NVivo

Development of a dyadic mindfulness self-compassion intervention for patients with lung cancer and their family caregivers: A multi-method study

Objective

Lung cancer and its prolonged treatment are profoundly unsettling for patients and their family caregivers, and developing dyadic measures to alleviate their negative affectivity is pivotal. This study aimed to develop a complex intervention to alleviate dyadic psychological stress among patients with lung cancer and their family caregivers.

Methods

A stepwise multi-method study was conducted following the Medical Research Council framework. Three phases were adopted, namely: (1) a preparation phase, a systematic review was conducted to identify the evidence base, (2) a development phase, empirical data from a quantitative study and a qualitative study were integrated to identify effective components, and (3) a modification phase, an online Delphi survey was carried out to refine the intervention.

Results

The dyadic Mindfulness Self-Compassion intervention developed in this study consists of six weekly sessions. The key components of the intervention include: (1) getting along with cancer (introductory session targets illness perception), (2) practising mindful awareness (core session for mindfulness), (3) defining dyadic relationships and introducing self-compassion (core session for self-compassion), (4) promoting dyadic communication (maintenance session targets communication skills), (5) promoting dyadic coping (maintenance session targets coping skills), and (6) a summary session reviewing the rewards and challenges of dyadic adaptation named embracing the future.

Conclusions

An evidence-based, theory-driven, and culturally appropriate dyadic Mindfulness Self-Compassion intervention was developed for patients with lung cancer and their family caregivers. Future studies are warranted to pilot and evaluate the usability, feasibility, acceptability, satisfaction, and effectiveness of this complex intervention.

Trial registration

ClinicalTrial.gov NCT04795700.

Internet-delivered emotion regulation therapy for adolescents engaging in non-suicidal self-injury and their parents: A qualitative, online focus group study

OBJECTIVES

We explore adolescents' and their parents' experiences of internet-based emotion regulation therapy for non-suicidal self-injury (NSSI).

DESIGN

A qualitative study nested within a controlled feasibility trial.

METHODS

Online, semi-structured focus group interviews were conducted with outpatient adolescents with NSSI aged 13-17 years (n = 9) and their parents (n = 8) who had received therapist-guided Internet-delivered Emotion Regulation Individual Therapy for Adolescents (IERITA). Transcripts were analysed using reflexive thematic analysis.

RESULTS

Three main themes were generated: (1) Fatigue - barriers to and during treatment, comprised of two sub-themes 'Arriving to services exhausted, needing motivation, and leaving feeling abandoned' and 'the burden of IERITA and the consequences of fatigue', (2) inter- and intrapersonal insights as facilitators of change and (3) Online, written contact with the therapist is beneficial and contributes with less pressure, comprised of three sub-themes 'the therapist behind the screen is essential', 'less pressure sitting alone: the physical absence of a therapist' and 'engaging on your own terms, in your own tempo'. Themes were consistent among adolescents and parents.

CONCLUSION

Fatigue due to therapeutic engagement and previous help-seeking processes created barriers for engagement. Emotion regulation therapy was experienced as beneficial leading to inter- and intra-personal insights, facilitating change of maladaptive patterns. Therapists were regarded as indispensable, and the internet-based format did not hinder therapeutic alliance. The written format allowed for reflection and alleviated the pressure of relating to the therapist. Further research should explore experiences of other online treatment formats (e.g. synchronous or video-based) with regard to benefits, fatigue and therapist interaction.

Barriers and enablers for group-based manual emptying services for onsite sanitation facilities in Nairobi, Kenya: a qualitative study

Onsite sanitation, such as pit latrines, is essential to achieving universal access to safe sanitation, as outlined in Sustainable Development Goal target 6.2. However, manual emptying for pit latrines in low-income areas is often unhygienic, posing health and environmental risks. Enhancing the safety of these services increases costs, yet affordability for customers is essential. Thus, reducing service costs is a key priority. Group-based approach, where emptiers visit multiple toilets consecutively, has potential to improve both service efficiency and affordability. However, few studies have investigated its applicability to manual emptying. This paper aims to identify barriers and enablers for group-based manual emptying services in low-income neighbourhoods of Nairobi. We conducted 12 focus group discussions with landlords, tenants, and manual emptiers in the Korogocho informal settlement in Nairobi and interviewed 20 key informants from relevant sectors in Kenya. We identified five categories of barriers and enablers that affected general and group-based manual emptying: 1) funding, 2) expertise and equipment, 3) social and commercial habits, 4) physical conditions, and 5) regulatory systems. Of these, a norm that pits are not emptied until they get full, operating time constraints, fair and transparent pricing, and an organiser who can arrange group-based emptying from Category 3, and transport capacity from Category 4 specifically affected group-based manual emptying. Given that the barriers have a cascade structure, addressing some primary barriers such as capacity building and recognising manual emptiers' role in the sanitation policies could be effective ways to ensure safe and affordable emptying services.

Towards defining the competencies and leadership attributes for radiographer-led management in clinical practice: A scoping review

INTRODUCTION

Radiographer-led management is multifaceted and requires the optimal balance of clinical, administrative, technical, and people management duties. These duties demand a broad range of managerial and leadership competencies. However, the exploration of how to effectively apply these competencies and attributes in the context of clinical Radiography practice for senior leadership is limited. This review aims to identify and synthesise findings from existing literature on competencies, and leadership attributes essential for radiographer-led management.

METHODS

A literature search via EBSCOhost (MEDLINE, CINAHL, SCOPUS, Academic Search Ultimate) and key Radiography journals for relevant articles was conducted (August 2023 to January 2025). Eligible studies were screened and documented using the PRISMA-ScR framework. Data were extracted and thematically analysed using NVivo™ (v14) to identify key themes. Narrative synthesis was used to present the core competencies and leadership attributes relevant to Radiographer-led management.

RESULTS

The initial search identified 1905 articles. Following various levels of screening, twenty-five documents were included, comprising studies (n = 23) and policy documents (n = 2), primarily from the UK and Australia. Team collaboration and communication skills were the major competencies highlighted. Furthermore, leadership attributes, including interprofessional skills and visionary thinking, emerged as crucial for radiographer-led management. These findings centre on the need for collaboration, interdisciplinary teamwork, strategic vision, resilience, professional development and role clarity.

CONCLUSION

This review identified competencies and leadership attributes relevant to radiography-led management. It highlighted challenges, including resource constraints and role ambiguity, while recommending evidence-based leadership training and role alignment to support radiography managers and leaders in delivering efficient services.

IMPLICATIONS FOR PRACTICE

Actionable guidance is required for developing tailored training and clarity of radiographer-led management roles to drive innovation that improves team performance in the delivery of better services.

Supporting someone after their stroke: family members' views and experiences of self-management

PURPOSE

Self-management has increased in recognition in stroke research and rehabilitation along with growing trends of shorter hospital stays and more patient-centred care. Family members are key persons in the self-management process, but their views and experiences of self-management have not been studied in detail. This study aimed to explore family members' understanding of self-management, the strategies they use and the challenges they face when providing support.

METHODS

For this descriptive study, semi-structured interviews with family members (n = 27) were conducted. Data were analysed using inductive content analysis.

RESULTS

The analysis resulted in three main categories and eight subcategories. Most family members saw self-management as performing practical tasks, such as daily living activities and rehabilitation training. However, family members described a broad range of actions to support self-management, including emotional and motivational support. They found it challenging to give the right amount of support and expressed a need of more information after discharge.

CONCLUSIONS

Family members' conceptualisations of self-management differ from the strategies they use to provide support. A clearer understanding of self-management as a collective process can benefit the development and delivery of efficient self-management support.

Fetal Alcohol Spectrum Disorder: The Caring and Financial Burden to Caregivers-A Scoping Review

INTRODUCTION

Fetal Alcohol Spectrum Disorder (FASD) is a lifelong neurodisability caused by exposure to alcohol in utero. It can have a severe impact on the affected child as well as their families, yet the costs associated are unclear. This scoping review sought to identify the costs associated with raising a child with FASD.

METHODS

A database search was conducted in July 2024 on PubMed, Scopus, Ovid Medline and Web of Science, searching for all empirical research on the "cost" to "caregivers" of raising a child with "FASD". Articles were excluded if they did not outline the costs of FASD, or the effects of prenatal alcohol exposure, or if they did not contain parent/caregiver response. After the removal of duplicates, 421 unique articles were found based on the search criteria. Just three articles met the inclusion/exclusion criteria. Two additional publications were identified through citation checking. Thus, five articles were included in this review. Thematic analysis was used to interpret the findings and synthesise the results.

RESULTS

Personal costs ranged between USD$198.13-CAD$6215,27 per person per year. These articles identified that parents incurred costs related to medical care, education, social services, productivity losses, externalising behaviours, other direct costs to the family, and psychosocial impacts on families. Differences were considered in relation to the child's age, age at the time of diagnosis, severity of disability, relationship to caregiver, location, and other demographic factors.

DISCUSSION AND CONCLUSIONS

More research is needed to provide a more accurate estimate of the cost of raising a child with FASD.

"If I wasn't a pastor, I would be telling them about condoms, contraceptives and PrEP"-conflicts, dilemmas and credibility: qualitative insights from religious leaders and the promotion of pre-exposure prophylaxis (PrEP) in Eswatini

BACKGROUND

Religious leaders (RLs) form an influential group in Eswatini. This study explores their understanding and acceptance of pre-exposure prophylaxis (PrEP), with a view to improve PrEP service delivery for those who would benefit from PrEP the most.

METHODS

We conducted online and in-person in-depth interviews with (n=26) purposefully selected RLs (n=12 female and n=14 male) from Eswatini. Data were managed using NVivo V.12 and coded inductively. We used thematic analysis to analyse our data and structure our findings across the individual, interpersonal, community and institutional levels of an ecological framework.

