Patient and family engagement in Danish intensive care units: A national survey

BACKGROUND

Patient and family engagement in the intensive care unit increases the quality of care and patient safety.

AIM

The aim of our study was to describe current practice and experiences of contemporary patient and family engagement in the intensive care unit at the individual level, the organizational level, and in the research process according to critical care nurses.

DESIGN/METHOD

We conducted a national qualitative survey of intensive care units in Denmark from 5th May-5th June 2021. Questionnaires were piloted and sent to intensive care nurse specialists and research nurses at 41 intensive care units, allowing one respondent per unit. All respondents were provided with written information about the study by email, and by activating the survey link, they accepted participation.

RESULTS

Thirty-two nurses responded to the invitation, 24 completed and 8 partially completed the survey, yielding a response rate of 78%. At the individual level, 27 respondents stated that they involved patients and 25 said they involved family in daily treatment and care. At the organizational level, 28 intensive care units had an overall strategy or guideline for patient and family engagement, and 4 units had established a PFE panel. And, finally, 11 units engaged patients and families in the research process.

CONCLUSIONS

Our survey suggested that patient and family engagement was implemented to some degree at the individual level, organizational level, and in the research process, but only 4 units had established a PFE panel at the organizational level, which is key to engagement.

RELEVANCE TO CLINICAL PRACTICE

Patient engagement increases when patients are more awake, and family engagement increases when patients are unable to participate. Engagement increases when patient and family engagement panels are implemented.

Husbands' knowledge and involvement in sexual and reproductive health rights of women in Bahir Dar City, Northwest Ethiopia: a community-based study

Background

Sexual and reproductive health rights (SRHRs) are integral elements of the rights of everyone to the highest attainable standard of physical and mental health, but they are the most underdeveloped and least understood sphere of rights, especially in Africa, including the country of Ethiopia. The implementation of women's SRHRs is essential for achieving gender equality and promoting women's rights. Husbands' knowledge and involvement play a significant role in improving women's practice of their SRHRs. However, there is limited information/data about the level of husbands' knowledge and involvement in Northwest Ethiopia, including Bahir Dar City. Therefore, this study aimed to assess husbands' knowledge, involvement, and factors influencing their involvement in women's SRHRs.

Methods

Community-based cross-sectional study design was conducted from March 20 to April 5, 2023, in Bahir Dar City, Northwest Ethiopia, among 391 husbands. Multi-stage sampling and simple random sampling technique were applied to select kebeles and study participants, respectively. Participants were interviewed face-to-face using structured and pretested questionnaire. Binary logistic regression was applied to identify associated factors, and a p-value of <0.05 was a cutoff point to declare statistical significance.

Results

In this study, 50.6% (198/391) of the husbands had good knowledge about their wives' SRHRs and 44.2% (173/391) (95% CI, 39.3-49.1%) of the husbands were involved when their wives practiced their SRHRs. Access training/education about sexual health [AOR = 5.99; 95% CI (2.7-13.2)], husbands' advance educational level [AOR = 8.81; 95% CI (2.04-38)], good knowledge about SRHRs [AOR = 7.94; 95% CI (4.3-14.4)], low monthly income (<4,600 birr) [AOR = 9.25; 95% CI (4.2-20.5)], and had open discussion with family members and friends about SRHRs [AOR = 1.92; 95% CI (1.01-3.6)] were found to have significant association with husbands' involvement.

Conclusion

Husbands' level of knowledge on SRHRs of women and their involvement remain low. Therefore, responsible concerned bodies need to work on the strategies that help to improve men involvement and knowledge, and tackle the above-mentioned factors influencing their involvement.

Representation of child and youth participation within the Unified Medical Language System (UMLS)

PURPOSE

To examine (1) how much participation is represented in the benchmark Unified Medical Language System (UMLS) resource, and (2) to what extent that representation reflects the definition of child and youth participation and/or its related constructs per the family of Participation-Related Constructs framework.

MATERIALS AND METHODS

We searched and analysed UMLS concepts related to the term "participation." Identified UMLS concepts were rated according to their representation of participation (i.e., attendance, involvement, both) as well as participation-related constructs using deductive content analysis.

RESULTS

363 UMLS concepts were identified. Of those, 68 had at least one English definition, resulting in 81 definitions that were further analysed. Results revealed 2 definitions (2/81; 3%; 2/68 UMLS concepts) representing participation "attendance" and 18 definitions (18/81; 22%; 14/68 UMLS concepts) representing participation "involvement." No UMLS concept definition represented both attendance and involvement (i.e., participation). Most of the definitions (11/20; 55%; 9/16 UMLS concepts) representing attendance or involvement also represent a participation-related construct.

CONCLUSION(S)

The representation of participation within the UMLS is limited and poorly aligned with the contemporary definition of child and youth participation. Expanding ontological resources to represent child and youth participation is needed to enable better data analytics that reflect contemporary paediatric rehabilitation practice.

Is there scope to do better? Clinical communication with adolescents and young adults with cancer-A scoping review

INTRODUCTION

How to communicate effectively with adolescent and young adults with cancer (AYACs) is a research priority. In a UK-wide survey of young people with cancer's research priorities, communication was a striking cross-cutting theme. It is increasingly recognised that AYACs have experiences and communication needs that differ significantly from those of younger children and older adults. The purpose of this review is to explore the features of effective clinical communication with AYACs.

METHODS

A literature search was undertaken to identify and map the available evidence using a broad scope to get an overview of the pertinent literature, identify knowledge gaps and clarify concepts. The searches yielded 5825 records, generating 4040 unique articles. These were screened and 71 full articles were read by four researchers with disagreements resolved by discussion leaving 29 included articles. Narrative synthesis was undertaken in relation to each of the research questions.

RESULTS

Three key themes were identified: being an adolescent/young adult, supporters, and healthcare professionals (HCPs). AYACs need to feel that HCPs understand their unique perspective. They want to be involved, this changes over time and in different contexts. Supporters are a central tenet, are most often parents and undertake several roles which are not always universally supportive. HCPs enable involvement of AYACs, and this needs to be actively promoted. AYACs preference for their level of involvement requires continual assessment. The three themes are interlinked and exist within the wider scope of the triadic encounter and cancer experience.

CONCLUSION

Supporters, most often parents were a key feature across the data and were seemingly paradoxical in nature. Triadic communication, the presence of a third person, is a central tenet of communication with AYACs and we propose a conceptual model to represent the nuances, components, and facets of this complex communication.

I have never been invited-A cross-sectional explorative study of family members' experiences of encounters with healthcare professionals in diabetes care

AIM

To explore the experiences of family members of adult persons with type 1 diabetes concerning both the approach of healthcare professionals and feelings of alienation in encounters with professional diabetes care.

METHODS

A cross-sectional explorative quantitative and qualitative design. The Family Involvement and Alienation Questionnaire-Revised (FIAQ-R), including an open-ended question, was answered by 37 family members of adult persons with type 1 diabetes. Analyses included descriptive statistics and qualitative analysis. The study has received ethical approval.

RESULTS

Family members rated the approach of the healthcare professionals as being somewhat positive and considered that the approach towards them is important. They only felt partially alienated from the professional care. Qualitative data revealed that the family members often lacked direct access to the professional care and that their involvement was dependent on their relationship with the person with diabetes. Findings highlighted that the family members' wish to be involved in the care was sometimes unanswered.

CONCLUSION

Based on the findings, it is reasonable to stress the importance of considering family members' perspectives and involving them in diabetes care to improve overall patient support.

Caregiver strategies supporting community participation among children and youth with or at risk for disabilities: a mixed-methods study

Introduction

The purpose of this mixed-methods study is to examine the role of caregiver strategies to support community participation among children and youth with disabilities and those at risk, from the caregiver perspective. For the quantitative phase, we tested the hypothesized positive effect of participation-focused caregiver strategies on the relationship(s) between participation-related constructs and community participation attendance and involvement. For the qualitative phase, we solicited caregiver perspectives to explain the quantitative findings.

Methods

An explanatory sequential mixed-methods design (QUAN > qual) was used. For the quantitative phase, we conducted secondary analyses of data collected during a second follow-up phase of a longitudinal cohort study, including 260 families of children and youth (mean age: 13.5 years) with disabilities and those at risk [i.e., 120 families of children and youth with craniofacial microsomia (CFM); 140 families of children and youth with other types of childhood-onset disabilities]. Data were collected through the Participation and Environment Measure-Children and Youth, the Pediatric Quality of Life Inventory, and the Child Behavior Checklist and analyzed using structural equation modeling. For the qualitative phase, we conducted semi-structured interviews with eight caregivers of children and youth with disabilities and those at risk (i.e., three caregivers of children and youth with CFM; five caregivers of children and youth with other childhood-onset disabilities). Interviews were transcribed verbatim and inductively content-analyzed.

