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Acquiring information about one's child's cancer diagnosis is a complex and ever-changing process, and parents' needs change over time. As yet, we know little about what information parents require at different stages of their child's illness. This paper is part of a larger randomized control trial studying the parent-centered information given to mothers and fathers. The aim of this paper was to describe the topics addressed in person-centered meetings between nurses and parents of children with cancer and how those changed over time. Using qualitative content analysis, we analyzed nurses' written summaries of 56 meetings with 16 parents and then computed for each topic the percentage of parents who brought it up at any time during the intervention. The main categories were Child's disease and treatment (addressed by 100% of parents), Consequences of treatment (88%), Emotional management for the child (75%), Emotional management for the parent (100%), Social life of the child (63%), and Social life of the parent (100%). Different topics were addressed at different points in time, and fathers raised more concerns about the child's emotional management and the consequences of treatment than mothers. This paper suggests that parental information demands change over time and differ between fathers and mothers, implying that information should be person-centered. Registered at Clinicaltrials.gov (NCT02332226). [ABSTRACT FROM AUTHOR]

This qualitative study is part of a project aiming to evaluate a community-based approach to the delivery of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) through community health workers (CHWs) in four sub-Saharan African countries: the Democratic Republic of Congo (DRC), Madagascar, Mozambique and Nigeria. The study aimed to understand the factors that influence the anticipated acceptability of this intervention. A total of 216 in-depth interviews and 62 focus group discussions were carried out in the four country sites with pregnant women, women of reproductive age, community leaders, pregnant women's relatives, CHWs, formal and informal health providers. Grounded theory guided the study design and data collection, and content and thematic analysis was performed through a comparative lens. This paper focuses on one crosscutting theme: trust-building. Two mechanisms that underpin communities' trust in delivery of IPTp via CHWs were identified: 'perceived competence' and 'community and healthcare system integration'. Communities' perception of CHWs' competence shapes their trust in them, which suggests that CHWs' credentials should be made public and that specialised training in maternal health is required for them. Integration depends on the promotion of socially embedded practices and the involvement of formal healthcare systems in CHWs' work. [ABSTRACT FROM AUTHOR]

Understanding Twitter by individuals and organizations to raise awareness and give voice to the disability community provides important insight into digital discourse around disability. This study examines #disability tweets shared during National Disability Employment Awareness Month in October 2018. Sourced and cleaned, English language tweets (n = 12,963) were analyzed through a mixed-methods approach. As the title of this paper, a tweet from our dataset, suggests, Twitter discourse reflects disability activism and culture as it exists globally. This work highlights important methodological considerations for differentiating the ways individuals and organizations utilize Twitter and highlights the importance of qualitative analysis in this regard. [ABSTRACT FROM AUTHOR]

Tenant experience surveys are a key tool for social housing landlords to gauge their success in providing high quality housing. This paper examines feedback from a tenant experience survey facilitated in a low-income housing seniors' housing community to: (1) examine their perceptions of their housing across key domains related to tenant satisfaction; and (2) identify opportunities they felt would improve their housing experience. A total of 1,114 households completed the survey. Results showed that tenants generally had high satisfaction with property management, safety and security, communication with staff, access to services, community support, and tenancy management. However, open-ended comments from tenants highlighted specific situations that negatively impacted their housing, including maintenance issues, safety concerns, and limited access to health and social programs. Findings point to several suggestions for social housing providers to enhance their services to foster inclusive, supportive, and safe housing environments for low-income older adults. [ABSTRACT FROM AUTHOR]

Increasing scholarly attention has been paid to the reproductive injustices experienced by Indigenous women. However, the breastfeeding experiences of Indigenous women have infrequently been explored. This study uses a qualitative description research approach to explore the breastfeeding experiences of Indigenous women members of a non-federally recognized tribe in the Gulf South. Key themes included: 1) Shifting generational practices; 2) Lack of institutional resources; 3) Inadequate support from healthcare providers; and 4) Institutional and community supports for breastfeeding. These findings highlight the need for increased institutional and community support, and breastfeeding education, so that Indigenous women can reach their breastfeeding goals. [ABSTRACT FROM AUTHOR]

Non-communicable diseases including type 2 diabetes (T2D) are increasing rapidly in most Sub-Saharan African (SSA) countries like Uganda. Little attention has been given to how patients with T2D try to achieve treatment when the availability of public health care for their disease is limited, as is the case in most SSA countries. In this paper we focus on the landscape of availability of care and the therapeutic journeys of patients within that landscape. Based on fieldwork in south-western Uganda including 10 case studies, we explore the diabetes treatment options in the area and what it takes to access the available treatment. We analyse the resources patients need to use the available treatment options, and demonstrate that the patients’ journeys to access and maintain treatment are facilitated by the knowledge and support of their therapy management groups. Patients access treatment more effectively, if they and their family have money, useful social relations, and knowledge, together with the capacity to communicate with health staff. Patients coming from households with high socio-economic status (SES) are more likely to have all of these resources, while for patients with low or medium SES, lack of economic resources increases the importance of connections within the health system. [ABSTRACT FROM PUBLISHER]

The purpose of this paper was to describe romantic relationships from the perspective of urban, adolescent girls, to address gaps in our understanding of their relationship dimensions. Minority adolescent girls ( n  =  17) participated in private semi-structured interviews aimed to elicit the understanding of the adolescents' perspectives on their own relationship experiences and dynamics. The research team conducted conventional content analysis of the interview transcripts. Four major themes emerged about romantic relationships: (1) influence of male pursuit and social norms on relationship initiation factors; (2) a romantic partner is a confidant, friend, and companion; (3) negotiating intimacy respectfully; and (4) relationship conflict through control and abuse. Adolescents described sub-themes of social norms of male pursuit and relationship pressures that dictated relationship initiation. Relationships were depicted by emotional support, caring, and companionship. Adolescents described positive negotiation skills. However, relationship conflict, including controlling behaviors and violence, was illustrated in these same relationships. This study provides a rich description of romantic relationships from the perspectives of urban, adolescent girls. Most salient findings included social pressures and a combination of both positive and negative attributes. Implications include the need for intervention development at the community level to address social pressures, recognition of positive adolescent relationship attributes, and facilitation of skills to identify and address low-quality relationship characteristics. [ABSTRACT FROM AUTHOR]