RESULTS

RLs have the willingness, potential and influence to promote PrEP in their church communities. They are aware of the community need for HIV prevention, but describe a conflict between their professional role as a pastor and their personal commitment to the well-being of their church community. Participants expressed a dilemma between their pastoral ethics- which oppose sex outside of marriage-and the conflicting challenges of HIV stigma and evidence-based health promotion among church members. Discussing PrEP could compromise their credibility and expose them to potential censure from religious authorities and the church community.

CONCLUSION

RLs can play an important role in the community acceptance and implementation of PrEP but are conflicted between community health and their professional role. Addressing the sources of this conflict and offering tailored training about HIV prevention and PrEP is essential to reduce stigma and benefit from RLs' influence in the church community.

Mobile Health-Based Motivational Interviewing to Promote SARS-CoV-2 Vaccination in Rural Adults: Protocol for a Pilot Randomized Controlled Trial

BACKGROUND

Despite documented effectiveness, the public health impact of vaccinations is severely limited by misperceptions, hesitancy, and poor acceptance. Messaging from health care providers has not yet been optimized to overcome these barriers and has not been tailored to groups that face health disparities, such as rural Americans. Because vaccines have become controversial, as illustrated by the public response to the SARS-CoV-2 vaccines, traditional approaches that use persuasive education or advice to change perspectives are unlikely to have long-term effects and may even be counterproductive. Alternatively, motivational interviewing (MI) is a conversational approach to address modifiable behavior and its empathic nature can be useful when navigating challenging topics. Although MI has been found to be efficacious in improving vaccination rates among children and adolescents, it is unknown whether MI can reduce vaccine hesitancy and health disparities among underserved rural adults. Further, the ideal mode of delivery for MI is unknown, especially "dose," "intensity," and integration with mobile health (mHealth). Therefore, it is essential to investigate the efficacy of MI in promoting vaccine uptake in rural populations to reduce health disparities.

OBJECTIVE

This study aims to develop and evaluate the feasibility, acceptability, and preliminary efficacy of our mHealth-based MI intervention to diminish SARS-CoV-2 vaccine hesitancy (MOTIVACC).

METHODS

This pilot study uses mixed methods. A 2-phase study will be conducted: convening a community advisory panel to understand barriers and facilitators to vaccination and mHealth uptake among adults (phase 1, n=16-20), and a pilot 3-group single-blind randomized controlled trial (RCT) for 8 weeks (phase 2, N=60). In the RCT, we recruit adults who have received no previous dose of the COVID-19 vaccine and randomize them into one of three arms: standard MI (SMI; n=20), intensive MI (IMI; n=20), or mHealth-based MOTIVACC (n=20). The primary RCT outcomes are positive change in vaccine hesitancy and intention to obtain the vaccines, measured on Likert scales. The secondary RCT outcome is the actual vaccine receipt.

RESULTS

Phase 1 of this study was approved by the ethics committees of both the University of Oklahoma and Oklahoma State University in July 2022, and was completed in June 2023. Phase 2 of this study was approved by the ethics committee at the University of Oklahoma in April 2024.

CONCLUSIONS

This randomized trial will evaluate the preliminary efficacy of MI for targeting SARS-CoV-2 vaccine hesitancy, as well as compare traditional MI versus mHealth-based MI. This will provide pivotal data on scalable strategies to assist in navigating vaccine hesitancy, including in rural populations.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05977192; https://clinicaltrials.gov/study/NCT05977192.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/64010.

Sensory experiences that impact tics: young person and parent perspectives

PURPOSE

Sensory dysregulation impacts multiple areas within the everyday lives of young people with tic disorders. Although research indicates contextual and emotional factors worsen sensory dysregulation and impact tic expression, there is a paucity of qualitative studies investigating the interplay between sensory experiences and tics in young people. Thus, the purpose of this study was to explore the sensory experiences that reduce or exacerbate tics from the perspectives of young people and their parent(s).

METHODS AND MATERIALS

A qualitative descriptive method was used. Semi-structured interviews were conducted with 10 young people with tic disorders and their parent(s). Thematic analysis was used to analyse the data.

RESULTS

Three overarching themes were identified: sensory experiences associated with tics; environmental contexts that reduce or exacerbate tics; and occupational participation as a method of focus and distraction.

CONCLUSIONS

This study highlights the sensory experiences that reduce or exacerbate tics are unique to the individual. This indicates the need for a holistic approach that considers personal, environmental and occupational factors that may assist young people to better understand their sensory needs, identity safe sensory environments and participate in meaningful occupations to reduce tics.

Do We Ask What the Deities Can Do for Us? The Roles of Dao Religion and Resilience in Suicidality in Chronic Pain

Objectives: Resilience to pain is a protective factor against aversive pain outcomes, such as suicide. Religiosity as a cornerstone of resilience has been found to be associated with reduced risk of suicidality in chronic pain. However, affiliations to different religions have displayed differences in suicide risk. This study focuses on the roles of pain resilience and Dao religion in mitigating suicidal experience in individuals with chronic pain. Methods: This study adopted a mixed-method approach. A preliminary investigation was conducted regarding the internal consistency and construct validity of the translated version of the pain resilience scale (PRS). Qualitative data were collected through interviews with individuals experiencing chronic pain. Levels of PRS and gender were included in the logistic regression on the probability of suicide attempts. The role of Dao practice was qualitatively analyzed through narrative analysis. Results: Among the 24 participants, 14 were affiliated with the Dao religion; therefore, the transcripts of these 14 interviews were analyzed. Individuals with moderate scores on the PRS were 11.60 times less likely to have attempted suicide than those with low PRS scores. The likelihood further decreased by 38.7 times in those with high PRS scores. Four themes emerged from the qualitative interviews. The participants experienced a burden from pain, made efforts to please the deities in exchange for better pain control, continuously adjusted to pain, and ultimately developed a new perspective on the relationship between their religion and pain. Many individuals have engaged in Dao rituals to try to alleviate their physical and psychological pain. Most participants tended to offer a religious interpretation of enlightening moments after surviving a suicide attempt. Discussion: This study illustrates how pain resilience and Dao religious practices mitigate suicidality in chronic pain. Trial Registration: ClinicalTrials.gov identifier: NCT05148364.

Dealing with lipoedema: women's experiences of healthcare, self-care, and treatments-a mixed-methods study

BACKGROUND

Lipoedema is a loose connective tissue disease primarily affecting women characterized by an abnormal build-up of painful fat in the legs and arms. In healthcare, lipoedema is often confused with obesity, and today, diagnostic tools and standardized guidelines for adequate treatments are lacking. Still, research on how affected women manage their health problems and whether they are satisfied with their care remains sparse. Therefore, this study aimed to contribute knowledge on healthcare experiences, and their use and self-reported effects of self-care and treatments among women with lipoedema.

METHODS

This national study, with a mixed-methods design, involved 245 women with lipoedema, recruited from all Lipoedema Association groups across Sweden. Data were collected between June and September 2021 through an online survey that included closed- and open-ended questions on self-care, lipoedema treatment, patient satisfaction, and healthcare experiences. Data were analysed using descriptive and inferential statistics, and qualitative reflexive thematic analysis.

RESULTS

The results showed a delay in diagnosis spanning decades, often preceded by numerous healthcare visits. Many women attempted to cope with their health problems using various self-care approaches. However, lipoedema treatments performed by healthcare providers were deemed the most effective. Overall, the women reported significantly low satisfaction with healthcare. The lowest score, 48 points out of 100, was found in the overall impression of offered care, reflecting perceived inefficiency and unmet expectations. Compared to a general Swedish female population, the most significant gaps were found in the dimensions of information and knowledge, and emotional support, 22 and 25 points lower, respectively. The women described their experiences in healthcare as a challenging and isolated journey. Four themes were generated: A lonely and demanding journey in the healthcare system; An uncertainty of and inconsistency in available healthcare; A burden of being unheard and disrespected in healthcare; and The impact of lack of knowledge in healthcare.

CONCLUSIONS

Seeking care for lipoedema is a long and burdensome journey with limited access to tailored care. Many women make significant efforts to manage their health problems independently. This emphasizes a need for timely lipoedema diagnosis, improved support, and better access to effective treatments.

Person-centred care as an evolving field of research: a scoping review

Introduction

Changes in policy towards a healthcare approach viewing patients as persons provide calls for person-centred healthcare practices. The objective of this scoping review was to present an overview of the international literature on PCC.

Methods

Database-specific search string including index terms and free text words related to PCC were constructed to identify relevant literature indexed in PubMed, Scopus, PsychINFO, CINAHL and Web of Science. Two different methods of combined manual and computer-assisted screening were applied to identify citations to be included in the review.

Results

In total, 1,351 publications were included, whereof theoretical and empirical studies were most prevalent in the sample. For the latter, the most common setting was hospital care. The study population was most often health professionals or patients. The most frequently used term was patient-centred, followed by person-centred and family-centred. Research from six continents was included. An exploration of collaborations and research clusters has revealed several clusters.

Discussion

This review provides a snapshot of the literature on PCC. The lack of clarity in terminology presents barriers to comprehensively overviewing the vast amount of available research within the field, which in turn presents challenges for research-based policy and practice development.

The Relationship Between Food Insecurity and Mental Health Among Syrians and Syrian Refugees Working in Agriculture During COVID-19

The COVID-19 pandemic has disproportionately impacted vulnerable populations, such as internally displaced Syrians and Syrian refugees (SSRs) in Middle Eastern host countries, through a syndemic interplay of health, social, and economic challenges. Movement restrictions disrupted their livelihoods resulting in increased food insecurity. A mixed-methods approach was used to address the research question: "What is the relationship between Food Insecurity (FI), Mental Health (MH), and COVID-19 among displaced SSRs working in agriculture"? One hundred SSR participants working in agriculture were recruited from northern Syria and neighbouring countries to participate in a Household Survey. The survey data were analysed using correlation and regression analysis. Additionally, interviews with Household Survey researchers were conducted and thematically analysed. Increasing food insecurity was significantly correlated with worse mental health outcomes among SSR participants (rs = -0.24, p = 0.018). No moderation effects were found with COVID-19 measures or household responses to the pandemic. However, smaller food portions and storing food were positively correlated with poor mental health and food insecurity. The COVID-19 pandemic exacerbated food insecurity and mental health challenges among displaced Syrians and refugees, particularly during Ramadan in 2020, highlighting the compounded effects of overlapping crises and the need for further research into resilience strategies.