Results

Our model reached acceptable to close model fit [CFI = 0.952; RMSEA = 0.068 (90% CI = 0.054-0.082); SRMR = 0.055; TLI = 0.936], revealing no significant effect of the number of participation-focused caregiver strategies on the relationships between participation-related constructs (e.g., activity competence, environment/context) and community participation in terms of attendance and involvement. The qualitative findings revealed three main categories for how caregivers explained these quantitative results: (1) caregiver workload and supports needed for implementing strategies; (2) caregivers careful strategy quality appraisal; and (3) community setting characteristics hindering successful strategy implementation.

Discussion

The findings suggest that the insignificant effect of the number of caregiver strategies may be explained by the intensified need for caregiver effort and support to develop and implement quality strategies that are responsive to community setting characteristics.

Physiotherapists' and occupational therapists' experiences with cross-sectoral coordination of rehabilitation for people with mild stroke - a qualitative interview study

PURPOSE

To meet the needs of people with mild stroke, multidisciplinary, person-centred, cross-sectoral rehabilitation is internationally recommended. However, there seem to be gaps in the rehabilitation process. The aim of this study was to investigate how occupational therapists and physiotherapists experience working in cross-sectoral rehabilitation for people with mild stroke.

MATERIALS AND METHODS

Data were generated through interviews with occupational therapists and physiotherapists working in four different Danish rehabilitation settings. Four group interviews and two individual interviews with a total of 19 participants were conducted. Ricoeur's theory of interpretation was used to interpret and discuss the data.

RESULTS

Four themes were identified: the risk of overlooking symptoms: better safe than sorry; varying degrees of involvement of people with mild stroke; spontaneous involvement of relatives; and contextual challenges for coherence in the rehabilitation process.

CONCLUSION

The therapists experienced challenges in coordinating rehabilitation across sectors due to the timing of the needs assessment and contextual challenges. They used a preventive strategy of sending a plan or referral for later re-assessment. The therapists involved people with mild stroke to varying degrees. They involved relatives spontaneously. For successful rehabilitation, ongoing assessment, recognition of collaboration factors and relative involvement are essential.

The Frequency of Design Studies Targeting People With Psychotic Symptoms and Features in Mental Health Care Innovation: Secondary Analysis of a Systematic Review

This study examined and reflected on the frequency of people with psychotic symptoms and features as the target population in design studies for mental health care innovation.

Decisional needs in people with kidney failure, their relatives and health professionals about end-of-life care options: A qualitative interview study

AIM

To investigate the decisional needs in Denmark of people with kidney failure, relatives, and health professionals when planning end-of-life care.

DESIGN

A qualitative interview study.

METHODS

Individual semi-structured interviews were carried out with people with kidney failure, relatives and health professionals from November 2021 to June 2022. Malterud's systematic text condensation was used to analyse transcripts.

RESULTS

A total of 13 patients, 10 relatives, and 12 health professionals were interviewed. Overall, four concepts were agreed on: (1) Talking about end of life is difficult, (2) Patients and relatives need more knowledge and information, (3) Health professionals need more tools and training, and (4) Experiencing busyness as a barrier to conversations about end of life.

CONCLUSION

People with kidney failure, relatives, and health professionals shared certain decisional needs while also having some different decisional needs about end-of-life care. To meet these various needs, end-of-life conversations should be systematic and organized according to the patients' needs and wishes.

IMPACT

Non-systematic end-of-life care decision-making processes limit patients' involvement. Patients and relatives need more knowledge about end-of-life care, and health professionals need more competences and time to discuss decisional needs. A shared decision-making intervention for people with kidney failure when making end-of-life care decisions will be developed.

REPORTING METHOD

This empirical qualitative research is reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

PATIENT OR PUBLIC CONTRIBUTION

Patients, relatives, and health professionals have been involved throughout the research process as part of the research team and advisory board. The patients are people with kidney failure and the relatives are relatives of a person with kidney failure. For this study, the advisory board has particularly contributed to the validation of the invitation letter for participation, the interview guides and the preparation of the manuscript.

Meaningful Engagement of People Living With Noncommunicable Diseases: Challenges and Opportunities

Meaningful engagement of people living with health conditions means actively incorporating them in all stages of health decision-making. Despite efforts by global health agencies and governments towards meaningful engagement of people living with noncommunicable diseases (PLWNCDs), many opportunities for participation are tokenistic. PLWNCDs often report feeling excluded from technical discussions and outnumbered by other stakeholders. Participation in decision-making is a human right, and PLWNCDs must continue advocating for a "nothing about us without us" approach. They should be respected as decision-makers with voice, agency, voting power, rights, and duties. This article highlights four key themes: (1) both tokenistic participation and exclusion of PLWNCDs from technical discussions are still common; (2) the "patient" label implies passivity and can perpetuate limited participation, whereas the identifier of PLWNCDs connotes valuable knowledge associated with lived experience; (3) meaningful participation of PLWNCDs in health decision-making processes should be considered a human right; (4) PLWNCD should be empowered to continue to advocate for inclusion and be respected as decision-makers.

Parents' perceptions: Participation patterns and desires for change for children and adolescents with autism spectrum disorder-A descriptive population-based study from Switzerland

BACKGROUND

Low participation in youth with autism spectrum disorder (ASD) has been reported, but age-related and contextual information is rare.

OBJECTIVE

This study aimed to describe, from parental perspectives, two patterns of participation and parental desires for change of children (age: 5-11) and adolescents (age: 12-17) with ASD in Switzerland.

METHOD

A cross-sectional design used the German version of the Participation and Environment Measure-Child and Youth to describe and juxtapose the participation results of 60 children and 55 adolescents with ASD in 45 activities at home, school and in the community and parental desires for change.

RESULTS

Participation patterns differed between settings and age groups. Both groups were found to participate most at home, followed by school, whereas community participation was either low or nonexistent. Children were more involved at home than adolescents, while school involvement was higher than participation frequency in both age groups. Community participation frequency was generally low but higher in children than in adolescents, while involvement was similarly low in both groups. Half the parents expressed desire for change with three tendencies: (1) widespread desire for change at home due to high support needs, (2) parents of adolescents expressed more desire for change in all settings than those of children and (3) all parents mainly desired to increase participation frequency and involvement.

CONCLUSIONS

This study informs research and social, health and community service providers to further reshape their programmes to meet parental needs and increase the participation of youth with ASD.

Co-producing digital mental health interventions: A systematic review

Objective

Smartphone apps (apps) are widely recognised as promising tools for improving access to mental healthcare. However, a key challenge is the development of digital interventions that are acceptable to end users. Co-production with providers and stakeholders is increasingly positioned as the gold standard for improving uptake, engagement, and healthcare outcomes. Nevertheless, clear guidance around the process of co-production is lacking. The objectives of this review were to: (i) present an overview of the methods and approaches to co-production when designing, producing, and evaluating digital mental health interventions; and (ii) explore the barriers and facilitators affecting co-production in this context.

Methods

A pre-registered (CRD42023414007) systematic review was completed in accordance with The Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Five databases were searched. A co-produced bespoke quality appraisal tool was developed with an expert by experience to assess the quality of the co-production methods and approaches. A narrative synthesis was conducted.

Results

Twenty-six studies across 24 digital mental health interventions met inclusion criteria. App interventions were rarely co-produced with end users throughout all stages of design, development, and evaluation. Co-producing digital mental health interventions added value by creating culturally sensitive and acceptable interventions. Reported challenges included resource issues exacerbated by the digital nature of the intervention, variability across stakeholder suggestions, and power imbalances between stakeholders and researchers.

Conclusions

Variation in approaches to co-producing digital mental health interventions is evident, with inconsistencies between stakeholder groups involved, stage of involvement, stakeholders' roles and methods employed.