Rates of HPV infection and HPV-related cancers are elevated in the Black population of the US. Efforts to promote HPV vaccination and cervical cancer screening are important to reducing the cancer burden among Black populations. The purpose of this qualitative descriptive study guided by social ecological model (SEM) was to describe from the perspective of key informants, the challenges and opportunities for HPV vaccination and cervical cancer screening promotion among Black adults. Twenty-three key informants participated in individual interviews over zoom video conferencing. The sessions were audio-recorded, transcribed verbatim, and checked for accuracy prior to data analysis. Two qualitatively trained researchers analyzed the data using content analysis. Participants were aged 50 ± 4.1 years, 12 were females, and 18 identified as Black. Participants included health care providers, teachers, church and community leaders. Themes included HPV and cancer literacy, influence of religion, health care provider recommendations, social and cultural influences, accessibility and availability of services, economic constraints, limited community resources, and HPV vaccine mandates. SEM factors contribute to low HPV vaccine uptake and cervical cancer screening and these factors need to be addressed. Interventions addressing SEM factors peculiar to Black populations may promote HPV vaccination and cancer screening in this population. [ABSTRACT FROM AUTHOR]

The purpose of this study was to identify clinician knowledge regarding manual wheelchair (MWC) training in an inpatient rehabilitation (IPR) setting, identify current MWC education provided to new manual wheelchair users (MWUs), and determine how MWC training resources can be developed or modified to promote use among IPR clinicians. Semi-structured interviews were conducted with 20 licenced IPR clinicians who work with MWUs. Using a traditional qualitative research design, researchers completed open, data-driven coding of interview transcripts. Overarching themes were determined through content analysis. Participants included 12 physical therapists, six occupational therapists, one physical therapy assistant, and one occupational therapy assistant. Five themes emerged from the interviews: (1) clinician knowledge, education, and experience (2) current training content (3) training environment, (4) desired programme components (5) barriers to implementation. Participants reported receiving minimal education in school and from their employers on training MWUs. While clinicians expressed the importance of MWU education, they used varying training approaches with little standardization. Participants identified that training protocols for IPR are beneficial if they are quick, straightforward, and flexible. While MWC training occurs during IPR stays, it appears to be inconsistent across facilities, clinicians, and patients, with varying degrees of adherence to evidence-based practices. This is likely due to limited feasibility and awareness of existing MWC training resources. Clinician input gathered from these interviews provides information for how to best integrate MWC training programmes into the rehabilitative process. Findings may inform the development and assessment of more clinically feasible MWC training protocols. New manual wheelchair users must learn numerous wheelchair-related skills in order to participate in everyday life activities. Manual wheelchair education for new users during inpatient rehabilitation is often inconsistent across facilities, clinicians, and patients, with varying degrees of adherence to existing evidence-based practices. Systematic challenges often act as a barrier to the implementation of more comprehensive, structured manual wheelchair training protocols. Manual wheelchair training resources must be concise, flexible, customisable, and easy to follow in order to promote increased implementation among inpatient rehabilitation clinicians. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic affected health and well-being worldwide, but little is known about how the pandemic specifically impacted families with young children. Evidence suggests a relationship between well-being and health behaviors (diet, physical activity) and that preexisting health disparities were exacerbated during the pandemic. This project sought caregiver perspectives on pandemic impacts, overall and by race, ethnicity, urbanicity, and household income. Caregivers of 4- to 11-year-olds were randomly selected to complete a mixed-mode survey in the winter of 2021–22 to evaluate ongoing community health education and programming. Qualitative content analysis of open-ended survey responses was conducted. Data were analyzed blind to demographic characteristics; later, differences by population were explored. Survey analysis (n = 1,429, response rate 27%) identified positive and negative impacts of the pandemic on youth diet and physical activity. Caregivers, unprompted, provided responses about the interconnected impacts on mental and physical health and health behaviors. Pandemic stress was described, including reduced energy, social isolation, and "fear of spread." Significant differences by key characteristics were found. These findings reflect patterns that could underlie growing disparities. Translation to Health Education Practice: This work provides context for designing interventions that equitably promote healthy behaviors for young families. [ABSTRACT FROM AUTHOR]

The study's aim was two-fold: (1) to explore the experiences and perceptions of industry, academic, and research professionals concerning technologies used within aged care; and (2) to identify needs-led priorities for the future development and application of technologies within aged care. Global population ageing requires a recalibration of aged care policies, systems, and services to promote and support healthy ageing. It is expected that technology will play an important role in this regard. This study qualitatively assessed the landscape of technology use in aged care from the perspective of industry, academic, and research professionals. A purposefully designed cross-sectional survey collecting experiences, perspectives, and barriers about technology through open responses. Using convenience sampling, thirty-five participants completed an online survey between April and October 2020. A descriptive qualitative content analysis approach was used to analyse the written responses. Reporting of findings followed the EQUATOR's Standards for Reporting Qualitative Research checklist. Four themes were identified that characterised the use of technologies within aged care: (1) User Perceptions and Attitudes: wariness and reluctance to technology; (2) Systemic Issues within Aged Care: Under-resourced with opportunities for innovation; (3) Technology-Related Barriers: Equity, costs, privacy, integration, and interoperability and (4) Research Priorities: Co-design and integration of technology. The existing technology does not meet the needs of older people, aged care personnel and the system in general, which prevents its successful implementation and uptake. [ABSTRACT FROM AUTHOR]