Bovine adenovirus prevalence and its role in bovine respiratory disease complex: A systematic review and meta-analysis

Bovine adenoviruses (BAdVs) are major contributors to the bovine respiratory disease complex (BRDC). A systematic review and meta-analysis were carried out to explore the epidemiology of BAdV across diverse cattle populations using different detection methods. The study showed a higher BAdV prevalence of 0.66 in general cattle populations using antibody detection, compared with 0.28 in cattle showing clinical signs. The study identified significant prevalence differences between BAdV-3 (0.87) and BAdV-7 (0.21) in general cattle populations. However, in clinical cattle, BAdV-3 and BAdV-7 showed similar prevalence at 0.27 and 0.32, respectively. Moreover, a high herd-based BAdV seroprevalence of 0.82 was observed. When nucleic acid detection methods were used in general cattle populations, a lower BAdV (0.05) prevalence was observed, in contrast to the higher prevalence (0.32) in cattle exhibiting clinical signs. In contrast, using antigen detection in cattle with clinical signs of disease showed a prevalence of 0.06, compared to 0.32 with nucleic acid methods, indicating detection method-specific sensitivity and specificity. The study also highlighted the role of BAdV in BRDC, particularly BAdV-3 and BAdV-7. Existing empirical evidence on BAdV epidemiology and pathobiology is scarce and requires further investigation; however, the current findings offer insights into the epidemiology of BAdV and its role in the BRDC, which could potentially inform and enhance disease control strategies.

A Qualitative Study of Pregnant Patient Perspectives on Genetic Privacy of Cell-Free DNA and Optimal Design of a Prenatal Genetics Video-Based Educational Intervention

OBJECTIVE

To receive feedback on the design and content of a prenatal genetics video tool and explore pregnant patients' views on genetic information privacy.

METHODS

Video education covered prenatal aneuploidy screening and diagnosis and genetic privacy of cell-free DNA (cfDNA). English or Spanish-speaking adult patients, presenting for pregnancy dating ultrasound at a health center or clinic were eligible to answer a demographic questionnaire and view video education. Virtual, in-depth semi-structured interviews were then performed. Thematic analysis of transcripts was performed; all were double coded.

RESULTS

Twenty participants completed interviews, achieving data saturation.

DEMOGRAPHICS

median age 30.5 years, 50% Spanish-speaking, 55% White, 60% Hispanic, 65% had a high-school degree or less, 60% parous. Themes: The intervention was acceptable, accessible, and aided in decision-making. Tangible adjunctive resources were desired. Content misunderstandings included absolute risk of diagnostic testing and perception of aneuploidy as hereditary. Genetic privacy played a minor role in decision-making. Participants were amenable to data-sharing with third parties, but wanted to be informed. They misunderstood that genetic data could never truly be de-identified. No differences were found in opinions on sharing fetal versus maternal data or with academic versus private institutions.

CONCLUSION

Video education was acceptable and comprehensible, yet participants showed limited awareness of cfDNA privacy implications.

Parents' perspectives on conversations about prognosis and an assessment of prognostic information available online: A mixed-methods study

BACKGROUND

Conversations about prognosis for genetic neurodevelopmental conditions are becoming more frequent; however, there is a lack of evidence and guidance on how to approach these conversations and frame the information being provided.

OBJECTIVE

(1) To understand how parents perceive prognostic conversations with healthcare professionals and their preferences for these conversations, (2) To investigate the framing of prognostic information found online.

METHODS

This was a mixed-methods study, comprising of (1) a thematic analysis of interviews with parents and (2) a quantification of prognostic information available on the internet that portrayed a negative message. The strategy to classify the framing of prognostic information was defined iteratively, informed by the information found online.

RESULTS

We interviewed 32 parents from across Australia. Parents had a child with a genetic neurodevelopmental condition, such as Fragile X syndrome (28 %), 22q11.2 deletion syndrome (16 %) or Angelman syndrome (16 %). Parents reported their preference to discuss their child's potential strengths as well as challenges regarding prognosis. They reported that conversations about prognosis often focused on the child's possible deficits and that online information they encountered was similarly framed negatively. Our analysis of online information confirmed parents accounts: 95.3 % was coded as negative, while only 4.7 % was positive/neutral.

CONCLUSIONS

Our data provide evidence of an over-emphasis of deficit-framed prognostic information about genetic neurodevelopmental conditions. The initial exposure to negative information may adversely affect parents' psychological well-being and expectations, which future research could address. Health professionals could consider strengths-based framing of prognostic information gained from current and emerging technologies when returning results to families. Findings from this study can help to inform health communication practices as well as online content development.

Exploration of Roles and Contribution of Spiritual Care Practitioners in Mental Health: An Australian Study

Mental health is inherently multidimensional, requiring a holistic approach to intervention that integrates various aspects of an individual's well-being. Spirituality, a vital component of mental health, remains under addressed in Australian mental healthcare. Spiritual care practitioners may play a key role in addressing spiritual needs in mental healthcare; however, their roles and contributions in this context remain unexplored in the extant literature. Bridging this gap, this study explores the potential role of spiritual care practitioners within mental health context. Using a qualitative research approach, this study engaged eight experienced spiritual care practitioners working in various mental health settings across Australia (n = 8). Through reflexive thematic analysis, the study identified and examined the practitioners' perspectives on their roles and contributions. The findings were summarised in three overarching themes: (1)  Core values; (2) Unique contributions in mental health; and (3) Spiritual care practitioners in the mental health system. The study's findings suggest that by employing a person-centred approach, spiritual care practitioners can play a crucial role in mental health assessments and interventions. Their contributions include providing insights rooted in clients' unique spiritual beliefs, aiding in the discernment between spiritual experiences and psychopathological symptoms, advocating for clients' spiritual needs, and supporting the education of mental health professionals. The study also highlights the need for professional recognition of spiritual care practitioners and their greater integration within the mental health system.

Allied Health Student-Led Clinics: An Opportunity for Workforce Development

OBJECTIVE

The project evaluated multidisciplinary allied health student placements co-located within a rural general practice clinic.

METHODS

Occupational therapy, social work and speech pathology placement students under discipline-specific supervision led an allied health clinic model servicing clients with diverse health needs.

DESIGN

A cross-sectional survey design recording interventions, student and stakeholder experiences and client satisfaction was applied.

SETTING

General Practice clinics in MMM 4-6 regions in Queensland.

PARTICIPANTS

Between February and July 2024, 10 students completed placements within the student-led clinic, working with clients.

MAIN OUTCOMES MEASURE

Descriptive statistics were used to summarise clients' demographics, satisfaction and the services provided using SPSS version 29.0. Qualitative survey responses were analysed using Nvivo.

RESULTS

Student-led allied health services co-located within a general practice clinic benefited rural communities by providing increased access to allied health services and a holistic approach to health care. Student-led allied health services alleviated the work burden for general practitioners (GPs) in a rural health care setting.

CONCLUSION

Multidisciplinary allied health student placements within a rural GP clinic benefited rural and remote communities through increased access to allied health services. Further research is needed to investigate interdisciplinary models of care and sustainable funding streams.

Systematic review with qualitative meta-synthesis of parents' experiences and needs in relation to having a child or young person with a mental health difficulty

QUESTION

What are the experiences and needs of parents of children and young people (CYP) aged 5-18 with diagnosed mental health difficulties, particularly in relation to the parents' own well-being?

STUDY SELECTION AND ANALYSIS

A systematic review with thematic meta-synthesis was conducted, including qualitative studies published in English. Seven databases were searched (MEDLINE, PsycINFO, CINAHL Ultimate, AMED, EMBASE, Web of Science and Cochrane Library) from inception to September 2024. Studies focused on parents of CYP aged 5-18 years, where the CYP had a confirmed mental health diagnosis.

FINDINGS

Of 75 862 screened studies, 46 met inclusion criteria. Six overarching themes were identified: support needs and gaps; impact on everyday life; altered family dynamics; parental worries and fears; emotional experience of caregivers and self-care paradox. Parents face significant challenges, including unmet support needs from healthcare and education systems, substantial impacts on daily life and altered family dynamics. Emotional experiences such as worry, guilt and stigma were pervasive, compounded by systemic gaps in information and resources. Parents often prioritise their child's needs over their own, creating barriers to self-care. These challenges were consistent across diagnoses but heightened in cases of life-threatening conditions like eating disorders and depression.

CONCLUSIONS

The findings highlight support needs for parents of CYP with mental health difficulties. Tailored interventions, better professional training and family centred care are needed. Future research should focus on developing theoretical models of parental distress to guide interventions and inform support mechanisms that mitigate these broad impacts on parents' well-being.

Online search and activities of parents of children with ADHD: a qualitative study

BACKGROUND

Parents' perceptions of their child's mental health play a crucial role in their decision to seek mental health services. Additionally, mental health literacy, which includes knowledge about mental health disorders, is essential for identifying, managing, and preventing mental health problems. Online health information searches are a vital resource for parents of children with attention deficit hyperactivity disorder (ADHD)- one of the most common neurodevelopmental disorders- as they provide emotional support and information on risk factors, treatments, and prognosis. However, while online resources are widely used, little is known about how parents navigate, interpret, and integrate this information into their care decisions. This study explored parents' lived experiences of seeking ADHD-related information online, examining how these searches shape their perceptions, decision-making, and interactions with healthcare professionals.

METHOD

This qualitative study followed the Inductive Process to analyze the Structure of lived Experience (IPSE) approach. Twenty parents of children with ADHD were recruited using a purposive sampling strategy, and data were collected through semi-structured interviews until saturation was reached. Data analysis was conducted using a descriptive and structuring procedure to identify key experiential themes.