Perspectives of Hospitalized Mental Health Care Users Concerning the Involvement of Family Members in Their Care: A Qualitative Study

The value of families and professionals in mental health care is well understood. Patient perspectives appear to have gotten less attention to date. This study investigated the perspectives of hospitalized mental health care users on the involvement of family members in their care using a qualitative phenomenological design. The participants with lived experience of family members being involved in their care were chosen using non-probability, purposive sampling. Individual interviews were carried out with the assistance of a voice recorder and observation notes. Because of data saturation, only fifteen people were interviewed. The interviews were transcribed verbatim and analyzed using Colaizzi's method. It started with reading and reviewing the transcript to extract key statements about the phenomenon. The meaning was then determined by carefully studying the primary significant statements and phrases. The established meanings were then organized into themes and subthemes. The three themes that emerged from the data analysis are as follows: a wide variation in patients' perspectives when family members remind them of their medicine, unpredictable visitation by family members, and a lack of support from family members. There were also the following five sub-themes: not visiting mental health care users in the hospital causes uncertainty about their future, mental health care users were concerned by fewer visits from relatives, friends were perceived as a contributory factor to no or limited visitation by family members, disappointment by a lack of financial support, and perceived lack of emotional support from family members. There is a need for family members to visit mental health care users to remove uncertainty about their future. Healthcare providers should listen to mental health care users to identify the challenges they are faced with, and hospital policies tailored to enhancing the involvement of family members should be formulated.

Community involvement in addressing the antibiotic crisis

Increasing student interest and success in STEM education is a top priority for many postsecondary educational institutions. One well-documented approach to both priorities is to have students participate in a Course Undergraduate Research Experience (CURE). Faculty from several technical colleges and universities in Wisconsin teamed up with the Tiny Earth organization to offer a CURE to address the search for new antibiotics. Students enrolled in undergraduate microbiology courses engaged in research and participated in community outreach. To involve the community, faculty from various institutions joined an NFL team, the Green Bay Packers, and created the Tiny Earth in Titletown symposium. Here, students presented their work via scientific posters, to community and industry members, and networked with other scientists from around the region. The Tiny Earth in Titletown symposium started in 2018, was held again in 2019, and returned in 2022 following a 2-year hiatus due to the COVID-19 pandemic. Record attendance in 2022 suggests that community outreach and education may be helping restore trust in science that was lost during the pandemic.

Content validity of the instrument 'Picture My Participation' for measuring participation of children with and without autism spectrum disorder in mainland China

BACKGROUND

Picture My Participation (PMP) is a valid instrument for measuring participation of children with disabilities, but it has not yet been evaluated for its content validity for children with autism spectrum disorders (ASD) in mainland China.

AIM

To explore the content validity of the simplified Chinese version of PMP (PMP-C; Simplified) for children with ASD and typically developing (TD) children in mainland China.

METHODS

A sample of children with ASD (n = 63) and TD children (n = 63) recruited through purposive sampling were interviewed using the PMP-C (Simplified), which contains 20 items of everyday activities. Children rated attendance and involvement on all activities and selected three most important activities.

RESULTS

Children with ASD selected 19 of 20 activities as the most important activity while TD children selected 17 activities. Children with ASD used all scale points for rating attendance and involvement on all activities. TD children used all scale points for rating attendance and involvement in 10 and 12 of 20 activities, respectively.

CONCLUSION

The contents of 20 activities of PMP-C (Simplified) were relevant for all children and especially for children with ASD for assessing participation in community, school and home activities.

Correlates of residents' enrolment intention toward inclusive commercial health insurance in China: involvement, perceived benefit, perceived sacrifice, and government participation

Background

As an application of inclusive finance in health insurance, inclusive commercial health insurance (ICHI) is a new public-private partnership-based health insurance scheme and has been vigorously promoted by the Chinese government in recent years to develop China Multi-level Health Insurance System, a system that aims to seek a mix of public and private sources to provide more affordable financial protection to all levels of society in line with their needs. However, the overall enrolment of ICHI scheme is still at a low level, and little is known about what influences residents' enrolment intentions. The aim of this study was to examine the multidimensional factors influencing residents' behavioral intentions and to develop a multivariate conceptual model to explore the psychographic process in the formation of enrolment intention.

Methods

The empirical data used for model validation were obtained from a cross-sectional study conducted in Nanjing, China, a representative pilot city of ICHI scheme in 2022. Exploratory factor analysis, ANOVA, standard multiple regression, and hierarchical multiple regression were mainly employed for hypothesis testing.

Results

The findings revealed that involvement, perceived benefit, and perceived sacrifice are all crucial psychographic process factors in the formation of residents' enrolment intentions. Government participation positively moderates the influence path of "perceived benefit-enrolment intention" but negatively moderates the path of "perceived sacrifice-enrolment intention". Moreover, it was discovered that perceived benefit mediates the effect of involvement on enrolment intention, while perceived sacrifice does not.

Conclusions

Improving residents' perceived benefit and involvement degree of the product, as well as reducing their perceived sacrifice, are both key to increasing their enrolment intentions. This study also points out that one of the main dilemmas in the current development of ICHI scheme is the low level of involvement among residents, and that optimizing the product design to make it more relevant to residents' lives is a more beneficial strategy to increase overall involvement.

Diversity in patient and public involvement in healthcare research and education-Realising the potential

BACKGROUND

Patient and public involvement (PPI) is an increasing priority in health-related research and education. Attracting and supporting people from different demographic groups to give up their time and get involved is important to help ensure that all parts of society are empowered, represented and their voices heard in decisions that may affect their health and quality of life.

OBJECTIVES

(1) To determine if a demographically diverse cross-section of society would be interested in contributing to healthcare research and education. (2) To understand factors that can act as barriers and enablers to effective and diverse PPI.

METHOD

PPI survey data was collected via engagement events, with the aim of scoping interest in PPI from a diverse public. A Focus Group study involving members of the public, academic and professional service staff, was then conducted to gain a deeper understanding around the barriers and enablers of diversity within PPI.

RESULTS

71% of a diverse rich public indicated they would like to get involved in healthcare research and teaching. 76% of survey respondents indicated that they would be happy to share a personal or family experience of healthcare. The two biggest factors impacting on our cohort getting involved are' availability of time' and 'being aware of PPI opportunities'. These factors may disproportionally affect specific groups. Shared and individual PPI enablers and barriers were identified across all stakeholder groups within the Focus Group Study, as well as generic and novel factors that would impact on an institutions' ability to improve PPI diversity.

CONCLUSION

These data points confirm a demographically diverse public's appetite to get involved in academic health research and teaching. This needs to be recognised and harnessed to ensure public contributor networks are representative of society. Equality Impact Assessments should be undertaken in relation to all PPI opportunities. There is a need to recognise the investment of time and resources required to build mutually beneficial relationships with diverse communities as well as the development of inclusive 'fit for purpose' PPI infrastructures to support the uptake of diverse PPI contributors.

PUBLIC CONTRIBUTION

This study involved members of the public responding to a short survey. Public contributors made up one of the three focus groups. The School of Medicine lead public contributor was also involved in the preparation of this manuscript.

Developing sustainable service user involvement practices in mental health services in Sweden: the "Userinvolve" research program protocol

Background

The purpose of this paper is to outline the protocol for the research program "UserInvolve," with the aim of developing sustainable, service user involvement practices in mental health services in Sweden.

Methods

This protocol outlines the knowledge gap and aim of the UserInvolve-program. It further provides an overview of the research infrastructure, with specific focus on the organization and management of the program as well as the design of the six underlying research projects. These six research projects form the core of the UserInvolve-program and will be carried out during a six-year period (2022-2027). The projects are focused on examining articulations of experiential knowledge in user collectives, on four specific user involvement interventions (shared decision-making, peer support, user-focused monitoring, and systemic involvement methods) and on developing theory and method on co-production in mental health research and practice.

Results or conclusion

The knowledge gained through the co-production approach will be disseminated throughout the program years, targeting service users, welfare actors and the research community. Based on these research activities, our impact goals relate to strengthening the legitimacy of and methods for co-production in the mental health research and practice field.

Seeing the light versus being in the dark: parent, child, and service providers' use of metaphors to express system complexity, therapy engagement, and personal experiences of adaptation

Purpose: To describe parent, child, and service providers' use of metaphors to communicate the meaning of participation in life and therapy engagement in the field of childhood disability.Methods: Metaphors concerning participation and engagement were extracted from 59 qualitative articles recommended by a group of experts in pediatric rehabilitation. A systematic process of metaphor analysis was used, involving identification of source and target domains, categorization into target-source groupings, and interpretation.Results: 209 metaphors were identified and categorized into seven target-source groupings. These seven groupings reflected environmental, interpersonal, and personal domains of experience: (a) the service system and life context, (b) the interpersonal therapy context, and (c) personal aspects. Together, the groupings expressed experiences concerning service system complexity, therapy engagement, and personal experiences of adaptation. Speakers used several metaphor dichotomies to express different experiences (e.g., open vs closed doors to opportunities).Conclusions: When service providers pay attention to clients' use of metaphors, this can lead to a deeper, more evocative understanding of the meaning of their participation and engagement experiences. Service providers can use metaphors generated by clients to communicate their understanding to clients, thereby creating a common ground for collaboration and assisting clients to interpret their experiences in different ways.Implications for RehabilitationMetaphors are useful clinically as they provide a bridge to joint understanding between a speaker and listener(s), due to their cognitive and communicative functionsService providers can note and attend to clients' use of metaphors to understand clients' experiences in deeper waysService providers can themselves use metaphors to express new ideas to clients, thereby encouraging clients to adopt new perspectives on their experiencesBy paralleling clients' use of metaphors, service providers can communicate that they understand clients' experience and provide them with a sense of support.