There is building evidence that oesophageal screening (OS) should be considered a critical component of videofluoroscopic swallow studies (VFSS). This study surveyed Australian speech-language pathologists (SLPs) regarding current practices and perceptions of OS in VFSS. A 16–24 item online survey was distributed to Australian SLPs via relevant email forums. One response per site was requested. Survey questions explored experience and training in VFSS, skill and confidence with OS, OS protocol use, and pathways following OS. One hundred and one SLPs across all Australian states and territories responded, with 70% (n = 69/99) from metropolitan hospitals and 74% (n = 75/101) having more than five years' VFSS experience. While 69% (n = 70/101) of SLPs conducted OS, only half (n = 35/70) conducted OS routinely, and only 4% (n = 3/70) always used published OS protocols. Barriers to OS, for some participants, were concerns about scope of practice and confidence. This study confirms higher levels of OS in Australia compared to similar international surveys and provides rich data on the Australian context. Prescriptive clinical guidelines for OS, consensus regarding a preferred OS protocol, and specific OS training may clarify SLP scope of practice and improve SLP confidence and standardisation in OS. [ABSTRACT FROM AUTHOR]

To explore stakeholders' perceptions of the coordination of health and rehabilitation services for persons with disabilities in Sierra Leone. A qualitative study including seven focus group discussions with health, rehabilitation, and disability organisations stakeholders in Sierra Leone. Content analysis was used for data analysis. One theme emerged; poor governance in implementing disability policies, healthcare, and rehabilitation services, which included seven subthemes: insufficient implementation of healthcare policies for persons with disabilities; changes, lack of coordination and communication between ministries governing disability policies and rehabilitation services; need for accurate disability data and clinical record keeping; absence of funds and poor political priority to healthcare and rehabilitation services; continuous support for non-governmental organisations (NGOs) to provide healthcare and rehabilitation service delivery; lack of coordination between different healthcare and rehabilitation service providers and calling for increasing persons with disabilities capacity for greater inclusion in society. Increasing governmental prioritisation, and ensuring coordination and trust between donors, NGOs, and governmental programmes were keys for sustainable health and rehabilitation services. Stakeholders need to ensure national coverage and equally distributed health and rehabilitation services. Including rehabilitation services and assistive technology in the Free Healthcare Initiative would contribute to implementing the Disability Act. Political prioritisation of persons with disability (PWD) need to increase to provide national coverage and equally distributed health and rehabilitation services for PWD. To ensure access to rehabilitation services and access to basic assistive technology for PWD, the government of Sierra Leone could agree on basic rehabilitation services and a priority list of assistive devices to be distributed through rehabilitation centres and funded by the Free Health Care Initiative programme or the Sierra Leone health insurance scheme. To increase access to health services for PWD, the government of Sierra Leone could ensure inclusion of PWD in the Free Health Care Initiative programme. The government, donors, and organisations providing or funding health and rehabilitation services for PWD need to mobilise and coordinate resources better and be mutually held accountable to maximise the benefits of PWD resources. [ABSTRACT FROM AUTHOR]

We explored how Latino cultural values play a role in perceived caregiving experiences. We conducted a qualitative study that used individual, in-depth, semi-structured interviews with middle-aged and older Latinos who were primary caregivers of family members with Alzheimer's disease and related dementias (ADRD). The interview guide consisted of questions about participants' perceptions of family caregiving and interrelationships between the caregiver and care recipient. The interviews were recorded, translated, and transcribed verbatim. We performed direct content analysis. Participants were caregivers, 50–75 years old (n = 16), and the majority were female. We identified four cultural values that were salient to participants' caregiving experiences: (a) familismo, (b) fatalismo (c) marianismo, and (d) machismo. Latino cultural values influenced the role of caregiving and caregiving roles of family members with ADRD. Future research should consider these values as they affect different familial and health dynamics. [ABSTRACT FROM AUTHOR]

To evaluate feasibility of System Support Mapping (MAP), a systems thinking activity that involves creating a diagram of existing self-management activities (e.g. symptom management, health behaviors) to facilitate autonomous engagement in optimal self-management. One-arm pilot study of MAP in colorectal cancer survivors (NCT03520283). Feasibility of recruitment and retention (primary outcome), acceptability, and outcome variability over time. We enrolled 24 of 66 cancer survivors approached (36%) and 20 completed follow-up (83%). Key reasons for declining participation included: not interested (n = 18), did not perceive a need (n = 9), and emotional distress/overwhelmed (n = 7). Most participants reported that MAP was acceptable (e.g. 80% liked MAP quite a bit/very much). Exploratory analyses revealed a −4.68 point reduction in fatigue from before to 2 weeks after MAP exceeding a minimally important difference (d = −0.68). There were also improvements in patient autonomy (d = 0.63), self-efficacy (for managing symptoms: d = 0.56, for managing chronic disease: d = 0.44), psychological stress (d = −0.45), anxiety (d = −0.34), sleep disturbance (d = −0.29) and pain (d = −0.32). Qualitative feedback enhanced interpretation of results. MAP feasibility in colorectal cancer survivors was mixed, predominantly because many patients did not perceive a need for this approach. MAP was acceptable among participants and showed promise for improving health outcomes. [ABSTRACT FROM AUTHOR]

Orgasm coercion occurs when someone pressures a partner to orgasm by implying that not orgasming will have negative consequences. But what happens when the coerced partner refuses to go along with orgasm coercion? And how do perpetrators of orgasm coercion react? In the current study, we analysed 100 participants' (cisgender women, n = 66; cisgender men, n = 24; gender/sex minorities, n = 10) descriptions of refusing orgasm coercion during their most recent orgasm coercion encounter. We assessed how participants expressed refusals, perpetrators reacted to these refusals, and perpetrator reactions connected to relationship and psychological outcomes. Results showed that participants used a variety of refusal strategies that were positively- or negatively-valenced. Some perpetrators (31%) reacted in positive, understanding ways. However, most perpetrators (61%) reacted negatively or with more coercion when confronted. Of note, results suggested that whether perpetrators responded in positive vs. negative ways did not depend on participants' refusal strategies. We also found that positive perpetrator reactions were associated with positive relationship outcomes, but participants reported high negative psychological outcomes regardless of perpetrators' reactions. Findings support that perpetrators of orgasm coercion are not necessarily invested in partners' positive experiences and that orgasm coercion cannot be resolved through better communication. [ABSTRACT FROM AUTHOR]

