South African mental healthcare providers' views about exercise for people with mental illness

Background

People living with mental illness (PWMI) have significantly reduced life expectancy compared to the general population, yet mental healthcare providers (MHCPs) do not regularly prescribe exercise, despite its proven health benefits.

Aim

This study aimed to evaluate South African MHCPs' views regarding exercise for PWMI.

Setting

A cross-sectional descriptive study conducted across five public sector specialised psychiatric units in Gauteng.

Methods

Mental healthcare providers were surveyed using the Exercise in Mental Illness Questionnaire - Health Professionals Version.

Results

Most participants were nurses (49.1%) and doctors (26.2%) and reported no prior formal training in exercise prescription (79.4%). The vast majority (up to 89.7%) agreed regarding the physical benefits of exercise, particularly cardiometabolic benefits. The most common barriers, as perceived by MHCPs, to exercise participation for PWMI were: stigma (56.5%) and medication side effects (56.5%). The majority (76.2%) reported prescribing exercise for PWMI at least 'occasionally'. The method most frequently used was personal discussion (77.3%) and aerobic exercise was most frequently recommended (81.0%). Specific instructions regarding physical activity recommendations however were often not provided. Regarding MHCPs personal exercise habits, only a third (34%) met physical activity guidelines. Most MHCPs (92.1%) indicated an interest in further training regarding exercise for PWMI.

Conclusion

Mental healthcare providers were supportive of exercise for PWMI. Strategies to address the stigma around mental illness and medication side-effects, to improve training regarding exercise prescription, as well as the exercise habits of MHCPs themselves, and collaboration with exercise professionals and organisations are recommended.

Contribution

This study provides insight into the views of South African MHCPs regarding exercise for PWMI.

Attitudes of western Canadian dairy farmers toward technology

Dairy farms have become more reliant on technology. The overall aim of this study was to better understand how dairy farmers view technology and its effects on animal care, including their views on the prospect of integrating gene-editing technology in the future. Virtual-semistructured interviews were conducted with dairy farmers (n = 11) from British Columbia and Alberta. To facilitate discussion, the participants were asked to develop and discuss a timeline describing when and why various technologies were adopted on their farm. Although farmers defined technology broadly and affecting multiple aspects of farm management, this paper focuses on their views regarding how technology can affect animal care. Following thematic analysis of the data, the following 3 themes emerged: (1) the changing role of the farmer (including intergenerational considerations and learning new technology), (2) the effect of technology on the cow and her relationship with the farmer and, (3) technology as the future of the farm. The discussions also highlight the concerns that some farmers have regarding challenges associated with reduced human-animal interactions and effective use of the large amounts of data that are collected through technology. We also specifically asked the participants their views about gene editing as a potential future technology. Most of the participants did not specifically address their views on gene editing, but they spoke about the effect on genetic technologies more generally, often making references to genomic testing. However, some questioned how this technology may affect farmers more generally and spoke about how it could affect human-animal relationships. These results illustrate differences among farmers in the way they view technology and how this can affect the dairy cattle they care for.

Letter to Editor on "Impact of smart phone use on adolescence health in India"

This letter to the editor with reference to Mahalakshmi et al. (2023) provides two additional views. In a tech-savvy world study in this field is of importance yet there is a huge gap. Such study should also consider screen time engagement of hospitalized patients given their predisposed physical condition in addition to student survey. Genetic analysis should also be included along with the questionnaire and counselling-based surveys. Thus, considering the known study pipeline and focusing on the two afore-mentioned aspects such research should be considered as a "High Priority" area.

Health Care Professionals' Views on the Use of Passive Sensing, AI, and Machine Learning in Mental Health Care: Systematic Review With Meta-Synthesis

BACKGROUND

Mental health difficulties are highly prevalent worldwide. Passive sensing technologies and applied artificial intelligence (AI) methods can provide an innovative means of supporting the management of mental health problems and enhancing the quality of care. However, the views of stakeholders are important in understanding the potential barriers to and facilitators of their implementation.

OBJECTIVE

This study aims to review, critically appraise, and synthesize qualitative findings relating to the views of mental health care professionals on the use of passive sensing and AI in mental health care.

METHODS

A systematic search of qualitative studies was performed using 4 databases. A meta-synthesis approach was used, whereby studies were analyzed using an inductive thematic analysis approach within a critical realist epistemological framework.

RESULTS

Overall, 10 studies met the eligibility criteria. The 3 main themes were uses of passive sensing and AI in clinical practice, barriers to and facilitators of use in practice, and consequences for service users. A total of 5 subthemes were identified: barriers, facilitators, empowerment, risk to well-being, and data privacy and protection issues.

CONCLUSIONS

Although clinicians are open-minded about the use of passive sensing and AI in mental health care, important factors to consider are service user well-being, clinician workloads, and therapeutic relationships. Service users and clinicians must be involved in the development of digital technologies and systems to ensure ease of use. The development of, and training in, clear policies and guidelines on the use of passive sensing and AI in mental health care, including risk management and data security procedures, will also be key to facilitating clinician engagement. The means for clinicians and service users to provide feedback on how the use of passive sensing and AI in practice is being received should also be considered.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42022331698; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=331698.

Reporting and Mapping Research Evidence on Perceptions of Clinical Hypnosis Among the General Population and Patients Receiving Health Care Including Cancer Care: A Scoping Review

Despite empirical evidence supporting clinical hypnosis for numerous conditions, its utilization in healthcare is limited due to skepticism and misconceptions. This review identifies and maps research on clinical hypnosis perceptions among the general population, healthcare patients, and more specifically patients with cancer. A systematic search following JBI PRISMA ScR guidelines was conducted in EBSCOhost, ProQuest, PubMed, and PMC, resulting in 18 peer-reviewed, English language articles (2000-2023). Most studies employed quantitative methods, which were complemented by some qualitative and one mixed-methods approach. The results found attitudes toward hypnotherapy, especially when administered by licensed professionals, are consistently positive; however, awareness of hypnosis remains low within the healthcare sector, particularly in cancer care. Although hypnotherapy was found to be useful, misinformation, a lack of understanding, and awareness persist. Few studies address the reasons behind people's opinions or focus on integrating hypnotherapy into healthcare. Research investigating hypnosis attitudes in cancer care is scant, necessitating further exploration.

Experience and views of healthcare professionals towards people who use new psychoactive substances: Evidence from statutory, non-statutory, and private mental health and addiction healthcare services

OBJECTIVE

It is unclear how healthcare professionals (HCPs) experience and view the challenges of working with people who use New Psychoactive Substances (PWUNPS), in different healthcare services (HCS). The aim of the study was to explore HCPs' experiences of working with individuals who use NPS across statutory, non-statutory, and private mental health and addiction HCSs.

METHODS

HCPs completed in-depth semi-structured interviews. Audio recordings were transcribed verbatim with a mean duration of 30 min 55 s. Data were analysed through thematic analysis.

RESULTS

A purposive sample of 14 HCPs (6 men, 8 women) with a mean age of 42.5 years were interviewed in 2019. Organisational issues, including funding, impacted the treatment for PWUNPS and HCPs perceived a lack of support dependent on their qualifications. They reported a lack of assessment, policy, harm reduction, and awareness of NPS-related symptoms including mental health problems and stigma faced by PWUNPS.

CONCLUSION

HCPs need better training, education, and assessment processes to manage acute NPS intoxications and address the stigma associated with PWUNPS. There is a need for policy-making opportunities across different HCSs to ensure better healthcare outcomes for PWUNPS.

Views of teenagers towards teenage pregnancy in the Capricorn district, Limpopo Province

Teenage pregnancy occurring in girls aged 10-19 years remains a serious worldwide health problem. Stillbirths and newborn deaths are 50% higher among infants born to adolescent mothers than among those born to mothers aged 20-29 years, which contributes to the increased deliveries of newborn babies among females aged 10 to 19 years. The aim of the study was to gain understanding of the views of teenagers towards teenage pregnancy in the Capricorn district, Limpopo province. A qualitat ive, explorative, and descriptive study was adopted. The target population constituted 15 purposively selected male and female teenagers aged between 13 and 19 years, from three secondary schools. Data were collected using in-depth interviews and analysed using the thematic approach. An inductive thematic approach was used to identify common and recurring themes. Four themes emerged during data collection namely: essentially, optionally, socio-cultural, and economic motivated influences. The findings showed that peer pressure, lack of knowledge on sexual issues, social media, inadequate parental guidance and support, poor access to health facilities, awkward operating hours, bad attitudes of nurses, and absence of youth-friendly services space contribute to the increased number of teenage pregnancies.

What should inpatient psychological therapies be for? Qualitative views of service users on outcomes

BACKGROUND

There is limited research on what, when and how outcomes should be measured in psychological therapy trials in acute mental health inpatient wards.

OBJECTIVES

This study aimed to consider what outcomes service users think are important to measure.