Perspectives on residential involvement and engagement in everyday life-a qualitative study

Background: Worldwide, the population is ageing, and the need for nursing homes is increasing. institutionalization and a culture change from task-orientated care delivery towards increased involvement and engagement in a meaningful everyday life are evolving and, thus, contributing to nursing home residents' quality of life and well-being.Aims/Objectives: To explore nursing home staff's and local managers' perspectives on everyday life with a specific focus on involvement and engagement.Material and Methods: Positioned within interpretivism and hermeneutics, a qualitative exploratory design was applied using individual and group interviews for data generation and abductive thematic analysis as the analytical method.Results: Through the analyses, three main themes appeared-A good day-Everyday life in a nursing home, Doing together-involvement in Everyday life and Involvement in Everyday life-difficult to practice-together with four subthemes-Home and people within, Knowing and relating to the person, If they can - they must and Service and Habits.Conclusions: Fulfilling the needs of both residents and the institution was found to be challenging by nursing home staff and local managers.Significance: A different approach to care, facilitated by, for example, occupational therapists, might be required to enable increased involvement and engagement in everyday life.

The impact of expert by experience involvement in teaching in a DClinPsych programme; for trainees and experts by experience

INTRODUCTION

There is a growing acknowledgement of the value of creating partnerships between those delivering and those accessing health services. Less is known about this in the context of clinical psychology doctoral training programmes. This study explores the models of involvement of experts by experience (EbEs) in teaching on a DClinPsych course in England; the impact of this both for EbEs and trainee clinical psychologists and whether improvements are required to better meet their needs.

METHODS

An audit of current involvement was conducted by reviewing course records. Two survey questionnaires designed around commonly used frameworks of participation and reflective learning were completed by EbEs and trainees. Thematic Analysis was used to evaluate the written feedback from the surveys.

RESULTS

Records of current EbE involvement were found to be lacking in detail and sometimes missing. Key themes extrapolated from the surveys highlighted the importance of EbE involvement in supporting the wellbeing of EbEs and the learning experiences of trainees.

CONCLUSIONS

Recommendations with regard to the processes for future involvement of EbEs in teaching are put forward.

PATIENT OR PUBLIC CONTRIBUTION

A carer of a service user was consulted about the design of the participant information sheet, consent form and the survey questionnaire which was sent to the EbEs. A trainee clinical psychologist was also consulted to provide a trainee perspective on the above forms and the survey questionnaire that was sent to trainees. Further to this, the first author's supervisor identifies as a user of physical and mental health services and provided continued supervision and support regarding the direction of the study including the research questions, design, methodology and interpretation of results.

Enhancing involvement of people with multiple sclerosis in clinical trial design

BACKGROUND

Although often overlooked, patient and public involvement (PPI) is vital when considering the design and delivery of complex and adaptive clinical trial designs for chronic health conditions such as multiple sclerosis (MS).

METHODS

We conducted a rapid review to assess current status of PPI in the design and conduct of clinical trials in MS over the last 5 years. We provide a case study describing PPI in the development of a platform clinical trial in progressive MS.

RESULTS

We identified only eight unique clinical trials that described PPI as part of articles or protocols; nearly, all were linked with funders who encourage or mandate PPI in health research. The OCTOPUS trial was co-designed with people affected by MS. They were central to every aspect from forming part of a governance group shaping the direction and strategy, to the working groups for treatment selection, trial design and delivery. They led the PPI strategy which enabled a more accessible, acceptable and inclusive design.

CONCLUSION

Active, meaningful PPI in clinical trial design increases the quality and relevance of studies and the likelihood of impact for the patient community. We offer recommendations for enhancing PPI in future MS clinical trials.

The Involvement of Service Users and People With Lived Experience in Mental Health Care Innovation Through Design: Systematic Review

BACKGROUND

Mental health care faces challenges that not only necessitate innovation but also require the involvement of service users and people with lived experience in developing and evaluating mental health care services. As the development of digital interventions is becoming more prevalent, design approaches are increasingly finding their way into mental health. There is evidence that these approaches can successfully integrate user experience into mental health services. However, there is no clear overview of the studies conducted and the lessons learned concerning the involvement of service users and people with lived experience.

OBJECTIVE

In this systematic review, we aimed to provide an overview of the involvement of service users and people with lived experience in mental health care services through design approaches and to synthesize the advantages of design approaches in mental health care.

METHODS

The following 5 databases were searched for relevant abstracts: PsycINFO, PubMed, Web of Science, Scopus, and Embase. In addition, 2 health design journal archives, Design for Health and The Journal of Health Design, were searched. To categorize the results, we collected the reported added value from the included articles and conducted a thematic synthesis in which the themes were developed from the retrieved data. The themes were discussed, revised, and checked until saturation was achieved.

RESULTS

We included and categorized 33 papers. Most studies involved service users, primarily adults, and used various design approaches. Most of these studies aimed to design or evaluate digital interventions. Service users and people with lived experience were involved in different roles but never as decision makers. Studies that used co-design approaches exhibited the highest levels of involvement. Various added values were reported, including tailoring and testing interventions and digital interventions, improving engagement and collaboration, gathering the needs of stakeholders, and empowering participants as resourceful actors. The challenges reported were maintaining participants' continued participation throughout the study, managing the iterative nature of design, providing a safe space, balancing insights from design and medical science, and navigating design processes in medical environments.

CONCLUSIONS

This systematic review provides an overview of the studies that used design approaches to involve service users and people with lived experience in mental health care innovation. Design approaches have advantages in mental health care innovation, offering added value and having manageable challenges. Future studies using design approaches in mental health care should involve participants as partners and decision makers and report on collaboration in a systematic and clear manner.

Father trait anger and associations with father-infant bonding and caregiving: The mediating role of mentalizing

Trait anger reflects a tendency to feel irritation, annoyance, and rage, and involves a narrowing of cognition and attention. This narrowed scope may impact the capacity to understand the mental states of oneself and others (mentalizing), which for fathers of infants may compromise bonding and caregiving involvement. Here, we investigated the extent to which mentalizing mediated the relationship between father trait anger and both father-infant bonding and father involvement in infant caregiving. Data were from 168 fathers (M = 30.04 years of age, SD = 1.36) of 190 infants (M = 7.58 months of age, SD = 5.06) in the longitudinal Men and Parenting Pathways (MAPP) study. We assessed fathers' preconception trait anger at Wave 1 and their mentalizing 2 years later at Wave 3. At Waves 3, 4, and/or 5, we assessed father-infant bonding and father involvement in infant caregiving when men had an infant younger than 18 months of age. Associations were examined using path analysis. Poorer mentalizing fully mediated the relationship between preconception trait anger and father-infant bonding (total score), but not involvement in infant caregiving. Further, poorer mentalizing fully mediated the relationships between trait anger and each component of the father-infant bond (i.e., patience and tolerance, affection and pride, and pleasure in interactions). Findings suggest that for men high on trait anger, targeted interventions that facilitate mentalizing capacities may help to develop a foundation for a strong father-infant bond. Interventions may be offered on becoming a father (perinatal), or prior to becoming a father (preconception) to prevent future bonding problems.

Participation Patterns of Israeli Children with and without Autism, and the Impact of Environment

AIMS

Participation is vital to children's quality of life, yet it is often limited for those with autism spectrum disorder (ASD). An improved understanding of the factors that may support or hinder their participation is important. This study aims to explore the participation patterns of children with and without ASD in the home, school, and community settings, as well as to explore the impact of environmental factors on the participation of children with ASD.

METHODS

78 parents of children aged 6-12, attending mainstream educational settings (30 with ASD; 48 without ASD) completed the Participation and Environment Measure for Children and Youth and a demographic questionnaire.