RESULTS

Data analysis produced three central experiential axes: [1] Internet and the care pathway; [2] Internet knowledge and its supporting role; and [3] Internet and discordant discourse on ADHD between health professionals. Most parents reported using social networks as a crucial source of support, guidance, and mutual aid. Specifically, online parent groups helped them navigate obstacles in the care pathway, manage conflicting perspectives on ADHD, and alleviate feelings of guilt.

CONCLUSION

Healthcare professionals and stakeholders should consider the impact of web-based resources on parental decision-making and work towards improving the accessibility and reliability of online health information.

Families' experience of anticipatory grief in home-based palliative cancer care and their support needs: A qualitative study

PURPOSE

The aim of this study was to investigate how families of patients with cancer in palliative care experience anticipatory grief and their expressed support needs in relation to loss and grief.

METHOD

The study applied a qualitative hermeneutic-phenomenology framework. Qualitative data were obtained through semi-structured family interviews with five families living in a municipality in Denmark. The interviews were audiotaped, transcribed and analyzed using a thematical analytical approach.

RESULTS

Three major themes were identified (1) anticipatory grief constantly present in everyday life. Anticipatory grief occurred when families watched the illness progress, and they experienced physical, cognitive and relational losses both with the patient and within family. (2) Experience of support from both family and professionals. (3) Families change perception when illness is present in daily life. Families experienced loss as a dynamic process oscillating between living their everyday life and feeling the presence of illness.

CONCLUSION

The study highlighted family's anticipatory grief is not addressed sufficiently in palliative care. Anticipatory grief occurred when families watched the illness progress, and they experienced physical, cognitive and relational losses both with the patient and within the family. Clinical interventions, such as a model for family interventions during anticipatory grief, are required to address different palliative care trajectories and reduce anticipatory grief in families.

Exploring College Students' Acceptance of and Behavioral Intentions Toward Different Sorghum-Based Foods

Sorghum is a nutritious, healthy, gluten-free whole grain, with the United States (U.S.) leading its production globally. While sorghum is consumed worldwide, it is mainly used for animal feed and biofuel in the U.S. Organoleptic characteristics and consumers' perceptions determine food acceptance and eating behavior. Therefore, this study aimed to investigate the acceptance of and eating and purchase intentions toward sorghum-based foods among college students in a southern university in the U.S. Eighty-three students participated in a series of sensory evaluations using two sets of four sorghum samples each and a 15 min break. Seven sensory attributes were evaluated with a nine-point hedonic scale, and a five-point scale was used for eating and purchase intentions. To assess the panelists' acceptance, the overall acceptance scale score (range: 1-9) was normalized (range: 0-100) and used for analyses. Spiced sorghum cookies (77.95 ± 14.23) had the highest acceptance, followed by sorghum shrimp grits (74.51 ± 19.42). Overall acceptance, eating intention, and purchase intention were strongly associated across all food items, although the strength differed by food type. Sorghum-based foods were accepted despite the participants' lack of exposure to sorghum and its null consumption. These outcomes will help to develop innovative sorghum-based foods to facilitate sorghum consumption and benefit consumer health in the U.S.

Bridging the gap: ICU nurses' experiences in detecting pressure injuries across diverse skin tones

BACKGROUND

Pressure Injury detection remains a challenge in patients with darker skin tones due to the absence of visible erythema, resulting in delayed diagnosis and poorer patient outcomes. Despite international guidelines, nurses face barriers in early recognition due to knowledge gaps and inadequate training in skin tone diversity. A timely assessment is critical for effective treatment. This necessitates that healthcare professionals recognise how early pressure ulcer signs may present in patients of all skin tone types.

AIM

To explore ICU nurses' experiences in assessing pressure areas in patients with dark skin tones and identify challenges and solutions.

METHODOLOGY

Following ethical approval, semi-structured interviews were conducted with 11 ICU Nurses. Interview data were analysed using thematic analysis using NVivo software.

FINDINGS

Three key themes emerged: (1) Gaps in education and training on diverse skin tones, (2) Challenges in early detection due to "white normativity" in assessment tools, and (3) The need for inclusive education and advanced diagnostic tools to mitigate disparities.

CONCLUSION

Urgent improvements in nursing curricula and clinical training are required to ensure equitable pressure injury detection for all skin tones. The study advocates for greater inclusivity in educational materials, continuous professional development, and the integration of advanced tools like infrared thermography and subepidermal moisture scanners.

Impact of a Mobile Money-Based Conditional Cash Transfer Intervention on Health Care Utilization in Southern Madagascar: Mixed-Methods Study

Background

Mobile money-based cash transfer interventions are becoming increasingly utilized, especially in humanitarian settings. southern Madagascar faced a humanitarian emergency in 2021-2022, when the second wave of the COVID-19 pandemic and a severe famine affected the fragile region simultaneously.

Objective

This mixed-methods study aims to analyze the impact and factors influencing the success of a mobile money-based conditional cash transfer intervention for health care utilization at 4 primary and 11 secondary facilities in Madagascar.

Methods

We obtained quantitative data from 11 facility registers, detailing patient numbers per month, categorized into maternity care, surgical care, pediatric care, outpatient care, and inpatient care. An interrupted time series analysis, without a control group, was conducted using the end of the intervention in July 2022 as the cut off point. For qualitative data, 64 in-depth interviews were conducted with health care providers, NGO staff, policymakers, beneficiaries, and nonbeneficiaries of the intervention, and was interpreted by 4 independent researchers using reflexive thematic analysis to identify facilitators and barriers to implementation.

Results

The interrupted time series analysis showed a significant negative impact on health care utilization, indicating a reduction in health care-seeking behavior after the end of the cash transfer intervention. The effect was stronger in the slope change of patient numbers per month (defined as P<.05), which significantly decreased in 39 of 55 (70%) models compared to the step change at the end of the intervention, which showed a significant but lower change (P <.05) in 40% (22/55) of models. The changes were most pronounced in surgical and pediatric care. The key factors that influenced the success of the implementation were grouped across three levels. At the community level, outreach conducted to inform potential beneficiaries about the project by community health workers and using the radio was a decisive factor for success. At participating facilities, high intrinsic staff motivation and strong digital literacy among facility staff positively influenced the intervention. Confusion regarding previous activities by the same implementing NGO and perceptions of unfair bonus payments for health care providers included in the project negatively affected the intervention. Finally, at the NGO-level, the staff present at each facility and the speed and efficiency of administrative processes during the intervention were decisive factors that influenced the intervention.

Conclusions

The conditional cash transfer intervention was overarchingly successful in increasing health care utilization in southern Madagascar in a humanitarian setting. However, this success was conditional on key implementation factors at the community, facility, and NGO levels. In the future, similar interventions should proactively consider the key factors identified in this study to optimize the impact.

Black Family Members' Experiences and Interpretations of Supportive Resources for Them and Their Relatives With Substance Use Disorders: A Focused Ethnography

While previous research explored the utilization of culturally supportive resources in multiethnic communities, there is a paucity of information regarding culturally relevant resources for Black Canadian family members. The study explored Black family members' experiences and interpretations regarding access to culturally supportive resources for family members and their relatives who suffer from substance use disorders. Black family members are defined as African Canadians, Caribbean Canadians, or Caribbean Blacks. A focused ethnography was conducted with a purposive sample of 26 Black family members in Ontario, Canada. The interviews were conducted from June to September 2021. Seventeen participants originated from parts of Africa, and nine were from different parts of the Caribbean. The participants comprised mothers (n = 5), fathers (n = 2), step-fathers (n = 1), husbands (n = 1), wives (n = 2), uncles (n = 5), aunties (n = 2), siblings (n = 5), in-laws (n = 2), and guardians (n = 1). Leininger's four Phases of Ethnonursing Qualitative Data Analysis were used for data analysis. Three themes were generated: (1) Navigating Existing Options and Resources for Families and Their Relatives; (2) Drawing upon Religion and Spirituality as Perceived Resources; and (3) Call for Culturally Relevant Programs for Substance Use Disorders Harm Reduction. Participants described experiencing a lack of culturally relevant resources and subsequently opting to navigate other resources. One such option was to send their relatives back to their country of origin to access cultural rehabilitation treatment options. There is a significant need for guidelines and policies regarding creating timely access to culturally relevant resources in Canada that support families and their relatives towards harm reduction and recovery outcomes.

Physician perspectives on providing virtual emergency department care for equity-deserving populations

OBJECTIVE

Patients from equity-deserving populations, such as those who are from racialized communities, the 2SLGBTQIA + community, who are refugees or immigrants, and/or who have a disability, may experience a unique set of challenges accessing and receiving care through virtual models. The objective of this qualitative study was to describe physician perspectives on their experiences providing care to patients from equity-deserving communities and their family members who received care from a Virtual Emergency Department (ED) in Toronto, Canada.

METHODS

We interviewed 14 Virtual ED physicians from different sites across the Greater Toronto Area. Semi-structured interviews were conducted to explore ED physicians' experiences with treating patients from equity-deserving populations who used the Virtual ED. Inductive thematic analysis was used to identify themes from the interview data.

RESULTS

Three themes were identified, which included: (1) Considerations for Virtual ED Inclusivity; (2) Beliefs about Compassionate Virtual ED Care Practices; and (3) Proposed Innovations for Advancing Equity through Virtual ED Care. An overarching and connecting theme was accessibility. Across these themes, providers highlighted factors that influenced Virtual ED accessibility for many equity-deserving populations.

CONCLUSIONS

The Virtual ED holds many promising applications for the delivery of equitable and compassionate care for equity-deserving populations. There are several patient, provider and system level issues that need to be considered to ensure its inclusivity and accessibility. One suggestion for innovation includes creating community hubs offering access to the Virtual ED to make it easier for equity-deserving populations who may face barriers to using it or need a safe space to do so.