Research suggests that women with intellectual and developmental disabilities are at increased risk for adverse pregnancy outcomes. Further, they report unmet perinatal care needs. This qualitative study examined clinician perspectives on barriers to providing perinatal care to women with intellectual and developmental disabilities. We conducted semi-structured interviews and one focus group with US obstetric care clinicians (n = 17). We used a content analysis approach to code data and analyse them for larger themes and relationships. the majority of participants were white, non-Hispanic, and female. Participants reported barriers providing care to pregnant women with intellectual and developmental disabilities across individual (e.g., communication challenges), practice (e.g., identification of disability status), and system levels (e.g., lack of clinician training). clinician training and evidence-based guidelines for perinatal care of women with intellectual and developmental disabilities as well as services and supports during pregnancy are needed. [ABSTRACT FROM AUTHOR]

With an official HIV infection rate of 18.5%, approximately one in five South Africans are HIV positive. Despite this prevalence, stigma and discrimination associated with being HIV positive is widespread. HIV-related stigma emanates from the fact that HIV is associated with risky behaviors such as drug use, sexual promiscuity, homosexuality and transactional sex. Participants were recruited through announcements in classrooms and during community meetings. Participants were selected if they knew someone who was discriminated against HIV as a result of being affected by HIV. The status of the participants was irrelevant. Seven focus group sessions were conducted with 62 participants. The results show that stigma is seen as a result of lack of HIV knowledge, with participants from rural areas showing more knowledge regarding HIV transmission and care as compared to urban participants. Most participants agreed that disclosure leads to more voluntary HIV testing, obtaining treatment and preventing further transmission of HIV. The results of this study provide indications that stigma can be mitigated by increasing knowledge of HIV prevention, targeted information campaigns in urban areas, and encouraging discussion about stigma and discrimination against the disease. Programmes should apply the Theory of Planned Behavior for the development of such interventions, take culture, creed, and other social affiliation into consideration. [ABSTRACT FROM AUTHOR]

More than 115 million women across the world are borrowers of microfinance loans. However, there is concern that women from poor backgrounds who take loans may suffer from multiple challenges of physical and mental health burdens. In this qualitative study we aimed to identify the types of health challenges faced by active women borrowers of microfinance loans. Open ended questions were asked from 442 women across seven cities and four provinces of Pakistan. Categories were developed through the content analysis approach using NVIVO. We have been able to identify thirteen different health challenges faced by poor women borrowers under two broad headings of "environmental factors" and "healthcare delivery system." We recommend the introduction and expansion of different health and social development services by microfinance provider's to support the health needs of poor women clients. Women also need support from the Government of Pakistan in improving access to education, health coverage, and formal sector work opportunities. Our study implies increased health policy support for disadvantaged women borrowers of microfinance across the world. [ABSTRACT FROM AUTHOR]

Gender equity is an important element of health promotion and is vital to ensuring that the benefits and burdens of participation in health promotion activities are fairly distributed. Yet, the gendered consequences of participatory interventions are often overlooked. This is particularly relevant for water and sanitation initiatives, given that women are generally responsible for maintaining domestic hygiene and procuring water. This study uses a qualitative approach to assess the gender dynamics of participation in community-led total sanitation (CLTS) activities in Mpwapwa District, Tanzania. We used semi-structured interviews and focus-group discussions to investigate men's and women's involvement in health promotion initiatives and their key motivators for and challenges to participation. We interviewed 77 community members from four villages and analysed the responses using qualitative content analysis. The study supports the notion that participation reinforces gender inequity and reproduces gendered norms due to activity-specific participation, women's passive participation within activities, and their limited opportunities for decision-making. However, there were also indications that participation provided a platform to increase the status of women, prioritise women's needs and demand a stronger position in decision making within the household and the community. CLTS organisers should, therefore, harness the opportunity to address gender inequalities within the community. [ABSTRACT FROM AUTHOR]

Patients have responded in variable ways to pain science education about the psychosocial correlates of pain. To improve the effectiveness of pain education approaches, this study qualitatively explored participants' perceptions of and responses to pain science education. We conducted a qualitative content analysis of interviews with fifteen, adult patients (73.3% female) who had recently attended a first visit to a chronic pain clinic and watched a pain science educational video. Participants thought it was important to improve their and healthcare providers' understanding of their pain. They viewed the video favorably, learned information from it, and thought it could feasibly facilitate communication with their healthcare providers, but, for many participants, the video either did not answer their questions and/or raised more questions. Participants' responses to the video included negative and positive emotions and were influenced by their need for confirmation that their pain was real and personal relevance of the pain science content. Study results support the feasibility and value of delivering pain science education via video and increase our understanding of patients' perceptions of and responses to pain science education. The video's triggering of emotional responses warrants additional research. [ABSTRACT FROM AUTHOR]

The purpose of this study was to describe experiences of being a manager in the municipal sector in rural northern Sweden. Semi-structured interviews were performed with 15 managers working in the municipal sector. The interviews were subjected to inductive qualitative content analysis. The managers' experiences were interpreted in the main theme, Striving for stability on shaky ground. They struggled within slimmed-down organizations with substitute shortages and reduced means. They expressed being burdened by conflicting demands, a work overload, work conflicts and a requirement to be present. They had to endure the negative consequences of working in small municipalities, and handling health and family life impairments. The managers expressed the importance of being strengthened by inner and outer resources, such as being motivated, having social support and finding strategies to cope. They also expressed benefits of working in small municipalities, such as great opportunities to influence and efficiency in decision-making. This study illuminates managers' adverse psychosocial working conditions, insights into working in a small municipality in the rural context and also the importance of organizational support. Future studies could focus on applying adapted workplace support interventions among managers in the municipal sector in rural northern Sweden. [ABSTRACT FROM AUTHOR]