METHODS

This qualitative study explored the views of 14 participants, who had an inpatient admission within the last year, on outcomes of psychological therapies using semistructured interviews. Data were analysed using thematic analysis from a critical realist perspective with both inductive and deductive coding.

RESULTS

The 126 outcomes that were important to participants were mapped onto an established taxonomy of outcomes across different health areas and the socioecological framework to consider the wider context and help summarise the outcomes. Most of the outcomes were mapped to the intrapersonal and interpersonal level. In addition to the outcome mapping, three themes were constructed from the qualitative data: (1) I am not a problem I am a person, (2) Feeling cared for and loved, (3) What does getting better look like.

CONCLUSIONS

Our results highlight the need for patient-reported outcomes which are cocreated with service users, disseminating research and training on preventing dehumanising experiences, enhancing psychological safety and therapeutic relationships and improving access to psychological therapy.

PATIENT OR PUBLIC CONTRIBUTION

The wider People with Personal Experience Involvement Committee at the University of Bath were consulted which included a focus group during the early planning stages. We also collaborated with a person with personal experience, at every stage of the research. This included developing our research question and aims, protocol, participant documents (e.g., information and debrief forms), advertisement and recruitment strategy, interview topic guide, the codes, the final themes and quotes and reviewing the manuscript. People with lived experience of being admitted to an acute mental health inpatient ward participated in our study.

Exploring Patient Beliefs and Medication Adherence in the Mediterranean Context: A Cross-Sectional Study in Patients with Cardiovascular Diseases and Cardiometabolic Disorders in Greece-The IACT-Study

BACKGROUND

Evidence has shown that poor adherence to vascular medications contributes to a considerable proportion of all cardiovascular disease (CVD) events and mortality. The aim of the present work was to examine patients' beliefs/views that affect their level of adherence to the assigned medical treatment in the context of a multi-center study in Greece.

METHODS

Between July 2022 and April 2023, 1988 patients (1180 females) with established cardiovascular disease or relevant cardiometabolic disorders were chosen from seven medical centers in Greece. The 4-item Morisky Medication Adherence Questionnaire gauged medication adherence and investigated patients' beliefs/views regarding treatment.

RESULTS

Among participants, 51.2% showed perfect medication adherence, contrasting with 48.8% displaying poor adherence. Patients with negative medication beliefs were around three times more likely to be non-adherent (OR = 2.73; 95% CI = 2.28-3.28). Non-adherers held concerns about drug efficacy (OR = 2.34; 95% CI = 1.10-4.97) and favored alternative therapies (OR = 2.25; 95% CI = 1.75-2.91).

CONCLUSION

The findings highlight the significance of addressing patient beliefs/views to improve medication adherence. The distinct Mediterranean context, influenced by cultural, socioeconomic, and clinical factors, emphasizes the need for tailored interventions. This underscores the call for contextually sensitive strategies to boost medication adherence and improve health outcomes in this unique region.

Views of healthcare professionals and service users regarding anti-, peri- and post-natal depression in Oman

WHAT IS KNOWN ON THE SUBJECT?: Anti-, peri- and post-natal depression negatively affect the relationship between mothers and their children. At least half of cases of anti-, peri- and post-natal depression were missed and underdiagnosed by healthcare professionals (HCPs) including doctors, nurses and midwives. Previous qualitative studies considered women's experiences relating to anti-, peri- and post-natal depression separately from studies looking at the views of HCPs. There is a lack of research in Middle Eastern countries, despite the high prevalence of anti-, peri- and post-natal depression. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This is the first qualitative study investigating the experiences of both HCPs and service users regarding anti-, peri- and post-natal depression from the Middle East perspective, particularly in Oman. This study revealed that anti-, peri- and post-natal depression has been neglected in primary healthcare systems in Oman. The study explored many barriers and facilitators which have been identified by both HCPs and patients in identifying and managing anti-, peri- and post-natal depression in the primary healthcare system. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses, midwives and doctors should develop an empathic screening procedure that allows for the discussion of mental health concerns and help-seeking behaviours with their patients. Training nurses and midwives in motivational interviewing, routinely screening mothers with any depressive symptoms, as well as providing public education programmes to increase mental health awareness, resources and access to a variety of mental healthcare alternatives, could be successful in recognizing and managing anti-, peri- and post-natal depression.

ABSTRACT

INTRODUCTION: Anti-, peri- and post-natal depression is known to affect the relationship between infants and their mothers adversely. Previous studies have identified barriers and facilitators, reported by women and HCPs, related to the identification and management of anti-, peri- and post-natal depression. However, these studies considered the experiences of women separately from those of the healthcare professionals, even though their experiences of anti-, peri- and post-natal depression are interconnected. Additionally, there is a lack of research among people living in the Middle East, including Oman, which has one of the highest rates of anti-, peri- and post-natal depression globally.

AIM

This study aimed to explore the views and experiences of HCPs and service users relating to anti-, peri- and post-natal depression from the Middle East perspective.

METHOD

A qualitative descriptive study using semi-structured interviews was conducted. This study took place at the Family Medicine and Community Clinic at the University Hospital and three selected primary healthcare centres in Muscat, between May 2020 and February 2021. Purposive sampling was used: 15 HCPs with 2-20 years of clinical experience in anti-, peri- and post-natal primary care and 13 pregnant patients plus 2 post-birth patients were interviewed. Audio-recordings were transcribed verbatim, and the anonymized transcripts were then entered into the qualitative data management software, NVIVO 12.

RESULTS

A thematic approach was used to analyse the data. Four themes were identified in the data, namely: (1) making sense of anti-, peri- and post-natal depression; (2) how to deal with anti-, peri- and post-natal depression; (3) barriers to addressing anti-, peri- and post-natal depression in primary anti-, peri- and post-natal care settings and (4) bridging the gap: facilitators in detecting and managing anti-, peri- and post-natal depression.

CONCLUSIONS

Improving the identification and management of anti-, peri- and post-natal depression in primary healthcare systems will require a whole-system approach with interventions at the patient, practice and comprehensive primary care team levels.

IMPLICATIONS FOR PRACTICE

The findings suggest implications for improving the identification and management of anti-, peri- and post-natal depression including an increased emphasis on mental health by enhancing the routine screening of mothers during the anti-, peri- and post-natal period, clearer referral systems, improving resources, providing training with regard to mental health and improving communication skills.

Role of Sensitization and Awareness Program on Knowledge, Attitude, Views, and Practice of Self-Medication Among MBBS Students in a Medical College of Bihar

Aims Self-medication is an essential component of self-care; however, its use has significantly increased. Its practice has many risks such as wrong diagnosis, adverse drug reactions, antimicrobial resistance, etc. Being future doctors, self-medication has a special impact on MBBS students. Henceforth, the present study was undertaken to sensitize MBBS students in a medical college in Bihar and to analyze its role in different aspects of self-medication. Methods and material This was a cross-sectional, questionnaire-based study. The questionnaire was circulated to MBBS students of all the phases. After collecting the responses, scoring and grading was done and then a sensitization and awareness program was conducted through different modes and medium. After three months the same questionnaire was distributed, and their response was again collected. Statistical analysis used With an expected 40% prevalence, the minimum sample size needed to attain a power of 95% and an alpha value of 0.05 was calculated to be 201. Statistical Package for Social Sciences version 16 was used for data analysis. The chi-square test was used to see the association in responses obtained, before and after sensitization. A P-value with ≤0.05 was considered statistically significant. Results The questionnaires were circulated among 439 students. On comparing the grades, we found that phase III students comparatively had better knowledge regarding different aspects of self-medication. On analyzing different aspects of self-medication, we found that there was a significant improvement in many aspects post-sensitization. Conclusions MBBS students are future doctors, hence they should be more educated about the pros and cons of self-medication. This study showed that the perception of participants improved after our educational activities. We hope that after becoming aware, these young budding doctors will spread awareness, which, in turn, will benefit society. Additionally, we hope that this study will have an impact on students from different medical colleges and even healthcare providers, promoting responsible self-medication practices when necessary.

The experiences and views of adults with intellectual disabilities accessing digital mental health interventions: A qualitative systematic review and thematic synthesis

BACKGROUND

Technology is ubiquitous in all aspects of daily life and research interest in the topic of digital mental health interventions (DMHI) for people with intellectual disabilities is growing. In addition, the COVID-19 pandemic has accelerated technology use in delivering mental health supports.

METHOD

This review used a qualitative systematic literature review methodology with the aim of collating the views and experiences of adults with intellectual disabilities accessing DMHI. The electronic databases MEDLINE, PsycINFO, CINAHL and SCOPUS were searched in March 2022.

RESULTS

Five studies were selected in this review, and three major narrative themes were generated, each with sub-themes: (1) User experience with DMHI (personal experience, digital experience); (2) Relationships fostered through technology (interpersonal support, relating to virtual characters, computer as skilled helper); (3) Psychological benefits (new skills development, personal autonomy development).