How to maintain recovery following low-intensity interventions for anxiety and/or depression? A qualitative exploration through perspectives of professionals and stakeholders

BACKGROUND

Globally, 301 million people have anxiety disorders and 280 million have depression. Talking therapies are the preferred option against pharmacological treatment for these populations. In the UK, over half of those who received low-intensity evidence-based talking therapy for anxiety and/or depression relapsed within a year. This study explored practitioners and stakeholders' perspectives on current practices routinely use to maintain recovery over time and identified opportunities to improve long-term treatment effectiveness in NHS Talking Therapies services.

METHODS

This is a qualitative study using semi-structured interviews. Twenty-five participants were interviewed remotely. Data were analysed deductively using the Consolidated Framework for Implementation Research (CFIR) and inductively to allow emerging codes that did not map into the framework.

RESULTS

Of the 36 CFIR domains, 27 were evidenced in the data, and 17 new constructs were developed. Data emphasised the absence of standardised approaches in addressing relapse prevention, limitations on available resources, the need for further training, the importance of defining recovery beyond clinical symptoms, and recommendations were identified to support recovery over time.

LIMITATIONS

The sample comprised primarily White British females, reflecting the current workforce. Those interested in participating may have resulted in social desirability biases. Furthermore, focussing on professional perspectives may not represent service user experiences.

CONCLUSIONS

All participants agreed on the importance of interventions targeting recovery over time and emphasised the need for effective training and resources to support professionals and patients in sustaining treatment gains over time. Cost-effective interventions targeting long-term recovery could prove fruitful to improve current provision.

"Who Has the Relationship?": Caring for a Shared Population of Children with Medical Complexity

Background: Many academic pediatric centers care for children with medical complexity (CMC) through established complex care and palliative care programs. There are little prior data investigating best practices for collaboration between these two subspecialties in caring for CMC. Objectives: The aim of this study is to explore the distinct and overlapping roles and responsibilities of pediatric complex care and palliative care teams as identified by providers when caring for a shared population of CMC and their families. Design: Qualitative analysis of semi-structured interviews. Settings/Subjects: Pediatric complex care and palliative care providers (physicians and nurse practitioners) actively caring for CMC at academic medical centers in the Midwestern United States. Measurements: Data obtained from semi-structured interviews were audio-recorded, transcribed, coded, and analyzed by two independent reviewers using thematic analysis. Results: Interviews revealed that both programs operate within a spectrum of clinical roles, thematically organized as complex-leaning, palliative-leaning, or blended. Responses highlighted that clinical roles are more likely defined by relationships established between specific providers and families, instead of by clear boundaries between the two programs. Conclusions: Pediatric complex care and palliative care teams provide both distinct and overlapping roles in caring for CMC. This overlap can vary between institutions and individual provider-caregiver dyads. Further studies are needed to explore collaborative practices on shared patients and caregiver perceptions on the benefits and challenges of utilizing both teams concurrently. Key Message: This qualitative study of providers of CMC highlights the overlapping roles and responsibilities between complex care and palliative care teams in caring for a shared population of patients and families.

An analysis of patient-reported outcomes in Asian blepharoplasty

BACKGROUND

Asian blepharoplasty, or double eyelid surgery, is widely accepted among Asians; however, personal and cultural influences on patient satisfaction remain underexplored. This study examines the sociocultural and psychological factors shaping patient-reported outcomes through qualitative and quantitative analyses.

METHODS

This mixed-methods study included 40 Asian-identifying women recruited via social media and community events. Qualitative interviews were analyzed using NVivo for thematic analysis, word frequency, and node matrix comparisons, with cross-tabulation to explore relationships between themes (e.g., motivations and cultural normalization) and demographics. Participants completed the FACE-Q Satisfaction with Eyes subscale; linear regression was used to assess association of satisfaction with age and ethnicity.

RESULTS

Overall, 86% viewed blepharoplasty as culturally normalized, especially in Korean and Chinese communities. Personal motivations were central, with 76% citing enhanced symmetry, confidence, and makeup ease as the primary reasons. Satisfaction was high, with 89% appreciating a "natural" look, though 10% had minor regrets about the crease shape. Social support was strong (81%), largely from family and friends. Quantitatively, FACE-Q satisfaction scores averaged 24.45 ± 1.91, with a range of 22 to 28, reflecting consistently high satisfaction levels across participants. Common terms included "natural" (65 mentions), "confidence" (58), and "supportive" (48), underscoring the value placed on aesthetic and social acceptance.

CONCLUSION

The study highlights the deeply personal motivations for blepharoplasty and cultural normalization within Asian communities. Age-based satisfaction differences suggest tailored counseling, with findings affirming the centrality of personal choice in surgical decisions. Future research should further examine long-term psychosocial impacts to optimize patient-centered care.

Cultural Humility Practices in Occupational Therapy Services: A Scoping Review

IMPORTANCE

Cultural humility may improve the quality of occupational therapy services, but how occupational therapy practitioners apply this approach in their practice contexts has not been clearly described in the literature.

OBJECTIVE

To describe peer-reviewed rehabilitation literature on the practice of cultural humility and align the findings with occupational therapy practice using the Canadian Practice Process Framework (CPPF).

DATA SOURCES

Nine databases were searched, using the term cultural humility to identify relevant peer-reviewed rehabilitation literature. Google Scholar and six journals were hand-searched to identify additional studies.

STUDY SELECTION AND DATA COLLECTION

This substudy of a larger knowledge synthesis was guided by Arksey and O'Malley's (2005) scoping review methodology. Titles, abstracts, and full texts of studies were screened using Covidence. Study descriptors, context, population, and cultural humility elements defined by Tervalon and Murray-García (1998), and recommendations were extracted, analyzed, and mapped onto the CPPF.

FINDINGS

In total, 11 studies were included. Cultural humility elements of self-reflection and critique (n = 7; 63.6%), self-awareness and egolessness (n = 8; 72.7%), and supportive interaction (n = 5; 45.4%) were identified. Most cultural humility elements aligned with the societal (n = 11; 100%) and practice (n = 10; 90.9%) contexts of the CPPF.

CONCLUSIONS AND RELEVANCE

Findings highlight how occupational therapists could integrate cultural humility at each stage and in each context of their practice. Additionally, these insights can inform occupational therapy education on integrating cultural humility into training programs and guiding practitioners in applying cultural humility principles to enhance their practice. Plain-Language Summary: Cultural humility may improve the quality of occupational therapy services. How occupational therapy practitioners apply cultural humility has not been clearly described in the literature. This review describes literature on the practice of cultural humility. The findings were aligned with occupational therapy practice using the Canadian Practice Process Framework. The findings highlight how occupational therapists could integrate a cultural humility approach at each stage, in each practice process and context, and into training programs. The findings also provide a foundation for future research on how to apply cultural humility principles to improve occupational therapy services.

'It's designed for someone who is not me': A reflexive thematic analysis of the unmet healthcare support needs in UK autistic adults aged 65 years and over

Autistic people are more likely to experience physical and mental health difficulties across the lifespan, leading to an increased risk of premature mortality likely due to health disparities. At present, little is known about the healthcare experiences of autistic older adults. Semi-structured interviews were conducted with 19 autistic adults aged 65 years or over living in the United Kingdom. Reflexive thematic analysis produced these themes: (1) A lifetime of being misunderstood; (2) Autistic people falling between the gaps; (3) Processing autism diagnosis in later life; (4) Concerns about service pressures and scarce resources; (5) Lack of continuity of care, empathy and understanding; (6) Anxiety, alexithymia and sensory overload; and (7) Reduced social support and concerns for the future. Some of the challenges autistic older adults faced were like those experienced by younger or middle-aged autistic adults. However, they also reported additional difficulties related to ageing and lifelong experiences of social exclusion. These difficulties were made worse by increased service pressures. A comprehensive approach is needed, including enhanced staff training, personalised care, targeted support and policy changes. Services should also consult with autistic older adults so they can advocate for their care, shape policy and co-design services.Lay abstractAutistic people often face both physical and mental health challenges throughout their lives, which can lead to a higher risk of premature death due to health inequalities. However, we know very little about the healthcare experiences of autistic older adults. In this study, we talked with 19 autistic adults aged 65 years or above living in the United Kingdom. We found these main themes: (1) A lifetime of being misunderstood; (2) Autistic people falling between the gaps; (3) Processing autism diagnosis in later life; (4) Concerns about service pressures and scarce resources; (5) Lack of continuity of care, empathy and understanding; (6) Anxiety, alexithymia and sensory overload; and (7) Reduced social support and concerns for the future. Themes show that autistic older adults face unique healthcare access challenges because services don't consider their lifelong experiences of social exclusion. Participants also worried about age-related decline coupled with reduced social support, which makes it harder for them to get support. To address these challenges, healthcare services should provide more targeted support, make policies and funding consistent, and improve healthcare provision by providing staff training. Importantly, they must also speak with autistic older adults so they can advocate for their current and future care.

"Your behavior is not welcome here…": forced internal displacement of sexual and gender minorities in Kenya

Background

While migration studies have boomed, little is mentioned about internal displacement of queer persons. In Kenya, internal displacement of sexual and gender minorities is often overlooked and not well understood, which results in increased marginalization and vulnerabilities. The article provides an in-depth analysis of forced serial internal displacement trajectories of sexual and gender minorities, and its effect on navigating socialites and livelihoods.

Methods

We draw on qualitative data conducted between 2010 and 2023 using participant observations, in-depth interviews, case histories, and focus group discussions with LGBTQ+ persons, as well as mothers and fathers of gay men in Kenya. We used a thematic approach and principles of interpretive anthropology to organize and describe the meaning of the data as a continuous process. Broader themes were identified from the beginning of the first study, resulting in the development of a codebook framework that was reiterated over time.

Findings

Our findings show that sexual and gender minorities are forced into internal migration. Factors informing are located at the individual, interpersonal, institutional, and communal levels. We identified three main themes with eight subthemes. The main themes were (1) reasons for migration, which were often related to stigma, violence and oppression, (2) patterns of migration, which primarily had rural to urban patterns and instability, and (3) kinship, networks, and social systems, which required rebuilding, and gaining "respectability" from kin.