RESULTS

Children with ASD were rated significantly lower than children without ASD in participation, and their parents expressed a greater desire to change their participation while reporting lower overall environmental support. Among the ASD group, significant differences in participation were found across the three settings, with the highest participation scores at home. Environmental factors that support or limit children's participation were identified.

CONCLUSIONS

The results highlight the importance of environmental factors in children's participation. It is essential to evaluate different environmental settings; identifying the supportive and limiting environmental factors will enhance interventions for children with ASD.

Could the Cerebral Involvement of COVID-19 Disease be Related to Microstructural Changes that are not Reflected in Conventional MRI Images?

In patients with COVID-19, neurodegeneration may develop before clinical symptoms appear. Diffusion-weighted (DW) MRI is an important technique for analyzing microstructural changes such as gliosis. In this study, a quantitative evaluation of microstructural changes in the brain with apparent diffusion coefficient (ADC) values in patients presenting with a headache after the COVID-19 disease was analyzed and compared. DW MR images of patients of 20 COVID-19 patients (13 females, 7 males) who required imaging due to headache; 20 controls (16 females, 4 males) were retrospectively reevaluated. ADC measurements were taken from 16 regions of the brain, including right and left symmetrical in patients with COVID-19 infections and control groups. All regions of interest (ROIs) were taken from the hypothalamus, parahippocampus, thalamus, corpus striatum, cingulate gyrus, occipital gyrus, dentate nucleus, and medulla oblongata posterior. ADC values in the dentate nucleus right (784.6 ± 75.7 vs. 717.25 ± 50.75), dentate nucleus left (768.05 ± 69.76 vs. 711.40 ± 52.99), right thalamus (731.15 ± 38.14 vs. 701.60 ± 43.65), left thalamus (744.05 ± 39.00 vs. 702.85 ± 28.88), right parahippocampus (789.10 ± 56.35 vs. 754.75 ± 33.78), right corpus striatum (710.00 ± 39.81 vs. 681.55 ± 39.84) were significantly higher than those in the control group. No significant changes were observed in other areas. A significant increase in ADC values at many levels in the brain in patients with COVID-19 disease and headache was observed. Thus, this study indicates that cerebral involvement in COVID-19 disease may be related to microstructural changes that are not reflected in conventional MRI images.

Factors Associated with Family Retention or Involvement in Treatment of Persons with Severe Mental Illness: A Scoping Review

Objective

A scoping review was conducted to detect the factors that affect family retention (FR) or involvement (FI) in the treatment of persons with severe mental illness (PwSMI) and to understand the gaps in this research area.

Design

We included studies that described factors associated with FR/FI in the treatment of persons with PwSMI. English language articles available in full text, published until June 2022, were included. The literature search was carried out in four major electronic databases, such as PubMed, Scopus, ProQuest, and EBSCOhost, for 6 months from January 2022 to June 2022, which yielded 5442 articles, of which six (four primary studies and two secondary studies) were considered for the final scoping review as per the inclusion criteria.

Results

Five major categories of factors were identified: (a) family level, (b) professional level, (c) mental health system level, (d) related to characteristics of the patient and illness, and (e) related to the external environment. Most studies described barriers to FI, while only a few elaborated on facilitators for FI/FR. Systemic and family-level factors were the major contributors to the barrier to FI and FR in the treatment of people with PwSMI.

Conclusion

There is a dearth of literature in the field of FR/FI in the treatment of people with schizophrenia. More research is required so that holistic interventions can be designed and provided.

Multidimensional social support and parenting among Black fathers: A profile-oriented approach

Though studies have examined the role of social support in the lives of Black men, less is known about the role and function of multi-domain social support as they navigate fatherhood. This investigation utilizes a profile-oriented approach to identify patterns of general and parenting-specific social support (i.e., family; peers; community) among a sample of 759 Black American fathers. Additionally, this study examines how identified support profiles are associated with Black fathers' parenting outcomes (i.e., stress, satisfaction, self-efficacy, and involvement). Latent class analyses identified 10 distinct social support profiles among Black fathers. Results also indicated that there was some profile variation in levels parenting outcomes. Findings suggest variation in the availability and utilization of general and parenting support among Black fathers.

LACC1: A critical involvement in macrophage immunometabolism

Laccase domain-containing 1 (LACC1) protein is an enzyme highly expressed in inflammatory macrophages, and studies have shown that it has a key role in diseases such as inflammatory bowel disease, arthritis, and microbial infections. Therefore, in this review, we focus on LACC1-mediated catalysis. In detail, LACC1 converts l-CITrulline (l-CIT) to l-ORNithine (l-ORN) and isocyanic acid in mice and humans and acts as a bridge between proinflammatory nitric oxide synthase (NOS2) and polyamine immunometabolism, thus exerting anti-inflammatory and antibacterial effects. Considering the actions of LACC1, targeting LACC1 may be a potent therapeutic avenue for inflammation-related diseases and microbial infection diseases.

Community engagement: health research through informing, consultation, involving and empowerment in Ingwavuma community

Introduction

The goal of community involvement in health research is to improve a community's ability to address its own health needs while ensuring that researchers understand and consider the community's priorities. Recent data show that socio-economic and environmental challenges continue to be a barrier to informing, consulting, involving and empowering communities in community-based health research beneficial to them. The aim of this study was to assess the extent to which the Ingwavuma community in KwaZulu-Natal Province, in rural South Africa, was informed, consulted, involved and empowered about two research projects conducted between 2014 and 2021.

Methods

The study used the modified random-route procedure to administer a standardized questionnaire to 339 household heads selected randomly. The questionnaires were administered face-to-face. The sample size was estimated using the Yamane sample size generating formula. Chi-square tests were performed to assess associations between demographic variables (age, gender, education, village) and respondents' knowledge and information of the projects, Malaria and Bilharzia in Southern Africa and Tackling Infections to Benefit Africa as well as their participation.

Results

The communities were generally well-informed about the health projects that were being carried out. Fewer than half of those who had heard about the projects had directly participated in them. The majority had been tested for one or more diseases and conditions, mostly high blood pressure, diabetes, and schistosomiasis, and had participated in a community feedback group; many had given their children's permission to be tested for schistosomiasis or to participate in project research activities. Others participated in public awareness campaigns and surveys. There was some evidence of a consultation process in the form of public consultation discussed in the projects, and not much discussion on empowerment.

Discussion

The findings demonstrate that researchers' CE approach was adaptable as communities were largely educated, involved, and subsequently empowered though without much consultation and that researchers had provided a space for sharing responsibilities in all engagement process decision-making. For the empowerment of the community, projects should take into account the intrapersonal and personal aspects affecting the community's capacity to effectively benefit from the information, consultation, involvement, and empowerment procedures.

Toward Inclusive Approaches in the Design, Development, and Implementation of eHealth in the Intellectual Disability Sector: Scoping Review

BACKGROUND

The use of eHealth is more challenging for people with intellectual disabilities (IDs) than for the general population because the technologies often do not fit the complex needs and living circumstances of people with IDs. A translational gap exists between the developed technology and users' needs and capabilities. User involvement approaches have been developed to overcome this mismatch during the design, development, and implementation processes of the technology. The effectiveness and use of eHealth have received much scholarly attention, but little is known about user involvement approaches.

OBJECTIVE

In this scoping review, we aimed to identify the inclusive approaches currently used for the design, development, and implementation of eHealth for people with IDs. We reviewed how and in what phases people with IDs and other stakeholders were included in these processes. We used 9 domains identified from the Centre for eHealth Research and Disease management road map and the Nonadoption, Abandonment, and challenges to the Scale-up, Spread, and Sustainability framework to gain insight into these processes.

METHODS

We identified both scientific and gray literature through systematic searches in PubMed, Embase, PsycINFO, CINAHL, Cochrane, Web of Science, Google Scholar, and (websites of) relevant intermediate (health care) organizations. We included studies published since 1995 that showed the design, development, or implementation processes of eHealth for people with IDs. Data were analyzed along 9 domains: participatory development, iterative process, value specification, value proposition, technological development and design, organization, external context, implementation, and evaluation.

RESULTS

The search strategy resulted in 10,639 studies, of which 17 (0.16%) met the inclusion criteria. Various approaches were used to guide user involvement (eg, human or user-centered design and participatory development), most of which applied an iterative process mainly during technological development. The involvement of stakeholders other than end users was described in less detail. The literature focused on the application of eHealth at an individual level and did not consider the organizational context. Inclusive approaches in the design and development phases were well described; however, the implementation phase remained underexposed.