CONCLUSION

This review highlights that, although there is a diversity of views and experiences of people with intellectual disabilities, the evidence suggests that DMHI has potential to support this population given the right opportunities. Findings also point to the benefit of technology as a complement to therapy, but not necessarily as a replacement to in-person therapeutic encounters.

Views on Short Stature of Female Versus Male Endocrine Pediatric Patients Undergoing Provocative Growth Hormone Testing and Their Parents

OBJECTIVE

Boys outnumber girls in short stature evaluations and growth hormone treatment despite absence of gender differences in short stature prevalence. Family views on short stature influence medical management, but gender-based analysis of these views is lacking. This study explored endocrine patients' and their parents' perceptions of short stature and its impact on quality of life by patient gender.

METHODS

Patients aged 8-14 years undergoing provocative growth hormone testing and one parent each completed semi-structured interviews. Clinical data were extracted by chart review.

RESULTS

24 patient-parent dyads (6 female patients, 22 mothers; predominantly non-Hispanic White) participated. Six major themes emerged: 1) patients' perceptions of their short stature were similar by gender, 2) physical experiences of short stature were similar by gender, 3) social experiences of short stature were both similar and different by gender, 4) parental perceptions of short stature as a factor limiting their child's functionality were similar by gender, 5) concern about societal stigma related to short stature arose for both genders, and 6) patients' perceptions of parental messaging about the import of their short stature were similar by gender.

CONCLUSION

Our data reveal more similarities than differences between genders in patient perceptions and patient and parent-reported experiences of short stature. Worry about stature-related stigma was noted for patients of both genders. Parental messaging about short stature emerged as an important area to explore further by patient gender. Our findings suggest that clinicians should be wary of making gender or stigma-based assumptions when evaluating children with short stature.

A place with a view: A first-person perspective in the hippocampal memory space

How do rodents' and primates' differences in visual perception impact the way the brain constructs egocentric and allocentric reference frames to represent stimuli in space? Strikingly, there are important similarities in the egocentric spatial reference frames through which cortical regions represent objects with respect to an animal's head or body in rodents and primates. These egocentric representations are suitable for navigation across species. However, while the rodent hippocampus represents allocentric place, I draw on several pieces of evidence suggesting that an egocentric reference frame is paramount in the primate hippocampus, and relates to the first-person perspective characteristic of a primate's field of view. I further discuss the link between an allocentric reference frame and a conceptual frame to suggest that an allocentric reference frame is a semantic construct in primates. Finally, I discuss how views probe memory recall and support prospective coding, and as they are based on a first-person perspective, are a powerful tool for probing episodic memory across species.

Connected Mental Health Solutions: Global Attitudes, Preferences, and Concerns

Background: Connected mental health (CMH) presents several technology-based solutions, which can help overcome many mental care delivery barriers. However, attitudes toward the use of CMH are diverse and differ from a cohort to another. Objective: The purpose of this study is to investigate the global attitudes toward CMH use and assess the use of technology for mental care. Methods: This study presents a synthesis of literature available in Scopus, Science Direct, and PubMed digital libraries, investigating attitudes toward CMH in different cohorts from different countries, based on a systematic review of relevant publications. This study also analyzes technology use patterns of the cohorts investigated, the reported preferred criteria that should be considered in CMH, and issues and concerns regarding CMH use. Results: One hundred and one publications were selected and analyzed. These publications were originated from different countries, with the majority (n = 23) being conducted in Australia. These studies reported positive attitudes of investigated cohorts toward CMH use and high technology use and ownership. Several preferred criteria were reported, mainly revolving around providing blended care functionalities, educational content, and mental health professionals (MHPs) support. Whereas concerns and issues related to CMH use addressed technical problems related to access to technology and to CMH solutions, the digital divide, lack of knowledge and use of CMH, and general reservations to use CMH. Concerns related to institutional and work barriers were also identified. Conclusions: Attitudes toward CMH show promising results from users and MHP views. However, factors such as providing blended care options and considering technical concerns should be taken into consideration for the successful adoption of CMH.

Primary Care Counseling of Parents Regarding Childhood Screen Media Use

Parental beliefs and motivation are instrumental in improving childhood digital media use (DMU). Parents (n = 611) completed questionnaires about childhood DMU assessing knowledge, interest in counseling, motivation to change, self-efficacy, and beliefs. Less than a third correctly recognized screen time limits. Twenty-seven percent received childhood DMU information from a doctor, while 46% stated they would like such information. Only 2% had a doctor-recommended DMU plan. Interest in DMU topics, motivation to improve, and management self-efficacy were moderate. Top negative beliefs were addiction to DMU (52%), sleep problems (39%), obesity (33%), social skills (33%), and inappropriate content (32%). Differences between age categories existed for social (48%, P = .01) and language (14%, P = .01) concerns (highest for toddlers), attention concerns (27%, P = .02; highest in preschoolers), and depression (13%, P < .001) and low self-esteem (8%, P = .04; highest in teens). Findings support further development of approaches to address DMU, tailored by age-specific common parental views.

Primary care professionals' views on population-based expanded carrier screening: an online focus group study

BACKGROUND

Population-based expanded carrier screening (ECS) involves screening for multiple recessive diseases offered to all couples considering a pregnancy or during pregnancy. Previous research indicates that in some countries primary care professionals are perceived as suitable providers for ECS. However, little is known about their perspectives. We therefore aimed to explore primary care professionals' views on population-based ECS.

METHODS

Four online focus groups with 14 general practitioners (GPs) and 16 community midwives were conducted in the Netherlands.

RESULTS

Our findings highlight various perspectives on the desirability of population-based ECS. Participants agreed that ECS could enhance reproductive autonomy and thereby prevent suffering of the child and/or parents. However, they also raised several ethical, societal, and psychological concerns, including a tendency towards a perfect society, stigmatization, unequal access to screening and negative psychosocial consequences. Participants believed that provision of population-based ECS would be feasible if prerequisites regarding training and reimbursement for providers would be fulfilled. most GPs considered themselves less suitable or capable of providing ECS, in contrast to midwives who did consider themselves suitable. Nevertheless, participants believed that, if implemented, ECS should be offered in primary care or by public health services rather than as hospital-based specialized care, because they believed a primary care ECS offer increases access in terms of time and location.

CONCLUSIONS

While participants believed that an ECS offer would be feasible, they questioned its desirability and priority. Studies on the desirability and feasibility of population-based ECS offered in primary care or public health settings are needed.

Beliefs and Norms Influencing Initiation and Sustenance of Exclusive Breastfeeding: Experiences of Mothers in Primary Health Care Facilities in Ermelo, South Africa

Exclusive breastfeeding (EBF) is not a norm in many communities in South Africa despite the World Health Organizations' recommendations for EBF in the first six months of infant's life. Thus, South Africa continues to observe suboptimal and poor practices of EBF. The purpose of the study was to explore the experiences of mothers who are HIV-positive and negative on EBF and examine the extent to which initiation and sustenance of EBF is influenced by cultural beliefs, societal norms, and family norms and practices in Mpumalanga Province. Three focus group discussions and twelve in-depth interviews were conducted among thirty mothers who were purposively selected during their visits to the facilities for childcare services. Interviews were audiotaped, transcribed verbatim, and transcripts were analysed through thematic analysis using NVivo version 10. Mothers were aged between 18 and 42 years, most were unemployed and were living in poor sociodemographic backgrounds in extended family households. We found evidence of factors that influence the decision to EBF and mix feed infants among mothers. Traditional and cultural beliefs and norms that exist within their communities informed decisions mothers took to EBF. These beliefs existed alongside mothers' opinions on breastfeeding (BF) and HIV infection, as well as the fears of harming the baby through HIV infection, leading to early cessation of BF. Mothers were also advised by family members, friends, and even some healthcare workers to use traditional medicines while BF. The association of EBF with sagging breasts and weight loss as well as discomfort with public BF are personal beliefs that influenced initiation and early cessation of EBF. Breastfeeding messages ought to be context specific to improve the knowledge, understanding, acceptance and practice of EBF among HIV-positive and negative mothers. Culturally appropriate counselling messages that address the known cultural practices of the populations affected are essential to changing the beliefs and norms of the communities including extended families of EBF mothers.

Men's experience of perpetrating intimate partner violence following disclosure of HIV status by their seropositive female intimate partners: a qualitative study

BACKGROUND

Gender-Based (GB) intimate partner violence is a social and public health issue globally. Several risks of violence related to male sexual partners' perpetration of intimate partner violence (IPV) following the disclosure of their female intimate partners' HIV + status have been reported. No research has been conducted on male sexual partner's perspectives of perpetrating IPV following their female intimate partners' disclosure of human immunodeficiency virus (HIV) seropositive status as a risk factor for the perpetration of IPV in Ghana.

OBJECTIVE

The objective of this study is to explore and describe male sexual partners' views or perspectives of perpetrating IPV following their female intimate partners' disclosure of being HIV positive in Ghana.