Conclusion

There can be little doubt that sexual and gender minorities face stigma and discrimination across levels of the socioecological model, and that in most cases, there has been multiplied grievances and anti- LGBTQ+ activities instigating serial forced migration. Forced serial displacement of sexual and gender minorities in Kenya requires research attention, and it might be better served if examined through the lens of "forced migration," given the non-voluntary aspects of fleeing and displacement. Rethinking LGBTQ+ IDPs through the lens of coercion may better capture the lived experiences given the structural stigma and violence in which they live and cannot escape.

Design, development and implementation of a digital burial record-keeping and management system in Bangladesh

Background

Digitalisation of death documentation in Bangladesh's graveyards is crucial for accurate mortality data and public health planning. Additionally, studying the usability, technology acceptance, and implementation aspects of the digital death record-keeping system, an innovative intervention that has not been previously explored, ensures the effectiveness, user adoption, and long-term sustainability. We designed, implemented, and evaluated a digital mortality surveillance system in graveyards in Dhaka city of Bangladesh.

Methods

The study was conducted in six graveyards of the Dhaka North City Corporation (DNCC). First, we conducted formative research to understand the documentation process of the graveyard record-keeping and inform architecture for a digital record-keeping system. We then developed a digital record-keeping system for graveyard. A cross-sectional quantitative and qualitative study was conducted among web and app users, and graveyard managers and death records keepers.

Results

A total of 200 app and web users and 14 record-keepers and managers participated. App and web users had high levels of system usability (88%) and found them easy to use (100%) and well-integrated (100%), with disagreement on complexity (100%), inconsistency (100%), and technical support needs (100%). These users had high technology acceptance and agreed the tools help accomplish tasks quickly (100%), improve performance (100%), and were easy to learn (100%). Digital death record-keepers reported using the system frequently (71%) but found it somewhat complex (14%) and not consistently easy to use (28%), with some reported that the systems were well integration (50%) and easy to learn (43%). While technology acceptance varied, death record keepers generally agreed that the system helps with quick task completion (50%) and performance improvement (57%), increase productivity (43%), enhance effectiveness (57%), and easy to use (50%). The digital death record-keeping system received mixed reactions, with younger, tech-savvy operators being optimistic, while older supervisors were sceptical and uncomfortable with technology. Additionally, the system was found to be feasible to an extent, particularly by data entry operators and graveyard managers.

Conclusions

The digital death record-keeping system was generally well-received by app and web users for its usability and integration, though graveyard supervisor found it somewhat complex, with mixed reactions based on tech-savviness; overall, the system was deemed feasible and sustainable.

Navigating the Healthcare System with a Complex Chronic Condition: Multidimensional Roles of Adolescents, Young Adults, and Parents

BACKGROUND/OBJECTIVE

Adolescents and young adults with complex chronic conditions and parents of children with complex chronic conditions interact frequently with the healthcare system. However, these groups have unique characteristics and needs. The objective of this qualitative study was to explore and compare the roles that adolescents and young adults with complex chronic conditions and parents of children with complex chronic conditions take on when engaging with the healthcare system.

METHODS

Semi-structured interviews were conducted with seven adolescents and young adults and nine parents at two pediatric centers from December 2018 to April 2019. The research team conducted thematic analysis. Transcripts were coded independently by two coders, achieving high interrater reliability (kappa > 0.85). We present findings related to illness experience and self-described roles within the healthcare context.

RESULTS

Informational roles described by both parents and adolescents and young adults included teacher, learner and researcher, and planner. Social-emotional roles common to both groups included source of strength, support, and hope and worrier, while the role of guardian was unique to parents. Action-oriented roles described by both groups included advocate, decision-maker, and communicator, while medical care provider was unique to parents and medical care manager was unique to adolescents and young adults.

CONCLUSIONS

Adolescents and young adults with complex chronic conditions and parents of children with complex chronic conditions balance similarly complex roles within the medical system. However, their experiences within these roles can differ, presenting unique challenges. Understanding these multidimensional roles will better equip healthcare providers to support these patients and families, especially around times of healthcare transition.

Perceptions and Earliest Experiences of Medical Students and Faculty With ChatGPT in Medical Education: Qualitative Study

BACKGROUND

With the rapid development of artificial intelligence technologies, there is a growing interest in the potential use of artificial intelligence-based tools like ChatGPT in medical education. However, there is limited research on the initial perceptions and experiences of faculty and students with ChatGPT, particularly in Saudi Arabia.

OBJECTIVE

This study aimed to explore the earliest knowledge, perceived benefits, concerns, and limitations of using ChatGPT in medical education among faculty and students at a leading Saudi Arabian university.

METHODS

A qualitative exploratory study was conducted in April 2023, involving focused meetings with medical faculty and students with varying levels of ChatGPT experience. A thematic analysis was used to identify key themes and subthemes emerging from the discussions.

RESULTS

Participants demonstrated good knowledge of ChatGPT and its functions. The main themes were perceptions of ChatGPT use, potential benefits, and concerns about ChatGPT in research and medical education. The perceived benefits included collecting and summarizing information and saving time and effort. However, concerns and limitations centered around the potential lack of critical thinking in the information provided, the ambiguity of references, limitations of access, trust in the output of ChatGPT, and ethical concerns.

CONCLUSIONS

This study provides valuable insights into the perceptions and experiences of medical faculty and students regarding the use of newly introduced large language models like ChatGPT in medical education. While the benefits of ChatGPT were recognized, participants also expressed concerns and limitations requiring further studies for effective integration into medical education, exploring the impact of ChatGPT on learning outcomes, student and faculty satisfaction, and the development of critical thinking skills.

Wind energy development in Norway: exploring the emotional landscape

Introduction

In Norway, despite ambitious goals for a low-carbon society, the extensive extraction of fossil fuels persists, accompanied by widespread climate skepticism. Wind energy is proposed as a solution but faces resistance.

Methods

This study examines the experiences of both developers and opponents of wind energy through qualitative interviews. Using appraisal theory, we classify emotional reactions, finding sadness and disgust as the most prominent negative emotions.

Results and discussion

Additionally, fear and frustration were prevalent, reflecting tensions between wind energy and individual values. Emotional reactions vary widely and suggest that opposition to wind energy is multifaceted. Opponents exhibit stronger emotional responses, while developers, representing business interests, show less intense emotions. We identified 23 key triggers for these emotions, which often can be seen as disruptions caused by the development of wind energy. Engagement, comprising cognitive, affective, and behavioral elements, is essential to addressing these conflicts. Early engagement gives stakeholders the opportunity to influence the process, thereby reducing the conflict level. This highlights the need for earlier and more inclusive engagement processes to foster meaningful dialog and uphold democratic principles.

Internal Facilitation by Health Assistants for the "WHO Lay Health Worker Dementia Care" in Rural Uganda: A Formative Evaluation

Background

Dementia is characterized by cognitive symptoms like memory loss, difficulty with language, and impaired judgment, alongside behavioral and psychological symptoms such as depression, anxiety, and aggression. Early diagnosis and tailored care are essential for managing these symptoms, improving quality of life, and reducing caregiver burden. Dementia affects a substantial portion of older people globally, especially in low- and middle-income countries like Uganda, where rural healthcare systems face challenges in dementia care access. To address these needs, we gathered key stakeholders' perspectives on a culturally tailored model employing lay health workers, supported by health assistants as internal facilitators, to implement the World Health Organization dementia toolkit in rural communities.

Methods

We conducted a formative qualitative study, utilizing one-on-one interviews with health assistants, district health team members, and primary healthcare providers in rural Uganda. We solicited their perspectives on implementing the World Health Organization dementia toolkit at the village level. The integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework guided data collection and analysis, focusing on implementation support, process improvement, and practice sustainment.

Results

Strong support was found for health assistants' roles in facilitating lay health worker-led dementia care at the community level. Health assistants' familiarity with lay health workers and pre-established structures were considered facilitating factors. Key challenges included knowledge gaps in dementia care and limited resources. Participants emphasized the importance of training, mentorship, and standardized reporting tools to enhance the implementation of dementia care. They recommended providing the health assistants with job guides, updated reporting templates to collect dementia indicators, and orientation on what they should do during internal facilitation with the lay health workers using the dementia toolkit.

Conclusion

Health assistants' internal facilitation provides a promising strategy for scaling dementia care in rural Uganda by leveraging community-based lay health workers. Addressing identified knowledge gaps, communication needs, and resource constraints will be essential to sustaining dementia care interventions in these communities.

A qualitative analysis of unintended effects of a digital conditional cash transfer intervention to encourage healthcare utilization in Southern Madagascar

INTRODUCTION

Cash transfer interventions, including those using mobile money, are becoming increasingly widespread, particularly in Sub-Saharan Africa. As such interventions can have significant positive and negative unintended consequences, further analyses are needed to identify these consequences.

METHODS

We investigated the unintended consequences of a digital conditional cash transfer intervention implemented at fifteen health facilities in Southern Madagascar. The intervention offered partial cost coverage for patients seeking care for potentially life-threatening conditions, accidents and injuries, maternal or pediatric care between February 2021 and June 2022. We conducted a qualitative analysis of in-depth interviews with policymakers, healthcare providers, (non-) beneficiaries of the intervention, and staff that implemented the intervention using reflexive thematic analysis.

RESULTS

We identified three key positive and three key negative unintended consequences of the intervention. The key positive unintended consequences were: i) improved quality of care, ii) improved interpersonal relationships, including between patients and providers and between healthcare providers, and iii) digital skills development of healthcare providers and increased trust in mobile money. The three key negative consequences we identified were i) facility overcrowding, ii) an increase in costs of care, and iii) cases of hospital imprisonment.

CONCLUSIONS

Designers and implementers of future (digital) cash transfer interventions should carefully consider and proactively seek to leverage the positive and mitigate the negative unintended consequences of cash transfer interventions for healthcare such as those highlighted in our work.

