researchers using video teleconferencing programs to continue qualitative research during the COVID-19 pandemic.

Technology-driven methodologies to collect qualitative data among youth to inform HIV prevention and care interventions

The use of technology as a platform for delivering HIV prevention interventions provides an efficient opportunity to reach those at risk for HIV with targeted and timely prevention and treatment messages. Technology-delivered HIV interventions are becoming increasingly popular and include interventions that use mobile text messaging and mobile phone apps or deliver prevention messages through telehealth platforms. Community-centered approaches of intervention development can help address the potential gap between science and practice by ensuring that interventions are appropriate and driven by community needs and desires. Common approaches to gaining community input rely on qualitative data gathered through in-person focus group discussions (FGD), in-depth interviews (IDI) and youth advisory boards (YABs). While these proven methodologies have strengths, youth engagement can be limited by structural barriers (e.g., lack of transportation, inconvenient timing) and reluctance to participate due to stigma or discomfort with group settings. This results in a number of biases that limit the quality of face-to-face qualitative data collection, i.e., social desirability bias or selection biases created by differential likelihood of recruitment and attendance. As an increasing number of HIV prevention and care interventions are successfully delivered online, innovative approaches to youth engagement in virtual spaces can also be applied across the intervention lifespan to increase the quality and validity of formative data. In this paper, we describe a range of qualitative data collection techniques that can be used via online platforms to collect qualitative data, and we outline their relative advantages over face-to-face FGD or IDI. We use four case studies to highlight the methodologies and findings and provide recommendations for researchers moving forward.

Barriers to health care services in migrants and potential strategies to improve accessibility: A qualitative analysis

BACKGROUND

While migrants in Taiwan are entitled to universal health care, barriers to health care services exist. We aimed to explore challenges encountered by migrants when accessing health care services and potential strategies to overcome these barriers.

METHODS

Invitations to participate in the study were sent to all hospitals, 12 migrant organizations, one language school, and one language service company in Taiwan, and convenience sampling was used to recruit study participants. Focus group interviews were held with 111 migrants, clinicians, migrant organization coordinators, and representatives from the medical institutions, language school and language service company. Interviews were audio-recorded and transcribed verbatim. Data were analyzed using a thematic approach.

RESULTS

The study participants acknowledged that the current support system for migrants in the health care sector is inadequate. Barriers to health care services were noted in three areas - language and information, sociocultural and economic, and policy and resources. Potential strategies to overcome these barriers included the provision of on-site or distant interpreting services, provision of multilingual instruction notes and forms, and establishing a multilingual medical assistance hotline.

CONCLUSION

While migrants benefit from the current support and welfare system, our study found substantial gaps that need to be filled including a lack of professional medical interpreters and training programs, a lack of legal framework for medical interpreting, and inadequacy in the dispersal of information on existing resources that may facilitate the integration of migrants into society and the health care system. Overcoming these barriers may improve migrants' access to health services.