METHODS

Interpretive phenomenological approach was used to collect and analyse data from a purposive sample of 18 Male participants whose female intimate relations informed them of being HIV + in Ghana. The sample population was taken from Ghana because such research has been reported elsewhere but none has been done in Ghana. A semi-structured interview guide was used to collect the data. The interview guide covered topics such as background information, participants' reaction to HIV positive disclosure, lived experiences of participants, and Participants' understanding of different forms of IPV.

RESULTS

The findings of this study reveal five main themes that emerged from the interviews which include views on the perpetration of emotional, psychological, and verbal abuse; views on the perpetration of sexual deprivation; views on the perpetration of social isolation; views on the perpetration of financial abuse and views on escalated perpetration of physical abuse.

CONCLUSION

From the data, HIV positive status disclosure served as a risk factor for different forms of GB IPV against HIV positive women in Ghana, thus making this group more vulnerable and exposed to more GB IPV. Strategies to prevent the perpetration of IPV against women newly diagnosed as HIV positive are needed. We recommend screening all newly diagnosed HIV-positive women for abuse as an additional prevention strategy for IPV associated with disclosure of positive HIV status. KEY MESSAGESHIV positive status disclosure serves as a risk for the perpetration of IPV.Men are predisposed to violence upon hearing that their female heterosexual intimate partners are HIV positive.HIV infection information is distressful to receive from an intimate partner.

Rural Nurses' Views on Breastmilk Banking in Limpopo Province, South Africa: A Qualitative Study

The development of breastmilk banks is being established among the African population, including in Limpopo Province. However, the views of nurses directly handling the donated breastmilk in the province remain unknown. This study was aimed at exploring and describing the views of nurses towards breastmilk banking in the Mankweng area, Limpopo Province. A qualitative, descriptive, and explorative study was undertaken at a tertiary hospital and a rural feeder clinic in the Mankweng area. Purposive sampling was employed to obtain participants for the interviews. One-on-one, semi-structured interviews were conducted to explore the views of these nurses. Data were analysed using Tesch’s open coding method, with the information obtained being grouped into different themes and sub-themes. Almost all nurses were willing to donate their breastmilk to the bank. However, receiving donated breastmilk for their own children seemed to be a challenge due to the safety of the donated breastmilk, uncertainty about the screening process, and cultural issues. Although donation of breastmilk appeared to be well supported by almost all the nurses, the use of donated breastmilk seemed to be not fully acceptable. Increased awareness about breastmilk donation and banking should be prioritised in the province.

Service User and Carer Views and Expectations of Mental Health Nurses: A Systematic Review

Service users' views and expectations of mental health nurses in a UK context were previously reviewed in 2008. The aim of this systematic review is to extend previous research by reviewing international research and work published after the original review. Five databases were searched for studies of any design, published since 2008, that addressed service user and carer views and expectations of mental health nurses. Two reviewers independently completed title and abstract, full-text screening and data extraction. A narrative synthesis was undertaken. We included 49 studies. Most included studies (n = 39, 80%) were qualitative. The importance of the therapeutic relationship and service users being supported in their personal recovery by mental health nurses were core themes identified across included studies. Service users frequently expressed concern about the quality of the therapeutic relationship and indicated that nurses lacked time to spend with them. Carers reported that their concerns were not taken seriously and were often excluded from the care of their relatives. Our critical appraisal identified important sources of bias in included studies. The findings of our review are broadly consistent with previous reviews however the importance of adopting a recovery approach has emerged as a new focus.

Differences in young adults' perceptions of e-cigarettes by history of use

Objective: The current study examined group differences in college students' views on e-cigarettes in terms of safety, popularity, health risks, social acceptability, efficacy as a cessation aid, and promoting combustible cigarette use. Participants: 337 undergraduates (Mage = 20.84, SD = 3.79; 72.1% female; 68.5% White) divided into three groups: Never Users (n = 178), Ever Users (n = 108), and Current Users (n = 51). Methods: Participants completed questionnaires for course credit. Results: Compared to Ever and Never Users, Current Users believed e-cigarettes were safer, healthier, a useful tool to quit smoking, did not lead to combustible cigarette smoking, and that nicotine was less dangerous. Current Users also were less likely to endorse boosting social image as a motive for use. Conclusions: Public health campaigns could benefit from targeting current users' positive beliefs about e-cigarettes to reduce the prevalence of e-cigarette use among college students.

A Qualitative Study of Stakeholders' Views on Pharmacovigilance System, Policy, and Coordination in Pakistan

Objectives: Due to the absence of necessary rules, poor coordination, and various challenges, the pharmacovigilance system of Pakistan is not optimally functional at all levels of the health system. The objective of the study was to assess the stakeholders’ perceptions of the current ADR reporting system and to identify the pharmacovigilance policy issues and problems of effective coordination.

Methodology: Stakeholders from a broad range of disciplines, academia, regulatory authorities, the pharmaceutical industry, international health organizations, as well as pharmacovigilance experts, and healthcare professionals were included in the study. A total of 25 stakeholders throughout Pakistan were interviewed during exploratory semi-structured interviews. The interviews were recorded digitally, transcribed, coded, compared, and grouped according to their similarity of themes. Participants provided insights into gaps, limitations, and challenges of Pakistan’s current ADR reporting system, issues with proposed pharmacovigilance rules, and coordination difficulties.

Results: The majority of the participants considered the ADR reporting system in Pakistan to be improving but in a nascent phase. The identified gaps, challenges, limitations of the system, and barriers to reporting were labeled as reasons for limited functioning. Almost all stakeholders were aware of the existence of draft pharmacovigilance rules; however, participants in the industry were familiar with the contents and context of draft pharmacovigilance rules. Bureaucratic red tape and lack of political will appeared to be the top reasons for delaying the approval of the pharmacovigilance rules. Wider consultation, advocacy, and awareness sessions of policymakers and HCPs were suggested for early approval of rules. Participants unanimously agreed that the approval of rules shall improve the quality of life and reduce the economic burden along with morbidity and mortality rates. The need for greater and collaborative coordination among the stakeholders in promoting medicines’ safety was highlighted. All participants suggested the use of media and celebrities to disseminate the safety information.

Conclusion: Participants showed partial satisfaction with the way pharmacovigilance in Pakistan is moving forward. However, stakeholders believed that engagement of multi-stakeholders, approval of pharmacovigilance rules, and the establishment of pharmacovigilance centers in provinces, hospitals, and public health programs (PHPs) shall support in achieving the desired results.

The impact of the responsibility of teachers regarding reproductive healthcare to teenage learners

The Life Orientation subject at school is meant to equip learners with important life skills and prepare them to be responsible adults that will contribute positively to the economy of the country. One of such skills is to avoid pregnancy while being a learner and therefore needs information about sex and sexuality. The school curriculum should thus include the subject Reproductive Health Care and the teachers be allowed the responsibility to teach the subject. Teenage girls who become pregnant as learners are in many times compelled to drop out of school to raise the child as it becomes challenging to cope with studies and looking after the baby. The study used a qualitative exploratory research design aimed to determine the impact of the responsibility of teachers regarding reproductive healthcare to teenage learners. The objectives were to, explore the knowledge of school teachers with regard to reproductive healthcare. To explore and describe the views of the teachers with regard to their responsibility to teach the reproductive healthcare topic to teenage girls. Lastly, to develop guidelines for schools to assist teachers regarding their responsibility to teach the reproductive healthcare topic to teenage girls. The article will report on the first two objectives only. In-depth focus group interviews were conducted with twenty willing participants and a narrative questionnaire was completed. The data analysis method used was the spiral method which follows the process of coding and categorising transcribed data. The process allows data to be organised and setting it for several times so as to get a sense of the whole. identifying general categories and themes of the data is the next step followed by integrating and summarising the data to get a response to the research question. Data analysis results were teachers who felt burdened with the responsibility. Some had a positive opinion of the subject as part of the school curriculum and thus the need for stakeholder collaboration for their assistance. In conclusion, teachers are in need of empowerment for the responsibility to teach reproductive healthcare.

'It is designed for everybody to find their own level and to improve themselves'; views of older people and instructors of the Falls Management Exercise (FaME) programme

BACKGROUND

Older adults are at increased risk of falls due to ageing, decreased muscle strength and impaired balance. Clinical trials have demonstrated the efficacy and effectiveness of the Falls Management Exercise (FaME) programme in improving functioning and preventing falls. However, programme completion is often low, impacting the potential benefits of FaME.

OBJECTIVE

To explore the barriers and facilitators for participation and completion of the FaME programme from an instructor and participant perspective.

METHODS

Semi-structured interviews were conducted with 20 FaME users and seven Postural Stability Instructors from the East Midlands region of England, UK. Interviews were conducted using a topic guide and explored their views of the programme, intended benefits, reasons for participating, instructor's approach and venue facilities. Data were transcribed verbatim and analysed using thematic analysis. Written informed consent was obtained from all participants and instructors.