CONCLUSIONS

The participatory development, iterative process, and technological development and design domains showed inclusive approaches applied at the start of and during the development, whereas only a few approaches involved end users and iterative processes at the end of the process and during implementation. The literature focused primarily on the individual use of the technology, and the external, organizational, and financial contextual preconditions received less attention. However, members of this target group rely on their (social) environment for care and support. More attention is needed for these underrepresented domains, and key stakeholders should be included further on in the process to reduce the translational gap that exists between the developed technologies and user needs, capabilities, and context.

Blinded by Attachment: Examining the Overconfidence Bias of Sports Fans' Intertemporal Ticket Purchase Decisions

Optimally deciding on the best deal for sport event tickets requires the ability to evaluate risk and make informed decisions in uncertain environments. This study examines how individual trait factors, such as experience, expertise, and involvement, influence consumers' decision-making process when purchasing tickets online for sporting events. To examine and test the study hypotheses, 640 respondents from a Qualtrics survey panel were recruited from geographically confined subjects of New York City sports fans over a ten-day data collection period. The research subjects were surveyed to assess their perception of the expected likelihood of obtaining event tickets at a lower rate (ELR) and the expected likelihood that tickets would remain available (ETA) as the event day approached. MANOVA showed that there was a significant effect of the time period on the participants' ETA and ELR risk assessments [Λ = 0.954, F (18, 1262) = 1.653, p < 0.05]. The ETA was highest ten days before the event and lowest the day before the event, with a similar pattern observed for the ELR. The mediation path analysis showed that fan involvement had a strong positive correlation with confidence (B = 0.496, p < 0.001). Confidence, in turn, was a significant predictor of the ELR (B = 5.729, p < 0.05) but not for the ETA (B = 1.516, p = 0.504). The positive mediation of confidence between fan involvement and the ELR indicates that consumers with higher fan involvement tend to have overconfidence in their ability to evaluate the uncertain purchase environment, which ultimately impacts their risk perception and decision-making. The study highlights the importance of considering both temporal and psychological factors when assessing the likelihood of ticket purchases and provides behavioral insights for sports marketers and ticket distributors.

Patients' perspectives on involvement in general practice: A thematic analysis of free-text comments

BACKGROUND

General practice (GP) plays a core role in managing the clinical pathways of patients with chronic diseases. Despite well-established knowledge of the benefits of involvement and personalized care, involvement in GP appears to be challenged. This study aimed to explore patient involvement in GP from the patients' perspectives.

METHOD

The study involved a questionnaire survey investigating patient involvement in GP from the patients' perspectives. The validated questionnaire includes an open-ended question encouraging responders to provide additional comments regarding their involvement in GP. The results from these comments are presented in this paper. A thematic analysis was applied.

RESULTS

Of the 468 responses, 139 included additional comments to the free-text question. Through our analysis, six analytic themes were generated-To be seen, met or heard, To feel safe or not, To be involved or dictated to, Accessibility, COVID-19, and For the resourceful-across 116 codings and 25 descriptive themes. The themes' interwovenness underscores the complexity of both involvement and how it is to live with a chronic disease. Our analysis indicates that involvement in GP is for the resourceful.

CONCLUSION

The six themes describing involvement in GP from the perspectives of patients with T2DM and/or COPD were deeply intertwined. Involvement is dependent on being seen, met and heard, all of which contribute to the patients' sense of feeling safe (or not). These aspects are dependent on accessibility to a general practitioner; thus, COVID-19 was a barrier during the data-collection period. Furthermore, it appeared that being resourceful not only contributed to a sense of being involved in GP but was perhaps even a prerequisite for being involved.

Observations on strategies used by people with dementia to manage being assessed using validated measures: A pilot qualitative video analysis

BACKGROUND

Analysis of video data was conducted of validated assessments with people with dementia as part of a feasibility control study comparing a lifelong learning service with other dementia services.

OBJECTIVE

The aim was to provide a new perspective on what occurs during the assessment process when using validated measures in research and explore which strategies people with dementia use to manage their participation.

DESIGN

Video recordings were made of pre- and postintervention assessments of people with dementia. An initial pilot analysis of 10 videos of the pre-assessments was conducted.

SETTING

Lifelong learning services and other dementia services situated in six municipalities in Northern Denmark took part in this study, with 55 people with dementia participating.

RESULTS

The themes identified were: 'State of mind' and 'Mental resources', showing how these aspects influenced the participants' reactions and the strategies they used.

DISCUSSION

The results are discussed in relation to how individual personality traits influence the assessment process and the way a person with dementia will manage the situation.

CONCLUSION

The assessment situation is complex and can be influenced by the strategies adopted by individuals with dementia as they try to manage the assessment process.

PATIENT OR PUBLIC CONTRIBUTION

People with dementia supported the decision-making for the choice of validated measure used within this study.

Hospital and homecare nurses' experiences of involvement of patients and families in transition between hospital and municipalities: A qualitative study

BACKGROUND

Involving patients and families in nursing care is essential to improve patients' health outcomes. Furthermore, families play an essential role in supporting patients by helping nurses understand the patient's everyday life. However, families also need support. Involvement of patients and families is especially important when patients are transferred between hospital and home as transitions heighten the risk of compromising quality and safety in care. However, no consensus exists on how to involve them. Consequently, this may challenge a systematic approach toward patient and family involvement.

AIM

To describe hospital and homecare nurses' experiences with involving patients and their family members in nursing care in the transition between hospital and municipalities.

METHOD

Focus group interviews were conducted in the Gastro unit at a large university hospital in Denmark. Participants included 10 hospital nurses from three wards at the Gastro unit and six homecare nurses from one of three municipalities in the hospital catchment area (total n = 16). Data were analysed using qualitative content analysis. The study is reported according to the Consolidated Criteria for Reporting Qualitative Research.

FINDINGS

Our analysis revealed one overall theme - "The complexity of involvement" - based on four categories: gap between healthcare sectors increases the need for patient and family involvement, lack of time is a barrier to patient and family involvement, involvement is more than information, and involvement as a balancing act.

CONCLUSION

The nurses experienced patients' and families' involvement as essential, but a discrepancy was found between nurses' intentions and their actions. Aspects related to a gap between healthcare sectors and various understandings of involvement challenged the systematic involvement of patients and families in the transition between healthcare sectors. However, the nurses were highly motivated to achieve a close cross-sectoral collaboration and to show commitment towards patients and families.

Communication, information, involvement and decision making: A systematic scoping review of child-parent-nurse relationships during postoperative pain management

AIMS

To examine the existing literature on child-parent-nurse relationships (in relation to communication, information, and involvement and decision-making) during postoperative pain management.

BACKGROUND

Pain in children is under-reported and under-treated in hospitals and research has continued to report high rates of pain among hospitalised children worldwide. The role of child-parent-nurse relationships may be a factor and to date, no review has been identified that focus on these relationships during postoperative pain management.

DESIGN

A systematic scoping review following Arksey and O'Malley with further adaptations based on JBI.

METHODS

A systematic search for published primary studies was conducted using the Medline, CINAHL, British Nursing Index, ASSIA, PsycINFO, Science Direct and Web of Science in English from 2000 to 2022. Two reviewers independently carried out data screening and extraction and any differences were resolved with the assistance of a third reviewer. The data were analysed using thematic analysis and presented descriptively. This study followed the PRISMA-ScR Checklist.

RESULTS

A total of 37 studies met the inclusion criteria. The findings mainly demonstrated a focus on the perspectives of parents and nurses with less on children's perspectives and none of the studies explored child-nurse relationships. The findings were categorised under three themes: communication, information, and involvement and decision making.

CONCLUSION

A prevailing deficiency in child-parent-nurse relationships significantly contributed to suboptimal postoperative pain care, causing prolonged and untreated postoperative pain in children. Children's hesitation in communicating with nurses, the limited communication skills of nurses, and the weak communication position of parents in a hospital setting all hindered the development of strong relationships between children, parents, and nurses. The unclear definition of the roles of children and parents in postoperative pain management resulted in confusion for both parents and nurses. This was exacerbated by parents' lack of knowledge and inadequate guidance from nurses, ultimately leading to a decreased level of parental involvement in their child's postoperative pain management while in the hospital. Unattended requests for pain management caused children to experience prolonged pain and led to a deterioration in the relationship between parents and nurses, as well as a reduction in the parents' ability to provide pain care to their child.

RELEVANCE TO CLINICAL PRACTICE

This study highlights the reasons behind the suboptimal management of postoperative pain in children. The importance of the relationship between children, parents, and nurses in pain management must be acknowledged, and the results of this study may be used to inform improvements in nursing pain management practices.