Self-regulation refers to self-management and self-control, with or without disability. Outcomes of rehabilitation with respect to self-regulation are unclear. This study aims to identify elements of self-regulation that former patients consider important in the context of medical rehabilitation. Qualitative exploration based on focus group discussions (FGDs). Transcripts were analysed using thematic analysis as well as open coding. Forty individuals participated in seven diagnosis-related FGDs. Six subthemes were raised in the FGDs which could be merged into three main themes. Two main themes are conditional for regaining self-regulation: 1) having insight into one's condition and abilities (i.e., insight into impairments. consequences of impairments. abilities); 2) to know how to cope with the consequences of the condition (be able to communicate limitations; have to trust in body and functioning). The subject of the last theme 3) is how to apply self-regulation in one's own life (to make use of abilities and optimize functioning). Three main themes of self-regulation in the context of medical rehabilitation were identified by former patients, partly relating to the ability to self-regulate and partly to the execution of self-regulation. This knowledge can be used to define specific rehabilitation goals and further develop rehabilitation outcome measurement. Awareness of the fundamental subthemes of self-regulation in rehabilitation will positively contribute to theory building and improve clinical practice (e.g., goal setting). Paying explicit attention to the six subthemes as standard elements of rehabilitation will help to provide a comprehensive view concerning self-regulation. The conceptual model of self-regulation, based on patient perspectives, can contribute to the measurement of rehabilitation outcomes. [ABSTRACT FROM AUTHOR]

Participatory approaches are increasingly popular in public health, but remain little used to address adolescent health issues. However, adolescent participation in research has enormous potential for identifying solutions to health issues that concern them. In Senegal, a youth-led participatory action research (YPAR) project was implemented in four communities where teams of adolescents were trained to conduct a research project and identify solutions to address adolescent sexual and reproductive health and rights (ASRHR) issues. This article presents the results of the project evaluation, which aimed to explore the potential of YPAR to address ASRHR issues and inform future YPAR projects. Observations and interviews were carried out during results dissemination meetings in each of the communities. The evaluation of the project demonstrated the potential of YPAR to identify relevant solutions, while promoting positive and meaningful adolescent participation. Despite some difficulties, such as community resistance, the youth researchers were able to successfully complete their research project, while developing their confidence and self-esteem. The adolescents were convinced that they could act as agents of positive social change. This project has shown that it is possible and relevant to involve adolescents in research projects, and that this approach has significant potential in global health. [ABSTRACT FROM AUTHOR]

Black Americans face disparate health burdens of diet-related chronic diseases. Black Americans who live in communities with inadequate access to healthy foods are at an even greater risk for disparate health outcomes. Urban agriculture in communities with inadequate access to healthy food can complement the existing traditional food system and can make a difference in the accessibility of fresh fruits and vegetables and subsequently, increase fruit and vegetable consumption. However, integrating urban agriculture into a local food system can be challenging. Community capacity-building efforts have the potential to enhance organizational development and enable collaborations to enhance efforts to incorporate urban agriculture into communities with inadequate food access. This study used Chaskin's relational framework to describe community capacity-building efforts to enhance urban agriculture in predominantly Black communities. We found that strategies for community capacity building in urban agriculture include building on existing resources, community engagement, expanding organizational capacity, identifying threats to community capacity building, and identifying ideal solutions to enhance community capacity-building efforts. Urban farmers, gardeners, and advocates identified these strategies to strengthen local control of the food environment through sustainable urban agriculture. Additional research is needed to further identify community engagement strategies that emphasize sustainability, such as workforce development efforts, building networks for new growers, and strengthening connections between farmers, gardeners, urban agriculture advocates, and community residents. [ABSTRACT FROM AUTHOR]

Latinos/as – the largest minority group in the U.S. – are avid Facebook users, making this an opportune tool to educate on the uptake of cancer prevention and screening behaviors. However, there is a dearth in scholarship exploring how Latinos/as engage with and act upon health content encountered on social media, which may be influenced by cultural values. This qualitatively-driven, mixed-methods study explores how Latinos/as engage with and act upon cancer prevention and screening information (CPSI) on Facebook. During one-on-one, in-depth interviews, participants (n = 20) logged onto their Facebook account alongside the researcher and discussed cancer-related posts they engaged with during the past 12 months. Interview questions included the reasons for engagement, and whether engagement triggered further action. Interviews were analyzed thematically. In parallel, a content analysis of the CPSI posts identified during the interviews was conducted. The majority of CPSI posts participants engaged with contained food-related content and visual imagery. Engagement was most common when individuals had personal relationships to the poster, when posts included videos/images, and when posts contained content promoting the curative properties of popular Latin American foods. Engagement often led to information-seeking and sharing, discussing content with others, and/or changing health behaviors. Findings highlight the importance of adequately contextualizing how cultural values influence the ways in which Latinos/as engage with and act upon CPSI on Facebook, which may lead individuals to bypass evidence-based procedures. Multi-pronged efforts are necessary to adequately leverage social media to empower Latinos/as to partake in behaviors that effectively reduce cancer health disparities. [ABSTRACT FROM AUTHOR]

Despite the increased availability of vaccines, masking and social distancing remain important strategies to mitigate COVID-19 transmission. This qualitative study aimed to understand experiences navigating public health recommendations to slow the spread of COVID-19 among economically and ethnically diverse mothers with young children. Mothers of preschoolers (n = 25) were recruited from Project EAT 2010–2018 (Eating and Activity over Time) longitudinal cohort. Participants completed a virtual semi-structured interview about their experiences during COVID-19. Interview transcripts were coded using deductive and inductive content analysis and analyzed using thematic analysis to identify themes. The first identified theme, 'Selective adherence to recommendations' included subthemes highlighting how social distancing was more challenging than mask wearing, family and children were primary reasons for reduced adherence, and concern for the wellbeing of others influenced adherence. The second theme, 'Personal experiences and relationships were important determinants of perceived severity of the virus and critical aspects of desired support,' included subthemes on feelings of uncertainty, personal experiences with the virus, and desired community supports. Participants felt stressed and confused about what information to trust. Personal experiences with COVID-19 influenced perceptions of its seriousness, and mothers were more confident about following recommendations when they them from trusted medical professionals and desired for communities to work together. How findings among this diverse population of mothers can help inform future public health messaging and policies throughout the remainder of this pandemic, its aftermath, and future public health emergencies, in which masking and social distancing will be needed, are discussed. [ABSTRACT FROM AUTHOR]