RESULTS

Common themes identified by participants and instructors for adherence related to perceived health benefits, psychological well-being, intervention characteristics, cost, instructors' qualities, opportunity to socialise, venue accessibility and facilities. Further factors such as maintaining independence, discipline, relationship with peers and caring responsibilities influenced participants' engagement with the programme. Instructor factors such as progression were also reported as important predictors.

CONCLUSIONS

Instructor and participant factors influence uptake, attendance and adherence of FaME. The findings from this study can inform the development and improvement of additional falls-prevention programmes. It can also guide marketing strategies to promote uptake of exercise-based falls-prevention programmes among older adults.

Nurses' views and practices on parental mental illness: An integrative review

When a parent has a mental health problem, family members can be affected by it. Nursing professionals can provide care for the whole family, including children. Nurses can support the parental role of parents with mental illness. This integrative review aimed at the following: To identify and to synthesize the views and practices of nurses on parental mental illness (PMI). An integrative review methodology was employed, following PRISMA guidelines. Theoretical and empirical literature was included. Twenty-three articles were obtained to be analysed, using the Whittemore and Knafl approach. A lack of knowledge about nurses' views and practices on PMI was found. Especially, in some demographic areas such as Mediterranean countries and Central and South America. Different issues which influence how nurses perceive PMI were identified: subjective meaning of family concept, personal experience of being parent, and perceptions of mental illness, among others. The main findings on nurses' practices were as follows: guidelines to implement family-focused practices, knowledge, and skills; therapeutic relationship; and teamwork and interagency communication; among others. These issues are intimately related. They could act as enablers or barriers to support parental role of parents with mental illness. Adequate guidelines and policies are necessary to support parents with mental illness and their families. There is a need to include knowledge about PMI and family-focused approach in nursing education curricula. Training could include reflection on nurses' experiences and personal values to become aware of how these can affect their interventions and practices.

Patients' and Family Members' Views on Pacemaker Reuse: an International Survey

INTRODUCTION

The reuse of cardiac implantable electronic devices may help increase access to these therapies in low- and middle-income countries (LMICs). No published data exist regarding the views of patients and family members in LMICs regarding this practice.

METHODS AND RESULTS

A paper questionnaire eliciting attitudes regarding pacemaker reuse was administered to ambulatory adult patients and patients' family members at outpatient clinics at Centro Nacional Cardiologia in Managua, Nicaragua, Indus Hospital in Karachi, Pakistan, Hospital Carlos Andrade Marín and Hospital Eugenio Espejo in Quito, Ecuador, and American University of Beirut Medical Center in Beirut, Lebanon. There were 945 responses (Nicaragua - 100; Pakistan - 493; Ecuador - 252; Lebanon - 100). A majority of respondents agreed or strongly agreed that they would be willing to accept a reused pacemaker if risks were similar to a new device (707, 75%), if there were a higher risk of device failure compared to a new device (584, 70%), or if there were a higher risk of infection compared to a new device (458, 56%). A large majority would be willing to donate their own pacemaker at the time of their death (884, 96%) or the device of a family member (805, 93%). Respondents who were unable to afford a new device were more likely to be willing to accept a reused device (79% vs. 63%, P<0.001).

CONCLUSIONS

Patients and their family members support the concept of pacemaker reuse for patients who cannot afford new devices. This article is protected by copyright. All rights reserved.

Comparison of Three Ultrasound Views for Internal Jugular Venous Cannulation in Patients Undergoing Cardiac Surgery: A Randomized Trial

Background:

The quality of needle visualization during ultrasound-guided internal jugular vein (IJV) cannulation determines the ease of procedure, whereas posterior IJV wall puncture is the most common risk associated. The IJV can be imaged in different views, which offer certain advantages over each other. We compared three different ultrasound views for IJV cannulation short axis (SAX), long axis (LAX), and oblique axis (OAX) with respect to the quality of needle visualization, first pass success rate, and posterior IJV wall puncture.

Methods:

Two hundred ten patients undergoing elective cardiac surgery were analyzed in this prospective randomized clinical trial. Patients were randomly assigned to one of the three groups: SAX (n = 70), LAX (n = 70), and OAX (n = 70). The quality of needle visualization, first pass success rate, and incidence of posterior IJV wall puncture in each of the three ultrasound views were studied. The Chi-square test and ANOVA were used for the comparison of means and proportion between the groups.

Results:

The quality of needle visualization was graded as good in 90% patients in OAX group, 81.4% patients in LAX group, and 14.2% patients in SAX group, respectively (P < 0.0001). OAX group had the highest first pass success rate (94.2%) followed by SAX (88.5%), and then, LAX (82.8%), but it was statistically insignificant among the groups (P = 0.105). The mean IJV access time was longer in LAX group when compared to OAX and SAX group (P < 0.0001).The incidence of IJV posterior wall puncture was 14.2% patients in SAX group and none in other groups (P = 0.0011).

Conclusion:

The results suggest that OAX view can be adopted as standard approach during ultrasound-guided IJV cannulation as it safe and reliable.

Healing the Past by Nurturing the Future: Aboriginal parents' views of what helps support recovery from complex trauma

We aimed to understand support needs for Aboriginal and Torres Strait Islander parents experiencing complex trauma.Becoming a parent is an exciting yet challenging transition, particularly for parents who have experienced past hurt in their own childhood which can have long lasting effects, including complex trauma. Complex trauma-related distress can make it harder to care for a baby, but the parenting transition offers unique opportunities for recovery.

This formative research is part of a community-based participatory action research project which aims to co-design perinatal awareness, recognition, assessment and support strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma. We used an Indigenist approach and grounded theory methods. Aboriginal and Torres Strait Islander parents who were pregnant and/or have children up to two years old were recruited through perinatal care services and community networks in three Australian sites (Alice Springs, Adelaide and Melbourne). Parents were offered a group discussion or individual interview, facilitated by Aboriginal researchers. Third-person scenarios and visual tools were used to facilitate reflections about the impact of past experiences, what keeps parents strong, hopes and dreams, and what is needed to achieve those dreams. Parents were also shown themes from a previous systematic review of parents’ experiences as a prompt to identify any additional key issues.

Seventeen Aboriginal and Torres Strait Islander parents participated in August to September 2019. Most were mothers (n = 15).  The study’s grounded theory methods provided the foundation of a theoretical supposition that positions the transformation of the compounding cycle of trauma, to a reinforcing cycle of nurturing at the intersection of: 1) parents’ connectedness; 2) social and emotional wellbeing; and 3) the transition to parenting. Unique opportunities and challenges situated at the interface are bound to the compounding or reinforcing nature of the intersecting factors. Findings reveal complexity, differing experiences by gender and age, as well as within and between communities.

Statistical Analysis of Articles Published in China CDC Weekly - Worldwide, 2019-2020

Introduction: This study analyzed views and downloads of articles published in China CDC Weekly from 2019 to 2020 as part of an evaluation of the academic level and quality of the journal.

Methods: The study included articles published between November 29, 2019 and December 25, 2020 and evaluated views and downloads through February 9, 2021 using standard bibliometrics. We conducted network analysis with VOSviewer software.

Results: There were 283 articles from 101 institutions published in China CDC Weekly during the analysis period, among which 22 (21.8%) institutions were overseas institutions. There were 220 unique first authors, with 1.28 articles per first author. There were 2,404,882 views and 58,760 downloads in total. The article with the highest view and download counts had 1,244,826 views and 38,978 downloads. Article types with more than 4,500 views per article were Vital Surveillance, Notes from the Field, and Preplanned Studies. Subjects with more than 3,500 views per article were epidemiology of infectious diseases, epidemiology of non-infectious diseases, and maternal and child health. Articles with descriptive research and articles discussing public health monitoring received more attention, shown by larger average per article page views.

Discussion: Study results can help the editorial department improve the journal’s international influence through targeted measures, such as adjusting article types according to view and download analyses and increasing the proportion of international manuscripts selected.

Attitudes and beliefs towards implementation of nurse prescribing among general nurses and nurse specialists in China: A cross-sectional survey study

Aims

To investigate the attitudes and beliefs towards the implementation of nurse prescribing among general nurses and nurse specialists.

Design

A cross‐sectional survey among general nurses and nurse specialists was conducted in seven provinces and one autonomous region in mainland China using convenience sampling method.

Methods

The attitudes and beliefs towards nurse prescribing were assessed using the Nurse Attitudes and Beliefs towards Nurse prescribing scale, of which Cronbach's coefficient was 0.902, retest reliability was 0.808. Respondents from eight hospitals across the country were employed to complete an online questionnaire.