NO PATIENT OR PUBLIC CONTRIBUTION

Patient or public contribution is not a necessary stage in a systematic scoping review following Arksey and O'Malley's framework.

Understand Delegates Risk Attitudes and Behaviour: The Moderating Effect of Trust in COVID-19 Vaccination

The continuing COVID-19 pandemic has prompted many people to receive the needed vaccines. However, how trust in vaccination affects the attitude and behavior of delegates attending a convention in Macau has yet to be determined. Accordingly, we applied quantitative method in conducting a survey involving 514 participants and analysed the data using AMOS and SPSS. The results showed that trust in vaccines has a significant impact on moderating the relationship between risk attitude and satisfaction. Trust in vaccines has a significant positive effect on involvement. Risk attitude negatively affects involvement, satisfaction, and loyalty. The major contribution of this research is the introduction of a model based on trust in vaccination. To boost delegates' confidence to attend convention activities, governments and organizations should deliver accurate information on vaccines and pandemic risks, and that delegates should obtain accurate information about it. Lastly, unbiased and professional operators of the MICE industry also can offer precise COVID-19 vaccination information to reduce misperception and increase the security.

Fathers' Experiences of Caring for a Child with a Chronic Illness: A Systematic Review

The prevalence of children living with chronic health conditions is increasing worldwide and can disrupt family roles, relationships, function, and parental involvement in family caregiving. The purpose of this systematic review was to explore fathers' experiences and involvement in caring for a child with a chronic condition. Systematic searches using seven databases were conducted. Study criteria included (1) peer-reviewed original research in English, Spanish, French, or Portuguese, (2) children less than 19 years of age with a chronic condition, (3) fathers (biological or guardian) as direct informants, and (4) outcomes addressing fathers' experience, perceptions, and/or involvement in the child's care. Data were synthesized from ten articles reflecting eight separate studies that utilized quantitative designs. Three areas of focus were identified: Family Functioning, Father's Psychological Health, and Need for Support. Data suggested increased involvement from the father in caring for their child with a chronic condition was associated with improved family functioning, increased anxiety and distress, decreased self-esteem, and increased need for support. This review revealed a paucity of data regarding fathers' experiences and involvement when caring for a child with a chronic condition, with that available primarily from developed countries. Rigorous empirical studies are needed to deepen understanding of how fathers are involved in the care of their child with a chronic condition.

Attentional Prioritization of Infant Faces in Parents: The Influence of Parents' Experiences of Care

Infant faces are prioritized by the attentional system in parents, resulting in a greater cognitive engagement in terms of response time. However, many biological, contextual and environmental factors relating to this cognitive mechanism have been left unexplored. To fill this gap, this study aims to (i) confirm that infant faces engage more attention compared to adult faces; (ii) investigate whether the attention to infant faces is affected early care experiences of parents; (iii) explore the effect of parents' sex by taking the amount of involvement with early childcare into consideration. 51 mothers and 46 fathers completed a modified Go/no-Go task, a brief sociodemographic questionnaire, the short version of the Adult Parental Acceptance-Rejection scale, and an ad-hoc question relating to the amount of parental involvement with early childcare. Parents' response times were slowed in the presence of infant versus adult faces. Parents whose mother was perceived as more sensitively accepting were more engaged by infant cues. By considering the amount of early parental involvement, the sex of parents did not significantly interact with the type of face. These findings provide new insights on the attention process in response to infant cues in parents and suggest that the investigation of experience-based factors may shed further light on this topic.

The impact of price transparency of bundled vacation packages on travel decision making: An experimental study

Price transparency is a vital factor in consumers' judgements and decisions. When selecting a bundled vacation package, travelers are often influenced by transparency in the prices of individual elements of the package. However, because of the diversity of elements bundled in a vacation package, it is a challenge to research the impact of price transparency. To try to overcome this challenge, our study used five experiments to examine the primary impact of element price transparency on travelers' purchases, along with the moderating effects of consumer involvement and the vertical position of element prices in product descriptions. For the primary effect, we found that tourists preferred vacation packages with low transparency in element prices. We also found that the primary effect of price transparency remained consistent and robust across both revised and actual vacation packages. For moderating effects, we found that tourists with low involvement attached greater importance to price transparency than those with high involvement when the element price was presented higher in the product description of the travel package. The findings of the five experiments have theoretical implications for price transparency and Heuristic-systematic Model and practical implications for tourism professionals designing and marketing vacation packages.

The Impact of COVID-19 on Motivation, Involvement, and Behavior of Cyclists in Taiwan

Coronavirus disease (COVID-19) has spread all over the world and has impacted tourism globally, with countries taking various measures such as travel restrictions, border closures, lockdowns, or quarantines to contain the virus. Tourists' motivation has also been affected by COVID-19, but so far, the literature has not yet discussed their concern over COVID-19 as well as the relationships among their motivation, involvement, and behavior intention. Therefore, this study fills the gap in the literature by taking cycling tourism as an example to understand the involvement of tourists concerning COVID-19 and presents the depth and breadth of its effects upon tourism. Due to the challenge of face-to-face, on-site investigation, we employ an online survey for data collection, use exploratory factor analysis to extract the main factors of motivation, involvement, and behavior intention, and set up a structural equation model to examine the relationships among the three factors. The results show that COVID-19 has positively and significantly affected motivation and involvement. Motivation positively and significantly affects involvement, and involvement affects motivation and behavior intention. The main finding herein is that motivation does not affect behavior, but involvement does mediate between the motivation and behavior of cyclists during COVID-19. Therefore, people may perceive the risk of health and wellbeing through such involvement.

Co-production to understand online help-seeking for young people experiencing emotional abuse and neglect: Building capabilities, adapting research methodology and evaluating involvement and impact

BACKGROUND

Involving young people (YP) as co-researchers (YCoR) in mental health research is important for ethical and epistemological reasons. However, approaches to involve and evaluate 'meaningful involvement' in complex qualitative mental health research, and how to evaluate impacts (or change) for the co-researcher and the research is less well defined.

OBJECTIVES

This co-produced research explored the experiences of YP seeking help for emotional abuse and neglect via an online, peer-peer message board. This practical case study aims to evidence the meaningful role and impacts associated with YCoR involvement in sensitive and complex mental health research using a flexible approach to co-production.

METHODS

During the Covid-19 pandemic, we explored on- and off-line approaches and adapted research methodology to build relationships, knowledge, skills, and confidence with YCoR. The virtual involvement was evaluated against the five principles of co-production. Anonymous, continuous digital feedback, reflective practices and multiple dissemination outputs are used to evaluate the impact of the study on those involved and the research.

RESULTS

Ten members of NeurOX Young People's Advisory Group were involved in the core project. Additional members were invited at later stages and in the dissemination of outputs. We describe a supportive, scaffolded learning approach to build capabilities and embed the lived experience of YCoR in complex qualitative research. A digital blended approach was acceptable to YCoR, principles of co-production were met and the impact/benefits of involvement are described. To demonstrate the epistemological value of involving YP we evidence YPs capabilities for involvement and the 'change' or contribution YCoR made to the research through reflective practices.

CONCLUSIONS

This case study demonstrates how flexible approaches co-production with YCoR can be robust and responsive to balance ethical and epistemological impact in complex mental health research. Supportive, scaffolded practices and safe environments helped build the confidence and capacity of YCoRs to demonstrate valuable phenomenological insights in the analysis. YP's perspectives on how they describe 'meaningful' and impactful involvement illustrate the reciprocal benefits gained through working together.

PUBLIC CONTRIBUTION

This case study describes the YCoR involvement throughout the research and dissemination of outputs. YCoR co-authors were involved in developing the outline and reviewing the draft stages of the manuscript.

Citizen science: How to extend reciprocal benefits from the project community to the broader socio-ecological system

Quantitative plant biology is a growing field, thanks to the substantial progress of models and artificial intelligence dealing with big data. However, collecting large enough datasets is not always straightforward. The citizen science approach can multiply the workforce, hence helping the researchers with data collection and analysis, while also facilitating the spread of scientific knowledge and methods to volunteers. The reciprocal benefits go far beyond the project community: By empowering volunteers and increasing the robustness of scientific results, the scientific method spreads to the socio-ecological scale. This review aims to demonstrate that citizen science has a huge potential (i) for science with the development of different tools to collect and analyse much larger datasets, (ii) for volunteers by increasing their involvement in the project governance and (iii) for the socio-ecological system by increasing the share of the knowledge, thanks to a cascade effect and the help of 'facilitators'.