Difficulties of managing cutlery, manipulating food on the plate and transporting food to the mouth may negatively influence the ability for self-provision and nutritional status among older adults with motoric eating difficulties. The purpose was to explore perceptions and attitudes about eating with the fingers among older adults with motoric eating difficulties, and relatives and professional caregivers of older adults with motoric eating difficulties. Qualitative data was collected through individual interviews with older adults >65 years (N = 14) with motoric eating difficulties and focus groups with relatives (N = 15) and professional caregivers (N = 15). Data was analyzed using deductive and inductive content analysis. Although the older adults had normative ideas about proper eating and culinary rules, they regularly consumed several foods with their fingers without previously reflecting upon this. Using bread to grip or wrap foods and inserting skewers into foods may increase the acceptability of eating with the fingers. However, the importance of the disease causing the eating difficulties, how it was perceived, and its severity were crucial in understanding how eating with the fingers was perceived. Finger foods may be suitable for older adults with major eating difficulties because they have developed a self-acceptance in relation to their condition over time. [ABSTRACT FROM AUTHOR]

Around 20% of births in Somaliland take place at health facilities staffed by trained healthcare professionals; 80% take place at home assisted by Traditional Birth Attendants (TBAs) with no formal training. There has been no research into women's choice of place of birth. In this study, we explore multipara women's needs and preferences when choosing the place of birth. An explorative qualitative study using individual in-depth interviews analysed inductively using content analysis. The interviews were conducted in Somaliland with 25 multiparous women who had experience of giving birth both at home and at a health facility within the past three years. The results provide a description of how, for women in Somaliland, a lack of reproductive agency in facility-based births makes home births a first choice regardless of potential risks and medical need. The women in this study desired intentionality in their role as mothers and sought some measure of control over the environment where they planned to give birth, depending on the circumstances of that particular birth. The results describe what quality care means for multipara women in Somaliland and how women choose birthplace based on previous experiences of care. The expectation of respectful care was a vital part for women when choosing a place of birth. To meet women's needs and preferences in Somaliland, further investments are needed to strengthen the midwifery profession and to define and test a context specific midwife-led continuity of care model to be scaled up. A dialogue to create new roles and responsibilities for the TBAs who attend most home births is further needed to link them to the formal healthcare system and assure timely healthcare seeking during pregnancy and birth. [ABSTRACT FROM AUTHOR]

The aim of the current study was to examine the social representation (SR) of hearing aids in people with hearing loss (PHL) in India, the Republic of Korea (ROK), the United Kingdom (UK), and the United States of America (US). The study used a cross-sectional survey design. The data collected by using a free association task were analysed qualitatively (i.e. content analysis) and quantitatively (i.e. chi-square analysis, similarities analysis, prototypical analysis). 424 participants with hearing loss The most commonly reported categories across all countries were "beneficial," "cost and time," and "appearance and design." Approximately 50% of the associations reported were negative. There were variations in terms of the categories that were predominant in the SR of each country. "Others actions and attitude" category was predominantly reported by PHL in India. "Disturbance" and "dissatisfaction" of hearing aids and the "repairs and maintenance of hearing aids" categories were mainly reported from the ROK and the US, respectively. The current results highlight the main aspects that PHL report spontaneously when they think about hearing aids. The findings will help to further inform public health campaigns and will contribute to develop culturally appropriate media materials regarding hearing aids. [ABSTRACT FROM AUTHOR]

Sexuality education in school is important for students' reproductive health; however, devising ways of tailoring it to the needs of a particular society can be challenging. We compared preferences for type of sexuality education in high schools and the level of knowledge of reproductive health among students, parents and teachers in Myanmar. A cross-sectional study was conducted in public high schools in Pyin Oo Lwin. Students, their parents and teachers were asked their preferences for sexuality education and their reproductive health knowledge. Focus group discussions were held to explore their insights on sexuality education for students. We found that 73% of students preferred comprehensive sex education whereas 62% and 56% of parents and teachers preferred an abstinence only approach, respectively. Reproductive health knowledge was low, particularly among students, and particularly with respect to knowledge of sexually transmitted infections. Cultural issues, training and manpower emerged as key themes from the focus groups. Over half of the students said that they were not receiving any form of sex education at school. Reproductive health knowledge was unsatisfactory among all participants reflecting the insufficiency of current sexuality education classes. Training and support for teachers should be provided. [ABSTRACT FROM AUTHOR]

Background: Hookah smoking has been increasingly popular in Iran within the last two decades. The present study aims to explain the determinants of hookah smoking cessation among southern Iranian women in Bandar Abbas. Methods: The present study is a pioneering qualitative research that employed a conventional content analysis to explore factors affecting the hookah smoking cessation between 2018 and 2019. In total, 36 in-depth, semi-structured interviews were held with experienced individuals (15 women with successful cessation and 21 women with unsuccessful cessation) who 15 maximally diverged in terms of age, education, and occupation, from different geographical areas of the city. The interview process went on until the data were satiated. The required data were then analyzed qualitatively in MAXQDA. Results: Overall, six major categories were extracted. They included incentive background, need for freedom, control of external stimuli, religious norms, self-efficacy, and political factors. Conclusions: As the results showed, there were many external factors affecting the decision to quit or cut down on the rate of smoking hookahs. Catering for the required conditions and factors to strengthen the promotive ones and perceived threats, spiritual support and self-efficacy can effectively help successful cessation or reduction programs of hookah smoking. [ABSTRACT FROM AUTHOR]