Results

Nurse specialists (n = 399) had statistically significantly more favourable intentions towards nurse prescribing than general nurses (n = 415; 105.64 ± 12.83 vs. 96.39 ± 13.16; p < .001). The years of clinical work experience, professional title, education degree were positively correlated with general nurses' and nurse specialists' attitudes and beliefs towards nurse prescribing (p < .05). Among nurse specialists, the variety of specialties and whether they work in nurse‐led clinics on an outpatient basis have positively influence on their intentions towards nurse prescribing (p < .05).

Educators' perceptions and views of problem-based learning through simulation

Background

The real-world problems and ever-changing challenges currently confronting the future of nursing education and healthcare require a problem-based learning approach using simulation strategy. This is exacerbated by the increasing burden of diseases such as tuberculosis, human immunodeficiency virus and acquired immune deficiency syndrome (HIV and AIDS) and more recently the coronavirus disease 2019 (COVID-19) pandemic, as well as advancing technology and changing regulations and policies. Problem-based learning is a student-centred learning strategy, where students are presented with situations drawn from practice, which can be used to bridge the theory–practice gap.

Objectives

To explore the perceptions and views of healthcare educators on how problem-based learning can be facilitated through simulation.

Method

A qualitative, exploratory, descriptive and contextual research design was used. Thirteen educators from the Faculty of Health Sciences of the University of Johannesburg, with 5 years’ teaching experience, were purposively selected from the Dean’s office, the Nursing Department, emergency medical care and the departments of podiatry, somatology and radiography. The participants were selected based on their extensive knowledge of problem-based learning and the use of simulation. Data were collected through in-depth, individual, semi-structured interviews. Thematic analysis provided six themes and 13 related sub-themes. The article focuses on the perceptions and views of educators regarding problem-based learning through simulation.

Results

Problem-based learning through simulation allows students to work together in teams, which demonstrates a new modus operandi and renders a holistic approach to patient care.

Conclusion

Problem-based learning through simulation should be utilised to encourage reflective knowledge exchange. Students from various departments can learn about new innovations, creativity and develop critical thinking when solving complex health-related problems.

Immediate and Persisting Effects of Controversial Media Information on Young People's Judgement of Health Issues

Whether true or false, media information shapes people’s thinking. False information trigger beliefs which could compromise health behaviour. In this intervention study, the effect of controversial messages on 91 young participants’ judgement of health issues was tested. Held opinions about health-related issues were assessed before, after and one week after viewing a controversial TV-interview. Using pre-interview opinions for baseline, changes in judgements were assessed immediately after and one week after the interview. At both times, the opinions differed statistically significantly from baseline (p < .001). The relationship between opinions immediately- and one week-after viewing the interview was statistically significantly stronger (p < .001) than their association with the baseline. The results provide evidence for immediate change in judgment resulting from controversial information and demonstrate that the change persists for at least one week. The findings can be explained based on the schema theory and suggest that controversial information could have powerful impact on subjective judgement. Consequently, young people need to be educated in health issues and in the evaluation of media information to enable them to make the right choice when the need arises.

The Perceptions and Views of Rural Residents Towards COVID-19 Recovered Patients in China: A Descriptive Qualitative Study

Introduction

With the effective treatments of novel coronavirus disease 2019 (COVID-19), thousands of patients have recovered from COVID-19 globally. The public perceptions and views are vital to facilitate recovered COVID-19 patients reintegrate into society. In China, the rural population accounts for nearly 70% of the total population. Therefore, we chose to evaluate perceptions and views of rural residents towards COVID-19 recovered patients in China.

Methods

Fifteen participants were sampled from a village with the severe COVID-19 epidemic in Zibo city, Shandong Province. The fifteen participants who lived in the village with COVID-19 recovered patients were included. They were over 18 years of age and were voluntary to participant in the study. A descriptive qualitative design using semi-structured telephone interviews was undertaken. Thematic analysis was undertaken.

Results

Five main themes emerged from the data: (1) Perceived personal characteristics of COVID-19 recovered patients; (2) Perceived difficulties faced by COVID-19 recovered patients; (3) Perceptions on the social relationship with COVID-19 recovered patients; (4) Views on COVID-19 recovered patients going to public venues; (5) Views on helping COVID-19 recovered patients. Each theme was supported by several subthemes.

Conclusion

Our study showed that discrimination and reduced social intimacy exist among rural residents. To improve their views or the situation, relevant departments could lead health educational programs and encourage supportive social connections. Through these strategic messaging, rural residents are expected to recognize that COVID-19 recovered patients need more social support, rather than discrimination and resistance, which helps recovered patients better return to society.

Divergent and Convergent Attitudes and Views of General Practitioners and Community Pharmacists to Collaboratively Implement Antimicrobial Stewardship Programs in Australia: A Nationwide Study

Setting up an interprofessional team for antimicrobial stewardship (AMS) to improve the quality and safety of antimicrobial use in primary care is essential but challenging. This study aimed to investigate the convergent and divergent attitudes and views of general practitioners (GPs) and community pharmacists (CPs) about AMS implementation and their perceived challenges of collaboration to design a GP–pharmacist collaborative AMS (GPPAS) model. Nationwide surveys of GPs and CPs across Australia were conducted January-October 2019. Chi square statistics and a theoretical framework were used for comparative analyses of quantitative and qualitative data, respectively. In total, 999 participants responded to the surveys with 15.4% (n = 386) response rates for GPs and 30.7% (n = 613) for CPs. GPs and CPs were aware about AMS however their interprofessional perceptions varied to the benefits of AMS programs. CPs indicated that they would need AMS training; significantly higher than GPs (GP vs. CP; 46.4% vs. 76.5%; p < 0.0001). GPs’ use of the Therapeutic Guideline Antibiotic was much higher than CPs (83.2% vs. 45.5%; p < 0.0001). No interprofessional difference was found in the very-limited use of patient information leaflets (p < 0.1162) and point-of-care tests (p < 0.7848). While CPs were more willing (p < 0.0001) to collaborate with GPs, both groups were convergent in views that policies that support GP–CP collaboration are needed to implement GPPAS strategies. GP–pharmacist collaborative group meetings (54.9% vs. 82.5%) and antimicrobial audit (46.1% vs. 86.5%) models were inter-professionally supported to optimise antimicrobial therapy, but an attitudinal divergence was significant (p < 0.001). The challenges towards GP–CP collaboration in AMS were identified by both at personal, logistical and organisational environment level. There are opportunities for GP–CP collaboration to improve AMS in Australian primary care. However, strengthening GP–pharmacy collaborative system structure and practice agreements is a priority to improve interprofessional trust, competencies, and communications for AMS and to establish a GPPAS model in future.

Investigating Nurses' Views on Care of Mentally Ill Patients with Skin Injuries

Background: Individuals with mental illness are at increased risk of skin injuries. The role of nurses in skin injury prevention and management is crucial and therefore their views on wound care may provide useful information for improving the quality of the care provided. Aim: To investigate nurses’ views on care of mentally ill patients with skin injuries. Method: A qualitative research design based on the principles of grounded theory approach was followed. Unstructured interviews were conducted with seven nurses working in psychiatric wards with frequent skin injuries. Data were analyzed using the constant comparative method of analysis. Results: Two main themes were emerged from data analysis. The first main theme, namely factors affecting the care of patients with skin injuries, included seven categories: (a) shortage of hospital supplies, equipment and services (b) staff shortages, (c) lack of knowledge, (d) nurses’ resistance to change, (e) difficulty in collaborating with patients, (f) patients’ physical conditions and (g) nurses’ attitudes as an obstacle to care. The second main theme, namely nurses’ suggestions for optimizing care, included five categories: (a) need for additional staff, (b) need for increasing hospital supplies and equipment availability, (c) need for training (d) need of changing nurses’ attitudes towards care and (e) need of changing the patients’ approach to collaboration. Conclusion: The care of mentally ill patients with skin injuries is affected by multidimensional factors that have a direct impact on the quality of nurses’ work and patients’ hospitalization. Specific efforts are needed to overcome the obstacles that hinder the care provided and to improve clinical practice.

I am the person who knows myself best: Perception on shared decision-making among hospitalized people diagnosed with schizophrenia in China

Shared decision-making is related to better health outcomes in serious mental illness. It is not well addressed in non-Western cultures, for example Chinese culture. Chinese could be influenced by both paternalism and familism when making treatment decisions. However, this is unexplored. The study purpose is to explore shared decision-making from perspectives of inpatients diagnosed with schizophrenia in China. This study adopted qualitative descriptive approach. Through semi-structured interviews, twelve participants from the psychiatry department of a tertiary hospital shared their perceptions of shared decision-making. An inductive thematic approach was used to analyse the transcripts. Primary results included three main themes with nine subthemes: (1) Having a positive attitude: i) wanting my voice to be heard, ii) needing my family to be involved, and iii) preferring the psychiatrist to decide; (2) Feeling excluded: i) having limited financial capacity, ii) lacking interactive communication, iii) too few psychiatrists, and iv) being unsatisfied with informed consent process; and (3) Self-motivation in decision-making by: i) easing the burden on the family and ii) actively collecting health information. In this context, patients have fewer treatment options and a limited role in SDM. Yet, they have preference for SDM, actively seeking health information from mental health professionals particularly nurses.