Patient preferences and experiences of participation in surgical cancer care

BACKGROUND

Quality cancer care necessitates opportunities for patient participation, supposedly recognizing the individual's preferences and experiences for being involved in their health and healthcare issues. Previous research shows that surgical cancer patients wish to be more involved, requiring professionals to be sensitive of patients' needs.

AIMS

To explore preference-based patient participation in surgical cancer care.

METHODS

A cross-sectional study was conducted. The Patient Preferences for Patient Participation tool (4Ps) was used, which includes 12 attributes of preferences for and experiences of patient participation. Data were analyzed with descriptive and comparative statistical methods.

RESULTS

The results are based on a total of 101 questionnaires. Having reciprocal communication and being listened to by healthcare staff were commonly deemed crucial for patient participation. While 60% of the patients suggested that taking part in planning was crucial for their participation, they had experienced this only to some extent. Learning to manage symptoms and phrasing personal goals were items most often representing insufficient conditions for preference-based patient participation.

LINKING EVIDENCE TO ACTION

To support person-centered surgical care, further efforts to suffice preference-based participation are needed, including opportunities for patients to share their experiences and engage in the planning of healthcare activities.

Factors Predicting Older Patients' Family Involvement by Nursing Staff in Hospitals: The View of Hospital Nurses in Israel

According to the family-centered approach, the involvement of family in the care of hospitalized older patients is a crucial element of quality care. Active involvement of family in care by the nursing staff depends on different factors, including attitudes towards the importance of family in the care and perception of the interactions with the family. This study aims to identify the factors predicting staff behavior of involving the family in the care process. A cross-sectional study was conducted among 179 nursing staff at a hospital, using a self-report questionnaire examining staff attitudes towards the importance of family in care, the perception of the interactions with the family (family behavior, communication and conflicts), and staff behavior toward family involvement. The findings point out the importance that staff attitudes have on their behavior in the active involvement of family in the care of older patients. Staff behavior of family involvement was predicted by their perceptions of the family (as conversational partners and having their own resources), less conflicts with the family, and staff academic education. Staff behavior toward family is influenced by their attitude and staff–family relationships. Educational programs should emphasize the importance of family, as well as dealing with conflicts.

The relationship between youth involvement, alliance and outcome in trauma-focused cognitive behavioral therapy

OBJECTIVE

Research suggests that combining the trauma-specific elements with a strong alliance helps optimize treatment outcomes in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for youth. Building on this, we investigate whether more positive and less negative involvement behaviors during trauma narration are associated with a stronger alliance and predict fewer posttraumatic stress symptoms (PTSS).

METHOD

Participants were 65 youth (M age = 15.5, SD = 2.2; 77% girls) receiving TF-CBT. Both youth self-report (Child PTSD Symptom Scale and Therapeutic Alliance Scale for Children) and observer ratings (Client Involvement Rating Scale) were used, and relationships were investigated with correlations and regression analyses.

RESULTS

The positive involvement behaviors demonstration of treatment understanding and self-disclosure predicted fewer PTSS but were not associated with the alliance - while initiation of discussions and showing enthusiasm predicted more PTSS but were associated with a stronger alliance. The negative involvement behaviors passivity and avoidance did not predict PTSS but were negatively associated with the alliance.

CONCLUSION

The relationships between traumatized youths' positive and negative involvement behaviors, alliance and PTSS outcomes appear mixed. The combination of a clear understanding of why processing the trauma can be helpful, more trauma-related self-disclosure and a stronger alliance seem favorable for alleviating PTSS.Trial registration: ClinicalTrials.gov identifier: NCT00635752..

Characteristics of the ideal healthcare services to meet adolescents' mental health needs: A qualitative study of adolescents' perspectives

INTRODUCTION

Despite increased focus on development of mental health services worldwide, many adolescents still hesitate to reach out to the services when they need them. This might be linked to the lack of adolescent involvement in the development of services. This study aimed to explore adolescents' perspectives on the ideal healthcare services to meet their mental health needs.

METHODS

A two-stage qualitative study was carried out to explore the perspectives of adolescents on the healthcare services to support their mental health. In the first stage, data from 295 adolescents attending a mental health seminar were analysed using qualitative content analysis. In the second stage, in-depth perspectives of 10 adolescent coresearchers were gathered through self-reflection and group discussions to further explore the categories developed in the first stage. Thematic analysis was used to develop the themes answering the research question. Ten adolescent coresearchers planned the study, collected and analysed data and authored the manuscript, with the support of a senior researcher.

RESULTS

Five themes describe adolescents' perspectives on the ideal healthcare services to meet their mental health needs: (1) Culturally Sensitive and Responsive; (2) Communication of Information; (3) Easy Access; (4) Variety of Support; and (5) Consistency. Culturally Sensitive and Responsive services influenced all other themes. The themes describe suggestions for mental health service improvement, including how to manage the barriers that adolescents face to receive help from the mental health services.

DISCUSSION

This study highlights the importance of culturally sensitive and responsive services. It raises the need for an expanded definition of culture going beyond nationality and ethnic background. Adolescents need flexible services that meet their individual mental health needs. This has implications for practitioners, educators, system organizers and researchers, who should also involve adolescents in planning, implementing and assessing the services. There is a need for a self-learning system to continuously adapt to user feedback.

CONCLUSION

This study provides insight into adolescents' perspectives on the ideal mental health services. It offers suggestions for ways to improve services to better meet the individual mental health needs of adolescents. Additional research is needed to further develop and implement service changes, as well as to assess their acceptability, effectiveness, cost-effectiveness and safety.

PATIENT OR PUBLIC CONTRIBUTION

This is a study lead by adolescents. Adolescent coresearchers have, with the support of a senior researcher, planned and carried out the study, collected and analysed data and authored the manuscript.

Patient Design: The Importance of Including Patients in Designing Health Care

A paradigm shift is underway in the patient-clinician relationship, driven by irreversible changes in information access, yet the model under which clinicians are trained, care is conducted, and care delivery is designed has not changed significantly even though we call it “patient centered.” Humanity endured centuries in which even doctors had little idea what the patient’s problem really was. Science slowly solved that, and for a century, only doctors could know what was worth knowing. Today, the rise of the internet and digital health has led to the end of that era. We are already witnessing early signs of the era of participatory health: genuinely empowered people living their lives and managing their health according to their own priorities, in partnership and consultation with physicians as needed. This may feel like a threat to the physician’s sacred role, but it is no more so than when physicians adopted informed consent and then shared decision-making. In the 2010s, many pharmaceutical, medical, and health care companies started to use patient centricity as a mantra. We argue that to drive this paradigm change fully into existence, we need to shift “patient centricity” from a relatively passive process, driven by industry needs, into a far more active, collaborative process driven by both parties’ needs and preferences. To build this new world of practice and workflow, we simply must engage with patients as true partners. To achieve medicine’s new potential, it must be optimized around the wants and priorities of the ultimate stakeholder—the party that has the most at stake in how it all plays out: the patient. Patient design is the approach that can make it happen.

Variation in Evidence-Based Practices Among Youth-Serving Residential Treatment Facilities

BACKGROUND

Residential treatment is among the most intensive and expensive settings for children with behavioral health challenges; yet, the extent to which evidence-based practices are used in these settings is unknown.

AIM

The purpose of this study was to describe the extent which family therapy, case management, telehealth, peer support, and family psychoeducation are provided in residential treatment using data from the National Mental Health Services Survey (N-MHSS). Organizational factors-region, ownership, payment, licensing/accreditation, and facility size-were examined in relation to evidence-based practices to understand disparities in care.

METHODS

This was a secondary analysis of publicly available data from the 2018 N-MHSS. A subpopulation was created consisting of residential facilities that served children (N = 576). Descriptive statistics were used to describe the sample, and Cohen's h was calculated to determine patterns of evidence-based practice utilization.

RESULTS

Evidence-based practices from most to least prevalent were family therapy (76%), family psychoeducation (74%), case management (71.1%), telehealth (17.2%), and peer support (8.7%). The provision of evidence-based practices was not evenly distributed. There were primarily small to moderate differences by organizational factors, including region (i.e., Northeast, Midwest), ownership status (i.e., for-profit), payment type (i.e., self-pay, private insurance), licensing/accreditation (Department of Family and Children Services), and facility capacity (>251 clients served per year).

CONCLUSION

Findings demonstrate a need for research-practice partnerships to determine the barriers that prevent effective evidence-based practices from being implemented in the residential treatment setting.