Purpose: To provide empirical evidence on learning barriers and facilitators in instructional science and engineering laboratory settings from a national survey on students with physical disabilities (SwD-P). Methods: A nationwide self-report survey, the Full Participation Science and Engineering Accessibility (FPSEA), was disseminated online via Qualtrics. Approximately 1200 organizations and universities across the United States were contacted through purposive sampling. Descriptive statistics were primarily used for the analysis of the results. Results: Survey findings reveal that students experience a wide range of limitations to full participation in the laboratory, from entering the laboratory (25%) to being given passive roles (50%). Additionally, while 66% of respondents indicated that instructors were willing to help SwD-P participate in science and engineering (S&E) laboratories, 16.8% were not willing to do so, and 47% SwD-P felt that practices were not in place to provide accommodations. The survey also reveals a range of facilitators such as elevators, ramps, accessible course materials and peer assistance. Most respondents (74%) also indicated that peers were helpful in completing laboratory tasks. Conclusion: This survey provides empirical evidence that was previously voiced through non-empirical information in the literature. Participants cited barriers such as inappropriate accommodations and instructors' negative viewpoints, as well as gaining access to facilities even after the enactment of the Americans with Disabilities Act (ADA). These findings suggest that while ADA has lessened some barriers to SwD-P, barriers remain in using the laboratory space. The FPSEA survey fills the gap in finding barriers and facilitators to using S&E laboratories from the SwD-P's perspective. Barriers students with disabilities encounter in science and engineering (S&E) laboratory environments remain unclear. The FPSEA survey fills the gap in finding barriers and facilitators to using S&E laboratories from the SwD-P's perspective. The FPSEA survey allows former and current SwD-P to share their experiences using a postsecondary S&E instructional laboratory. [ABSTRACT FROM AUTHOR]

Purpose: Ethics education is a critical component of training rehabilitation practitioners. There is a need for capacity-building among ethics educators regarding facilitating ethical decision-making among students. The purpose of this study was to evaluate the utility of an on-line ethics education module for occupational therapy clinician-educators (problem-based learning tutors/clinical placement preceptors/evidence-based practice facilitators). Method: The Knowledge-to-Action Process informed development and evaluation of the module. Clinician–educators (n = 33) viewed the module and reported on its impact on knowledge and facilitation practices via pre, post, and follow-up questionnaires. Results: Pre- and post-test data indicated improvement in self-reported ethics knowledge (t = 8.275, p < 0.01). Follow-up data indicated knowledge did not decrease over time (t = −1.483, p = 0.075). There was improvement in self-reported intent to change practice (t = 4.93, p < 0.01); however, actual practice change was not indicated (t = −1.499, p = 0.072). Conclusion: This study provides preliminary data regarding an on-line ethics education module for clinician–educators. Future recommendations include broader consideration of context, adding supplemental knowledge translation components, and further research exploring outcomes with larger samples, longer follow-up and randomized trial methodology. The on-line ethics module has potential to improve rehabilitation practice by addressing the noted gap in knowledge among clinician-educators. Viewing an on-line module regarding approaches to ethics education may not be sufficient to change clinician-educators' teaching practices. More time and opportunities to discuss ethics with student occupational therapists may be required to effect practice change among clinician-educators. Developing ethics education tools for clinician-educators requires ongoing and iterative input from knowledge users to optimize translation of ideas to practice. [ABSTRACT FROM AUTHOR]

Purpose: To explore and describe clients' needs during a surgical intervention process for Dupuytren's disease. Materials and methods: Design: Interview study with 21 men undergoing surgical intervention for Dupuytren's disease. Qualitative content analysis was performed with the model of Patient Evaluation Process as a theoretical framework. Results: The primary reason for seeking medical care was to receive an intervention to improve hand function. The need for knowledge was evident during the care process, and was connected to involvement in decision-making. During surgery and rehabilitation, participants needed support with pain relief, a sense of security, support for self-care, or sick leave. There was also a need for participation in the evaluation and improvement of care. Clients' life situations contributed to the occurrence of needs or were a resource for handling them. Depending on patient character, clients handled their perceived needs differently. Conclusions: Clients' needs during a surgical intervention process include needs for improvement of hand function, knowledge, and support during treatment, and participation in evaluation. Clients' needs change during the care process and can be influenced by their life situation or their character. The identified needs ought to be included in quality assessments from the carers' perspective, to ensure that important needs of the clients are met by the surgical intervention process. Communication and interaction between client and health care provider is a key aspect of fulfilling clients' needs. Implications for rehabilitation: Patients have need for knowledge throughout the care process: about the disease, risk factors, treatment options, practical and medical information related to the treatment and recovery, and about the care process as a whole. Need for knowledge is closely connected to patients' experience of being involved in decision making. Patients need support with both general human and specific medical issues during surgery and rehabilitation. Patients' needs change during the care process and can be influenced by the patient's life situation or character. From the carers' perspective, the identified needs ought to be included in quality assessments to ensure that important needs of the clients are met by the surgical intervention process. [ABSTRACT FROM AUTHOR]

Despite patients referred to home health having diverse and complex needs, it is unknown how nurses develop personalized visit plans. In this qualitative descriptive study, we interviewed 26 nurses from three agencies about their decision-making process to determine visit intensity and analyzed data using directed content analysis. Following a multifactorial assessment of the patient, nurses relied on their experience and their agency’s protocols to develop the personalized visit plan. They revised the plan based on changes in the patient’s clinical condition, engagement, and caregiver availability. Findings suggest strategies to improve visit planning and positively influence outcomes of home health patients. [ABSTRACT FROM AUTHOR]

Social, educational and health related equality is an ideal in the Nordic welfare states. However studies have shown that wellpositioned patients achieve better treatment and more services, for example time and examinations, than others do. This article examines how patients and relatives mobilise resources in decision-making in a stroke unit. In particular, it focuses on the challenges in optimising the rehabilitation process faced by patients and relatives, and the strategies they use. Data were generated using participant observation and semi-structured interviews. Qualitative content analysis was applied to investigate the patients' and relatives' experiences of decision-making. We present a field-specific form of capital: An individual or a family's resources that are valued in the field of rehabilitation as physical, behavioural and cognitively embedded attitudes and practices. Rehabilitation capital consists of four closely interrelated components: Performative Participation (Cognitively Embedded Performance and Self-initiating Activities), Bodily Progression, Institutional Acceptance and Institutional Potential. It is a resource potentially benefitting patients and relatives during inpatient rehabilitation and may provide patients with an advantage, to ensure the best rehabilitation. The possession of Rehabilitation capital (high or low) contributes explanations for unequal practices and treatments at a micro-level in healthcare institutions. [ABSTRACT FROM AUTHOR]