Uncertainties, Fear and Stigma: Perceptions of Zika Virus among Pregnant Women in Spain

Similar to other epidemics, knowledge about Zika virus (ZIKV) relies upon information often coming from outside the health system. This study aimed to explore views, perceptions and attitudes towards ZIKV among migrant women from Central and South America, diagnosed with ZIKV infection during pregnancy, and to comprehend healthcare professionals’ perceptions of ZIKV. An exploratory qualitative study, based on phenomenology and grounded theory, was conducted in Barcelona, Spain. Data were collected through in-depth and paired interviews with women diagnosed with ZIKV infection during pregnancy, and semi-structured interviews with healthcare professionals. Women showed good level of awareness of ZIKV, despite some knowledge gaps. The most consulted source of information about ZIKV was the Internet. Women expressed they suffered from anxiety and depression due to potential effects of ZIKV on their babies. They conveyed their sources of support came primarily from their partners and relatives, as well as healthcare professionals. This study stresses the dramatic health, social and emotional burden that the epidemic imposed on migrant women infected with ZIKV during pregnancy. These results may help guide psychosocial support and health measures for pregnant women and their children as part of the public health emergency response in emergent epidemics.

Exploring the implementation of cognitive behaviour therapy for psychosis using the Normalization Process Theory framework

OBJECTIVE

Evidence suggests that only a minority of service users experiencing psychosis have access to Cognitive Behavioural Therapy for psychosis (CBTp). Normalization Process Theory (NPT) is a theoretical framework which focuses on processes by which interventions are implemented and normalized in clinical practice. This study explored the views and experiences of mental health professionals regarding the implementation of CBTp. Barriers and facilitators to implementation were explored using the NPT framework.

DESIGN

A qualitative methodology was adopted involving semi-structured focus groups and individual interviews.

METHODS

A total of 14 members of staff working in the community and crisis mental health teams were recruited. Thematic analysis was used to generate initial themes. The framework approach was utilized to map initial themes to the NPT framework.

RESULTS

Inductive coding generated five overarching themes consisting of 15 individual subthemes which captured the perceived barriers to engagement; contextual barriers to implementation; optimization of implementation; positive attitudes towards implementation; and expectations of implementing CBTp. All but two subthemes mapped on to the NPT framework. The deductive analysis suggested that difficulties in making sense of CBTp among professionals were reflected as service level barriers which impeded wider implementation.

CONCLUSION

The results of this study suggested a mixture of barriers and facilitators to CBTp implementation. Interpreting our findings within an NPT framework indicates the importance of strong clinical leadership to address difficulties in sense-making and service investment in CBTp.

PRACTITIONER POINTS

Findings indicate a mixture of barriers and facilitators to CBTp implementation. NPT analysis indicates difficulties in coherence among stakeholders regarding the purpose and value of CBTp. Difficulties making sense of CBTp translates into service level barriers and impede the collective action of stakeholders. The role of clinical leadership is crucial in increasing coherence and collective action in services.

The Impact of Optimized Daylight and Views on the Sleep Duration and Cognitive Performance of Office Workers

A growing awareness has recently emerged on the health benefits of exposure to daylight and views. Daylight exposure is linked to circadian rhythm regulation, which can have significant impacts on sleep quality and cognitive function. Views of nature have also been shown to impact emotional affect and performance. This study explores the impact of optimized daylight and views on the sleep and cognitive performance of office workers. Thirty knowledge workers spent one week working in each of two office environments with identical layouts, furnishings, and orientations; however, one was outfitted with electrochromic glass and the other with traditional blinds, producing lighting conditions of 40.6 and 316 equivalent melanopic lux, respectively. Participants in the optimized daylight and views condition slept 37 min longer as measured by wrist-worn actigraphs and scored 42% higher on cognitive simulations designed to test their higher order decision-making performance. Both sleep and cognitive function were impacted after one day in the space, yet the impacts became more significant over the course of the week. The positive effect of optimized daylight and views on cognitive function was comparable for almost all participants, while increases in sleep duration were significantly greater for those with the lowest baseline sleep duration. This study stresses the significance of designing with daylight in order to optimize the sleep quality and performance of office workers.

Saudi medical students' views on obstetrics and gynecology as a future career specialty

Background:

The specialty of obstetrics and gynecology is showing a widening gap between the vacant positions and the number of applicants as reported by the Saudi Commission for Health Specialties (SCFHS). This study was conducted to explore the medical students’ views on obstetrics and gynecology as a future career and identify factors influencing these views.

Methods:

An observational survey was conducted on 148 medical students in years 5 and 6 at Jazan University between June 2019 and July 2019. Participants completed a self-report online questionnaire covering their sociodemographic details, interest in obstetrics and gynecology, and views on the specialty.

Results:

Overall, obstetrics and gynecology was selected as the first specialty choice by 8.8% and second choice by 17.6%. Intention to take a career in obstetrics and gynecology was associated with female sex (P = 0.01). While over half of the participants emphasized the merits of obstetrics and gynecology as exciting, interesting, and challenging, over 40% viewed the specialty as stressful, over one-third described it as demanding, and over one-quarter appreciated its riskiness.

Conclusion:

This study showed that 8.8% of the respondents chose obstetrics and gynecology as their first career choice. Sex was the only factor influencing the views of medical students on the specialty, with more females favoring the specialty than males. To improve its appeal, students should be supplied with more information about the specialty and its training opportunities, as well as exposure to areas of special interest.

Practical nursing students' discursive practices on smoking in Finland

Purpose: Based on focus groups, we analyse how practical nursing students deal with being as smokers and future healthcare workers. The way they justify their smoking is discussed within a group of peers.

Methods: The study has a qualitative design with an inductive approach using focus group interviews (FGIs) for data collection. A total of 29 students were interviewed in five groups of five and one group of four participants.

Results: In the analysis, we found four different discursive practices the students utilized for rationalizing their own smoking and coping with the moral dilemma of smoking in a context of health care where smoking is forbidden: (1) students normalized smoking with references to its prevalence within their social circles, (2) the students asserted that their smoking was under control, (3) students considered themselves responsible smokers, and (4) students identified smoking as a part of their identity.

Conclusion: Training should support the growth of professional identity and address the smoker’s identity right from the start of education. Smokers need special attention in the formulation of professional identity, however, without being stigmatized any further.

Internet-based pharmacy and centralised dispensing: an exploratory mixed-methods study of the views of family practice staff

OBJECTIVES

Over the last decade, technological advances, market competition and increasing pressures for efficiencies across healthcare systems have resulted in changes to the processes and policies involved in medicines prescribing and dispensing. The aim of this study was to explore the views of family practice staff, including GPs, on the perceived impact of changes associated with remote dispensing and the increasing availability of distance-selling pharmacies.

METHODS

Exploratory mixed-methods study using qualitative focus groups and an online cross-sectional survey distributed to a non-probability sample of staff from family practices across England. Survey items were developed based on existing literature and initial thematic analysis from the focus groups and adapted using cognitive interviewing techniques.

KEY FINDINGS

Findings suggest that family practice staff believe that where and how prescriptions are dispensed impacts on their practice and patients. Frequent contact with distance-selling pharmacies is not common; however, highlighted concerns included patient safety issues and the potential threat to the loss of valued elements and sustainability of community pharmacy and dispensing practices. Identified concerns and experiences are unlikely to be routinely discussed within or between practices, limiting opportunities for shared learning and consideration of the potential impact of changes to dispensing processes and policies.

CONCLUSIONS

Further research is needed to confirm these exploratory findings, due to the low response rate and sample size. Findings, nevertheless, highlight how wider changes in dispensing processes may have unintended consequences on other aspects of the healthcare system.

Challenging behaviours: Views and preferences of people with intellectual disabilities

Background

Challenging behaviour is a common problem among people with ID and in services for people with ID. This paper aims to provide an overview of the views and preferences of people with ID on challenging behaviour.

Method

Semi‐structured interviews were conducted with thirteen adults with mild to moderate ID and seven proxies (family or close associates of adults with ID who were unable to communicate and/or with severe or profound ID) in the Netherlands. The interviews were audio‐recorded, transcribed and analysed thematically.

Results

People with ID and (a history of) challenging behaviour have clear views and preferences on factors related to challenging behaviour, assessments, non‐pharmacological and pharmacological interventions and health professionals’ approach.

Conclusions

The identified views and preferences of people with ID are not always in accordance with current procedures and treatments for challenging behaviour and should be included in future care processes and research.

Transitional Experiences of Internationally Qualified Midwives Practicing in Australia: Protocol for a Mixed Methods Study

Background

Approximately 13% of the total Australian midwifery workforce is internationally qualified. Although the internationally qualified midwives (IQMs) play a significant role in the Australian midwifery system, there is limited understanding of their transitional experiences.