Parental experiences of raising an autistic child in Ireland: A qualitative thematic analysis

LAY ABSTRACT

Parenting an autistic child can be a challenging experience. Parents of autistic children often require social and professional support to cope with the various stresses they encounter and to ensure their children achieve their optimal potential. Recently, the way professional supports are organised in Ireland has changed. Very little previous recent research has investigated parents' experiences of raising an autistic child in Ireland. This study interviewed six parents asking them about their challenges, stress levels, coping strategies and their perceptions regarding professional support services. The data from these interviews were organised into themes. A major finding was that parents felt the healthcare system was failing to provide help for their children, and that support services in Ireland can cause more parental distress than dealing with their child's difficulties. Other causes of parental stress included the child's behaviours that they found challenging, stigma, a lack of awareness about autism and isolation. This study shows that both autistic children and their parents are at increased risk of developing mental health problems due to a flawed healthcare system that requires improvement urgently.

Competition of regulatory ecosystems in approving medicines: policy implications in the case of Europe

The competition between business ecosystems is relevant not only for strategic management, but also for health policy and regulators. Regulation is one key factor in ecosystem competition, and government and regulatory bodies implement new pharmaceutical legislations, policies, and guidelines contributing to business environments capable of attracting startups, biotech firms, and pharmaceutical industry investments in innovative medicines and technologies. Implications for patients and societal welfare require a thorough analysis of strategies aimed at enhancing the competitive advantage of the European Union (EU) in attracting pharmaceutical companies to prioritize the submission of their innovative medicines. This analysis is essential for ensuring that patients have timely access to new treatments, that society benefits from advances in healthcare, and could foster the competitive advantage of the European regulatory ecosystem. Here, we present data from 47 interviews with pharmaceutical industry professionals, offering direct insights into regulatory ecosystem competition and global health policy. Our report underscores the necessity for effective strategies that enhance the competitive advantage of the European regulatory system.

'Yeah, they suck. It's like they don't care about our health.' Medical mistrust among Black women under community supervision in New York city

Black women in the USA experience some of the poorest health outcomes and this is especially true for those involved in the carceral system who are at elevated risks for HIV/STIs, reproductive health, and chronic diseases. This study aimed to investigate Black women's experience accessing healthcare services. We conducted semi-structured interviews with 43 women from Project EWORTH under community supervision in New York City. We analysed responses focusing on barriers to healthcare engagement. All interviews were recorded, and data analysis was conducted using NVivo. Themes influencing Black women's ability to engage with healthcare providers and systems included: 1) disclosed provider mistrust/judgement; 2) feeling disrespected by providers and the medical system; 3) mistrust of medical providers/system/hospital/government; 4) lack of health communication; 5) low health literacy; 6) provider gender preference. Findings highlight the need to improve trust and collaboration between healthcare providers and Black women. This study addresses the critical gap in understanding perceptions of discrimination, stigma, and barriers to attaining health care. Funders and accreditation agencies must hold providers and organisations accountable for acquiring and making available diversity, equity and inclusion training for providers, demonstrating increasingly equitable medical relationships through responsiveness to patient feedback, and increasing the number of Black providers.

A nurse-led approach to testing and adapting a telehealth guide for e-empathy in goals of care conversations for Black patients with chronic kidney disease

OBJECTIVE

This study aims to explore and enhance the expression of empathy in telehealth visits (e-empathy) with Black American Chronic Kidney Disease (CKD) patients, focusing on goals of care conversations. It seeks to address the intersection of CKD, telehealth advancements, palliative care discussions, and the impact of racism in healthcare for holistic understanding.

METHODOLOGY

A qualitative case study design was employed in Washington, DC, involving Black patients with CKD. Data collection included cognitive testing via semi-structured interviews and feedback from a Stakeholder Advisory Group (SAG). Thematic analysis was conducted using NVivo 20 software.

RESULTS

Themes emerged regarding empathy definitions, telehealth understanding, factors influencing confidence, importance of patient stories, cultural awareness, handling upsetting conversations, prioritizing treatment preferences, end-of-life decisions, and definitions of mental health professionals.

CONCLUSION

The study highlights the significance of e-empathy in telehealth for Black CKD patients, emphasizing respect, trust, and effective communication. It underscores the need for culturally targeted guidance and acknowledges limitations such as self-selection bias and a small sample size. Future work should address healthcare disparities and improve palliative care discussions, including virtual advance directives.

PRACTICE IMPLICATIONS

Providers should prioritize e-empathy in telehealth visits with Black CKD patients, fostering trust and communication to improve patient outcomes during goals of care discussions.

Exploring clinician perspectives of systems-based practice: A physician training challenge

INTRODUCTION

Systems-based practice (SBP) has been a competency in US graduate medical education for over 20 years, but it is not well implemented. SBP is loosely defined as physician's responsiveness to the larger system of healthcare. The aim of this study was to describe healthcare professionals' perspectives regarding: (1) their knowledge and beliefs about SBP and (2) their beliefs regarding factors in clinical learning environments (CLE) that facilitate or hinder operationalisation and learning of SBP.

METHODS

Semi-structured interviews were conducted between November 2020 and April 2021 with 42 individuals from four health systems. Participants were healthcare professionals involved in graduate medical education, including physicians and interprofessional clinicians (e.g., nursing staff). Interviews were transcribed and coded using a social constructivist, codebook thematic analysis approach and themes were agreed upon through discussion amongst the research team.

RESULTS

Five themes were constructed: (1) SBP remains a challenge to define, (2) SBP may be intuitively understood, particularly when framed at the microsystem level, (3) SBP aligns with the Health Systems Science framework, (4) SBP learning must be intentionally integrated into the CLE, through training such as onboarding and (5) multidisciplinary settings and work processes are critical to engage in SBP. Workload compression is a barrier to SBP implementation.

CONCLUSIONS

Healthcare professionals highlighted that current CLEs are not designed to prioritise SBP. Graduate medical education programmes may benefit from focusing systems content at the microsystem level and purposefully integrating onboarding procedures, clinical settings and rotations specifically designed to teach SBP into their residencies.

An mHealth Intervention With Financial Incentives to Promote Smoking Cessation and Physical Activity Among Black Adults: Protocol for a Feasibility Randomized Controlled Trial

BACKGROUND

Black adults in the United States experience disproportionately high rates of tobacco- and obesity-related diseases, driven in part by disparities in smoking cessation and physical activity. Smartphone-based interventions with financial incentives offer a scalable solution to address these health disparities.

OBJECTIVE

This study aims to assess the feasibility and preliminary efficacy of a mobile health intervention that provides financial incentives for smoking cessation and physical activity among Black adults.

METHODS

A total of 60 Black adults who smoke (≥5 cigarettes/d) and are insufficiently physically active (engaging in <150 min of weekly moderate-intensity physical activity) will be randomly assigned to either HealthyCells intervention (incentives for smoking abstinence only) or HealthyCells+ intervention (incentives for both smoking abstinence and daily step counts). Participants will use study-provided smartphones, smartwatches, and carbon monoxide monitors for 9 weeks (1 wk prequit date through 8 wk postquit date). Feasibility will be evaluated based on recruitment rates, retention, and engagement. The primary outcomes include carbon monoxide-verified, 7-day smoking abstinence at 8 weeks postquit date and changes in average daily step count. Feasibility benchmarks include a recruitment rate of ≥5 participants per month, a retention rate of ≥75%, and a smoking abstinence rate of ≥20% at 8 weeks postquit date. Expected increases in physical activity include a net gain of 500 to 1500 steps per day compared to baseline.

RESULTS

Recruitment is expected to begin in February 2025 and conclude by September 2025, with data analysis completed by October 2025.

CONCLUSIONS

This study will evaluate the feasibility of a culturally tailored mobile health intervention combining financial incentives for smoking cessation and physical activity promotion. Findings will inform the design of larger-scale trials to address health disparities through scalable, technology-based approaches.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05188287; https://clinicaltrials.gov/ct2/show/NCT05188287.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/69771.

A qualitative process evaluation of SBIRT implementation in pediatric trauma centers using the Science to Service Laboratory implementation strategy

BACKGROUND

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based practice that can identify adolescents who use alcohol and other drugs and support proper referral to treatment. Despite an American College of Surgeons mandate to deliver SBIRT in pediatric trauma care, trauma centers throughout the United States have faced numerous patient, provider, and organizational level barriers to SBIRT implementation. The Implementing Alcohol Misuse Screening, Brief Intervention, and Referral to Treatment Study (IAMSBIRT) aimed to implement SBIRT across 10 pediatric trauma centers using the Science-to-Service Laboratory (SSL), an empirically supported implementation strategy. This manuscript aimed to assess trauma center staff preferences and experience with the didactic training, performance feedback, and ongoing coaching elements of the SSL via a retrospective qualitative process evaluation.

METHODS

Nurses, social workers, and site leaders that participated in IAMSBIRT were recruited to complete qualitative exit interviews guided by the Consolidated Framework for Implementation Research. Qualitative interviews were recorded, transcribed, and analyzed by two coders using a directed content analysis approach in NVivo software. Codes were then translated into frequently endorsed themes by the IAMSBIRT study research team.

RESULTS

Thirty-six exit interviews were conducted with site leaders, social workers, and nurses across the 10 IAMSBIRT pediatric trauma centers. Findings revealed key strengths as well as areas for improvement across the IAMSBIRT preparation phase and the three elements of the SSL: didactic training, performance feedback, and ongoing coaching. Trauma center staff generally reported that all three elements of the SSL were high quality and helpful for supporting SBIRT implementation. However, staff also noted that performance feedback and ongoing coaching were generally only available to center leadership or to individuals selected by leadership, making it challenging for non-leaders to troubleshoot SBIRT delivery.

CONCLUSIONS

Findings from the qualitative process evaluation revealed discrepancies in the experience of the SSL strategy between those in leadership roles and those involved in direct care delivery. These results suggest the need for several modifications to the SSL strategy, including increasing engagement of direct care staff in all elements of the SSL throughout the implementation process.