Purpose: To explore the mobility-related preferences among stroke survivors and caregivers following post-acute rehabilitation at inpatient or skilled nursing facilities.Methods: In this cross-sectional study; semi-structured, qualitative interviews of stroke survivors (n = 24) and informal caregivers (n = 15) were conducted. The participants were recruited from the community.Results: Comparative content analysis was used to identify themes by two independent coders. The survivors (68 years) and caregivers (58 years) mentioned mobility-related consequences including inability to walk, balance, drive, and transfer; and increased falls. The survivors (63%) and caregivers (73%) also mentioned the use of assistive devices. The common rehabilitation activities included: walking (62%); followed by standing and mobility; strength and balance; and wheelchair skills. Some stroke survivors were dissatisfied as their rehabilitation was not patient-centered. Frequently mentioned outcome preferences by survivors were ability to walk (88%), move, and balance. They also wanted to acquire assistive devices to move independently. Caregivers were concerned with the survivor’s safety and wanted them to drive (53%), prevent falls, have home accommodations, and transfer independently. Caregivers (40%) also expressed the importance of receiving realistic information.Conclusions: This study suggests a need to consider the stroke survivors’ and caregivers’ mobility outcome preferences to improve the patient-centered rehabilitation care. Implications for Rehabilitation Stroke survivors and caregivers tend to differ in their outcome preferences.Caregivers expressed concern for transfers, driving, fall prevention, home modifications, and wished for realistic information.Incorporating stroke survivors and their families’ perspectives during rehabilitation may enhance patient-centered outcomes. [ABSTRACT FROM AUTHOR]

Objectives: The implementation of new health services is a complex process. This study investigated the first phase of the adaptive implementation of the Dutch Meeting Centres Support Programme (MCSP) for people with dementia and their carers in three European countries (Italy, Poland, the UK) within the JPND-MEETINGDEM project. Anticipated and experienced factors influencing the implementation, and the efficacy of the implementation process, were investigated. Findings were compared with previous research in the Netherlands. Method: A qualitative multiple case study design was applied. Checklist on anticipated facilitators and barriers to the implementation and semi-structured interview were completed by stakeholders, respectively at the end and at the beginning of the preparation phase. Results: Overall, few differences between countries were founded. Facilitators for all countries were: added value of MCSP matching needs of the target group, evidence of effectiveness of MCSP, enthusiasm of stakeholders. General barriers were: competition with existing care and welfare organizations and scarce funding. Some countries experienced improved collaborations, others had difficulties finding a socially integrated location for MCSP. The step-by-step implementation method proved efficacious. Conclusion: These insights into factors influencing the implementation of MCSP in three European countries and the efficacy of the step-by-step preparation may aid further implementation of MCSP in Europe. [ABSTRACT FROM AUTHOR]

In China, an estimated 780,000 people have been infected with HIV (China AIDS, 2012). Even as this stigmatized population rapidly grows, with the majority of reproductive age (20-40 years old), information about their daily experiences in the domestic sphere has been scarce. Because the family remains a central unit of social and ethical organization in China, the current qualitative study examines family relations among people living with HIV (PLWH) with the goal of identifying the effect of HIV on family relations and, conversely, the effect of family relations on those with HIV. We analyzed data from 90 in-depth interviews with PLWH and people around them (i.e., their children, health care providers, other community members) in southwest China (Guangxi province). Through analyzing the families' experiences with illness, three themes emerged: how individuals with HIV interact with their community; how they cope with stigma alongside and against their family; and how families can support those with HIV. Our data ultimately showed the critical role of family in the quality of PLWH's well-being. Because concealment of their serostatus was the primary coping strategy, stigma manifestation was most obvious in the domestic spheres. Yet, when help was received, PLWH regarded family support as the most helpful, as those who received empathy from their families remained more optimistic. Thus, there is an urgent need for developing efficacious intervention programs that could lead to maximize family support, involving the families of PLWH, with a particular attention to family dynamics in daily interactions. Despite our awareness of the significance of family in China, this study reveals a particular kind of role of family that has rarely been considered, namely the role of family in healing and sustaining social bonds within the context of stigmatization, when those bonds might otherwise be broken. [ABSTRACT FROM AUTHOR]

Research increasingly shows that genital attitudes have an impact on sexual well-being and health-seeking behaviours. This study explored what women and men like and dislike about women's genitals. Data are from open-ended items, part of a cross-sectional internet-based survey anonymously completed by 496 women and 198 men. Overall, both women and men had positive attitudes towards women's genitals, although there was overlap between likes and dislikes. Some of the most common likes for women were related to aesthetics and for men were related to tactile and sexual aspects. Men listed more likes than dislikes. The emphasis on both positive and negative messages provides a more complete image of the complex ways people interact with their own and others' bodies and can help tailor clinical and educational messages. [ABSTRACT FROM PUBLISHER]

Longitudinal quantitative and qualitative analyses were conducted for male contemporary returned post-deployed (CRPD) veteran participants of an Australian 6-day structured peer outdoor support therapy (POST) program. Results demonstrated significant reductions in depression, anxiety and stress by day 6 compared to baseline, which was maintained at 2 months follow-up. Self-efficacy, overall life satisfaction and satisfaction with mental health also improved significantly. Qualitative analysis identified several key factors experienced: a sense of shared identity, involvement, and belonging with others, and increased self-determination and personal competence. Such programs may be an important adjunct or precursor to other forms of veteran therapeutic support. [ABSTRACT FROM AUTHOR]