Objective

The objective of this study protocol is to explore the transitional experiences and views of IQMs practicing in Australia, through the investigation of demographic profiles and key challenges that influence a smooth transition.

Methods

This paper presents an explanatory sequential mixed methods study protocol. This protocol incorporates an e-survey and individual interviews. The e-survey in the first phase will be distributed to IQMs in Australia via the website e-bulletins of the Australian Nursing and Midwifery Federation and the Australian College of Midwives. Additionally, potential respondents will be recruited via social media (ie, Twitter and Facebook) and associated snowball sampling. Data from the e-survey will be statistically analyzed. At the end of the e-survey, respondents will be asked whether they are willing to take part in an interview. The results of the e-survey and relevant literature review will help to develop a guideline for interview questions for the second phase. In phase two, a purposeful sample of participants will be recruited using the same selection criteria as for the e-survey. Semistructured interviews will provide a deeper insight into the transitional experiences of IQMs. Data from the interviews will then be thematically analyzed.

Results

An integration of the e-survey results (phase one) and interview findings (phase two) will be synthesized to explore and better understand the transitional experiences of this group of midwives. It is anticipated that data collection and analysis will be completed by June 2019 and results will be disseminated through peer-reviewed publications in late 2019.

Conclusions

This research protocol may generate new knowledge about the transition of IQMs in Australia. These findings could be used to formulate recommendations to inform the transition of future IQMs in Australia.

International Registered Report Identifier (IRRID)

DERR1-10.2196/13406

Physician View and Experience of the Diagnosis of Autism Spectrum Disorder in Young Children

Introduction: Clinicians working with children with autism spectrum disorder (ASD) occupy an important position between parents and the wide-ranging research findings. However, it is not widely known how clinicians view and experience ASD in children, even though their perspective has been shown to significantly influence their work. Material and methods: Sixteen physicians working with preschool children without a diagnosis of (intellectual or other) disability with a (presumed) diagnosis of ASD participated in a semistructured interview. They described their professional views on ASD, and how they experienced its use in their clinical practice. The data were analyzed by applying the qualitative research method of interpretative phenomenological analysis of the data through Nvivo 11. Results: The main topic of the interviewed physicians' views and experiences of ASD in a young child comprised three inductively established themes: 1) physicians' views on ASD are multifaceted but fit within their personal clinical styles; 2) the ASD diagnosis is a "descriptive" part of a clinical trajectory; and 3) ASD treatment is a mix of "standard" approaches and a personalized search. These physicians' perspectives on ASD are composed of multiple and sometimes ambiguous facets. However, their views are embedded in their personal clinical styles in general (i.e., beyond ASD) and are experienced as clinically "workable." With the aim of finding an adequate approach to the problems parents bring to their office, many interviewed physicians say that-complementary to or rather than a classificatory diagnosis-they prefer using a personalized "profile" of a child in a therapeutic "process." Conclusions: The interviewed physicians consider doubts and concerns to be an inherent part of their clinical work with ASD in young children, but do not experience this ambiguity as an obstacle to clinical care. These physicians deal with the multiplicity of their views on ASD by basing their eclectic views on their generally adopted clinical styles, and by selecting what works for them, and for the parents and child, from what they regard as the 'textbook knowledge' on ASD. We discuss the implications of these findings for translating research results to the clinic.

Perceptions of Australian physiotherapy students about the potential implementation of physiotherapist prescribing in Australia: a national survey

OBJECTIVES

To explore the perceptions of Australian physiotherapy students about (1) the potential implementation and use of non-medical prescribing by physiotherapists in Australia and (2) how physiotherapist prescribing might impact the care that the physiotherapy profession can provide in the future.

DESIGN

A cross-sectional descriptive survey of physiotherapy students across Australia was completed using an online questionnaire developed by subject-experts and pretested (n=10) for internal consistency. A hyperlink to the questionnaire was emailed to all students enrolled in any accredited, entry-level Australian university physiotherapy programme. A reminder email was sent 4 weeks later.

SETTING

Participants completed an online questionnaire.

PARTICIPANTS

526 physiotherapy students from universities across all states with entry-level programmes.

OUTCOME MEASURES

Quantitative data underwent primary descriptive analysis. Thematic analysis was used to synthesise qualitative data.

RESULTS

87% of participants supported the introduction of physiotherapist prescribing in Australia. 91% of participants stated that they would train to prescribe following introduction. Participants identified improvements in clinical and cost effectiveness, timely access to appropriate prescription medicines and optimisation of quality healthcare as key drivers for the introduction.

CONCLUSIONS

Student physiotherapists support the introduction of physiotherapist prescribing in Australia, reporting potential benefits for patients, health services and the physiotherapy profession. Stakeholders should use the results of this study in conjunction with supporting literature to inform future decisions regarding physiotherapist prescribing in Australia.

Perceptions about the implementation of physiotherapist prescribing in Australia: a national survey of Australian physiotherapists

OBJECTIVES

To explore: (1) the views of Australian physiotherapists regarding potential implementation of non-medical prescribing in Australia, (2) how the geographical location and health sector in which a clinician works may influence their perceptions and (3) the perceptions of Australian physiotherapists about how physiotherapist prescribing might impact the care that the profession can provide.

DESIGN

A cross-sectional descriptive survey using open and closed questions.

SETTING

Participants completed an online questionnaire.

PARTICIPANTS

883 Australian Health Professionals Registration Authority (AHPRA)-registered physiotherapists, working across all states and territories.

OUTCOME MEASURES

An online questionnaire was developed by a panel of subject experts and pretested (n=10) for internal consistency. A hyperlink to the questionnaire was emailed to all members of the Australian Physiotherapy Association. A reminder email was sent 4 weeks later. Quantitative data were analysed descriptively, with use of absolute risk reductions (ARRs) and 95% CIs to determine the likelihood that health sector or geographical location were associated with specific views. Thematic analysis enabled synthesis of the qualitative data.

RESULTS

79.0% participants felt that physiotherapist prescribing should be introduced in Australia, with 71.2% wanting to train as prescribers. Clinical governance, risk management, regulation of clinicians and the development of an education framework were identified as priorities for implementation. Participants working in the private sector were significantly more likely to train as prescribers than those in the public sector (ARR 9.9%; 95% CI 3.5 to 16.4) or educational/research institutions (ARR 23.3%; 95% CI 12.8 to 33.8), with city dwellers significantly more likely to train compared with physiotherapists in remote regions (ARR 19.8%; 95% CI 0.8 to 39.2). Physiotherapist prescribing was predicted to improve efficiency of healthcare delivery, access to medicines and reductions in healthcare costs.

CONCLUSIONS

AHPRA-registered physiotherapists perceive that the introduction of autonomous physiotherapist prescribing would be beneficial for the Australian population and should be introduced. Decision makers should consider the results of this survey in conjunction with cost-benefit and risk analysis when planning the introduction of physiotherapist prescribing.

Views of nurses and other health and social care workers on the use of assistive humanoid and animal-like robots in health and social care: a scoping review

BACKGROUND

Robots are introduced in many health and social care settings.

OBJECTIVES

To provide an overview of the existing evidence related to the views of nurses and other health and social care workers about the use of assistive humanoid and animal-like robots.

METHODS

Using the Joanna Briggs Institute guidelines we searched MEDLINE, PUBMED, CINHAL, EMBASE, PsycInfo, Web of Science, and IEEE Xplore digital library. Nineteen (19) articles met the criteria for inclusion.

RESULTS

Health care workers reported mixed views regarding the use of robots. They considered an array of tasks that robots could perform; they addressed the issue of patient safety and raised concerns about privacy.

CONCLUSIONS

A limited number of studies have explored the views of health care workers about the use of robots. Considering the fast pace with which technology is advancing in the care field, it is critical to conduct more research in this area. Impact Statement: Robots will increasingly have a role to play in nursing, health and social care. The potential impact will be challenging for the healthcare workforce. It is therefore important for nurses and other health and social care workers to engage in discussion regarding the contribution of robots and their impact not only on nursing care but also on future roles of health and social care workers.

The views of early intervention service staff on the treatment of first episode bipolar disorder

OBJECTIVE

Little is known about how first episode bipolar disorder (BD) is managed in early intervention for psychosis services (EIS). We aimed to investigate the knowledge and views of EIS staff on the assessment and treatment of BD.

METHODS

A 27-item anonymised online questionnaire was distributed to EIS mental health professionals in England. Descriptive data analysis was undertaken.

RESULTS

Responses were received from 117 EIS staff. Most were 'fairly confident' in their knowledge about causes, presentations and relapse indicators of BD, but less confident on pharmacological and psychological treatments. Eighty five percent expressed the view that more BD training was necessary in this area with 78% reporting no clear care packages within the service. Seventy two percent believe early BD should be treated within EIS only if patients have psychosis.

CONCLUSIONS

Clearer care packages and staff training are needed for EIS staff to optimise care for BD.