TRIAL REGISTRATION

Clinicaltrials.gov NCT03297060 . Registered 29 September 2017.

Exploring the Feasibility of a 5-Week mHealth Intervention to Enhance Physical Activity and an Active, Healthy Lifestyle in Community-Dwelling Older Adults: Mixed Methods Study

BACKGROUND

Advancements in mobile technology have paved the way for innovative interventions aimed at promoting physical activity (PA).

OBJECTIVE

The main objective of this feasibility study was to assess the feasibility, usability, and acceptability of the More In Action (MIA) app, designed to promote PA among older adults. MIA offers 7 features: personalized tips, PA literacy, guided peer workouts, a community calendar, a personal activity diary, a progression monitor, and a chatbot.

METHODS

Our study used a mixed methods approach to evaluate the MIA app's acceptability, feasibility, and usability. First, a think-aloud method was used to provide immediate feedback during initial app use. Participants then integrated the app into their daily activities for 5 weeks. Behavioral patterns such as user session duration, feature use frequency, and navigation paths were analyzed, focusing on engagement metrics and user interactions. User satisfaction was assessed using the System Usability Scale, Net Promoter Score, and Customer Satisfaction Score. Qualitative data from focus groups conducted after the 5-week intervention helped gather insights into user experiences. Participants were recruited using a combination of web-based and offline strategies, including social media outreach, newspaper advertisements, and presentations at older adult organizations and local community services. Our target group consisted of native Dutch-speaking older adults aged >65 years who were not affected by severe illnesses. Initial assessments and focus groups were conducted in person, whereas the intervention itself was web based.

RESULTS

The study involved 30 participants with an average age of 70.3 (SD 4.8) years, of whom 57% (17/30) were female. The app received positive ratings, with a System Usability Scale score of 77.4 and a Customer Satisfaction Score of 86.6%. Analysis showed general satisfaction with the app's workout videos, which were used in 585 sessions with a median duration of 14 (IQR 0-34) minutes per day. The Net Promoter Score was 33.34, indicating a good level of customer loyalty. Qualitative feedback highlighted the need for improvements in navigation, content relevance, and social engagement features, with suggestions for better calendar visibility, workout customization, and enhanced social features. Overall, the app demonstrated high usability and satisfaction, with near-daily engagement from participants.

CONCLUSIONS

The MIA app shows significant potential for promoting PA among older adults, evidenced by its high usability and satisfaction scores. Participants engaged with the app nearly daily, particularly appreciating the workout videos and educational content. Future enhancements should focus on better calendar visibility, workout customization, and integrating social networking features to foster community and support. In addition, incorporating wearable device integration and predictive analytics could provide real-time health data, optimizing activity recommendations and health monitoring. These enhancements will ensure that the app remains user-friendly, relevant, and sustainable, promoting sustained PA and healthy behaviors among older adults.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05650515; https://clinicaltrials.gov/study/NCT05650515.

Occupational Performance in the Discipline of Occupational Therapy During COVID-19 at a Public University in KwaZulu-Natal

Introduction: The application of the person-environment-occupation-performance (PEOP) model in occupational therapy education offers valuable insights into the interaction between person, environment, and occupational factors and how these elements influenced the strategies used to adapt and navigate the transformation of health professions education during the COVID-19 pandemic. This study explored how individual characteristics, contextual demands, and the nature of educational occupations shaped the adaptation and performance of educators and students. Materials and Methods: The study used a qualitative, exploratory research design at a public higher education institution (HEI) in South Africa, focusing on the occupational therapy program. Purposive sampling was used to recruit key participants (n = 44), including management, academic educators, clinical supervisors (academics), academic support educators, and occupational therapy students. Data collection occurred via the Zoom platform for 45-60-min semistructured interviews. Thematic analysis, guided by the PEOP model, was employed to analyze qualitative data, which was recorded, transcribed, and coded using NVivo (Version 12 Pro). The study ensured trustworthiness and adherence to ethical principles. Results: The PEOP model was used as a framework to formulate the themes, namely, (1) person, (2) environment, (3) occupation, (4) occupational performance, and (5) occupational performance and participation. In the context of occupational therapy education, particular emphasis was placed on the adaptations and responses of educators and students as they navigated the demands of their educational occupations during the pandemic. Discussion: The curriculum underwent rapid adjustments, requiring theoretical instruction and clinical practice modifications. These changes posed significant challenges and highlighted pre-existing gaps within HEIs, as experienced by educators and students. Conclusions: This study highlighted the importance of supporting optimal occupational performance among educators and students, emphasizing the necessity of providing adequate resources and support. This ensures the well-being of educators and students, enabling effective engagement and participation as they navigate the evolving educational landscape.

Navigating HPV Vaccination: a Qualitative Study on Chinese Women's Decision-Making Experiences

This qualitative study explores the decision experiences of adult women regarding HPV vaccination, highlighting their decision needs, outcomes, and expected support. A qualitative descriptive study design was used. A semi-structured interview guide based on the Ottawa Decision Support Framework (ODSF) was used to interview Chinese women (aged 18 to 45). These interviews were recorded, transcribed, and analyzed using deductive and inductive content analysis. Sociodemographic data were tabulated using descriptive statistics. Fifteen participants were interviewed, and three categories were constructed. (1) Unmet decision needs: participants have inadequate knowledge, biased knowledge sources, inadequate resources, and unrealistic expectations. (2) Current decision outcomes: the quality of decisions varied among participants, with some feeling satisfied and well-informed, while others expressed dissatisfaction due to unclear information and a lack of understanding. Twelve participants who decided to vaccinate adhered to their choice, managing side effects as expected. Three participants who chose not to vaccinate remained unvaccinated. (3) Expected decision support: participants expressed a need for systematic; reliable information presented in a user-friendly manner; improved access to vaccination services; and emotional support from family, friends, and healthcare providers to support making their HPV vaccine decision. Women deciding on HPV vaccination are facing several decision needs that need to be addressed. Future support targeting women's decision-making experience could provide them with better information, resource access, and emotional support, and eventually improve vaccination uptake.

Compassion Fatigue Among Australian Oncology Nurses Caring for Adult Cancer Patients: Antecedents, Impact and Mediators

AIMS

To explore how Australian oncology nurses perceive and experience compassion fatigue when caring for adult cancer patients, how they mitigate compassion fatigue and identify potential interventions to address compassion fatigue.

DESIGN

A qualitative, descriptive study.

METHODS

Twenty Australian oncology nurses caring for adult cancer patients were interviewed between August and September 2023. Participants were recruited from a larger, quantitative study. Interviews were conducted virtually, transcribed verbatim and analysed using thematic analysis.

RESULTS

Three themes and nine sub-themes were identified. Participants viewed heavy workloads, low staffing and organisational support as contributing factors to compassion fatigue. They described compassion fatigue as a feeling of having nothing left to give, impacting their ability to self-care, deliver quality patient care and maintain relationships. The pride participants felt in their cancer care work helped mitigate compassion fatigue. Self-care strategies, workplace mentoring and support were identified as ways to mitigate compassion fatigue.

CONCLUSION

The work of oncology nurses can contribute to compassion fatigue, which may impact nurses and patient care. Organisations would benefit from supporting staff to engage in self-care activities, professional development and mentoring.

IMPLICATIONS FOR PROFESSIONAL

Findings support a multi-tiered approach to addressing compassion fatigue among oncology nurses. Organisations can prioritise adequate staffing levels, mentoring opportunities, focused well-being interventions and provide avenues for meaningful recognition.

REPORTING METHOD

This study adheres to the COREQ reporting guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

An Intelligent System for Classifying Patient Complaints Using Machine Learning and Natural Language Processing: Development and Validation Study

BACKGROUND

Accurate classification of patient complaints is crucial for enhancing patient satisfaction management in health care settings. Traditional manual methods for categorizing complaints often lack efficiency and precision. Thus, there is a growing demand for advanced and automated approaches to streamline the classification process.

OBJECTIVE

This study aimed to develop and validate an intelligent system for automatically classifying patient complaints using machine learning (ML) and natural language processing (NLP) techniques.

METHODS

An ML-based NLP technology was proposed to extract frequently occurring dissatisfactory words related to departments, staff, and key treatment procedures. A dataset containing 1465 complaint records from 2019 to 2023 was used for training and validation, with an additional 376 complaints from Hangzhou Cancer Hospital serving as an external test set. Complaints were categorized into 4 types-communication problems, diagnosis and treatment issues, management problems, and sense of responsibility concerns. The imbalanced data were balanced using the Synthetic Minority Oversampling Technique (SMOTE) algorithm to ensure equal representation across all categories. A total of 3 ML algorithms (Multifactor Logistic Regression, Multinomial Naive Bayes, and Support Vector Machines [SVM]) were used for model training and validation. The best-performing model was tested using a 5-fold cross-validation on external data.

RESULTS

The original dataset consisted of 719, 376, 260, and 86 records for communication problems, diagnosis and treatment issues, management problems, and sense of responsibility concerns, respectively. The Multifactor Logistic Regression and SVM models achieved weighted average accuracies of 0.89 and 0.93 in the training set, and 0.83 and 0.87 in the internal test set, respectively. Ngram-level term frequency-inverse document frequency did not significantly improve classification performance, with only a marginal 1% increase in precision, recall, and F1-score when implementing Ngram-level term frequency-inverse document frequency (n=2) from 0.91 to 0.92. The SVM algorithm performed best in prediction, achieving an average accuracy of 0.91 on the external test set with a 95% CI of 0.87-0.97.

CONCLUSIONS

The NLP-driven SVM algorithm demonstrates effective classification performance in automatically categorizing patient complaint texts. It showed superior performance in both internal and external test sets for communication and management problems. However, caution is advised when using it for classifying sense of responsibility complaints. This approach holds promises for implementation in medical institutions with high complaint volumes and limited resources for addressing patient feedback.