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Medical students with chronic health conditions are an underrepresented and often overlooked population in medical education. Previous research describes the dual roles they hold as both healthcare recipients and providers and details challenges they face related to accommodations and accessibility. However, less is known about how having a chronic health condition shapes the day-to-day aspects of medical education. To address this gap in knowledge, I conducted semi-structured interviews with eighteen medical students with chronic conditions and examined data using reflexive thematic analysis. Findings revealed the competing demands students face between medical school expectations and the need to manage their health. They work to reconcile these demands using tools like accommodations and strategic communication and by reconstructing narratives to re-assess self-imposed expectations. These participants understand having a chronic health condition as just one piece of their larger sense of self. Participants approach this understanding in individualized and nuanced ways, yet all share a cohesive view that their experiences having chronic health conditions inform their medical practice for the better through the development of genuine empathy for patients. This paper concludes with recommendations drawn from participant interviews of how medical schools can better support students with chronic health conditions. • Chronic condition management and medical training compete for time and energy. • Demands are reconciled at structural, interpersonal, and intrapersonal levels. • Having a chronic condition influences but does not define medical training. • First-hand healthcare experiences build genuine empathy and improve patient care. [ABSTRACT FROM AUTHOR]

Background Ability to elicit individuals’ perceptions of complex behavioral processes can be challenging, as it hinges not only upon the skill of the researcher, but also upon assumptions of a shared language and individuals’ ability to recall, analyze, and effectively communicate events. In a case-based qualitative-descriptive study about teens’ experiences of asthma self-management, we found that variations in terminology and descriptions of events, symptoms, and responses made it difficult to understand teens’ experiences of asthma. In particular, teens’ conceptualization of their asthma symptoms and self-management responses differed from situation to situation, from other teens in the study, from the interviewer, and from prior reports in the literature. These differences across many levels made it difficult to identify patterns in individual processes of self-management, and among teens in general.. Objectives To address these challenges, we developed a card sorting activity to facilitate in-depth exploration of teens’ experiences of asthma. Design Case-based qualitative description. Setting: Teen-parent dyads (N=28) were recruited from the community, Emergency Department, Pediatric Pulmonary Department, and prior study subjects of a major medical center. Methods Teens first identified and then sequenced their own unique sets of asthma symptoms and self-management responses. Teens then developed contextually grounded narratives using the card sort they had created as a visual aid. Results This technique not only allowed us to bridge teen-interviewer communication barriers and develop shared terminology, but also resulted in a visible sequence of asthma symptoms and self-management responses. Conclusions The card sort technique facilitated researcher-teen discussion and enabled comparison of self-management patterns across teens in our study. This technique is potentially useful for other areas of research exploring behavioral processes with complex and individual-specific experiences, in particular those involving sequences of events and self-management responses. This paper delineates the development, utility, and potential applications of the symptom-response card sorting technique for research and clinical practice. [ABSTRACT FROM AUTHOR]

Background: An implementation gap exists between policy aspirations for provision and the delivery of self-management support in primary care. An evidence based training and support package using a whole systems approach implemented as part of a randomised controlled trial was delivered to general practice staff. The trial found no effect of the intervention on patient outcomes. This paper explores why self-management support failed to become part of normal practice. We focussed on implementation of tools which capture two key aspects of self-management support - education (guidebooks for patients) and forming collaborative partnerships (a shared decision-making tool). Objectives: To evaluate the implementation and embedding of self-management support in a United Kingdom primary care setting. Design: Qualitative semi-structured interviews with primary care professionals. Settings: 12 General Practices in the Northwest of England located within a deprived inner city area. Participants: Practices were approached 3-6 months after undergoing training in a selfmanagement support approach. A pragmatic sample of 37 members of staff - General Practitioners, nurses, and practice support staff from 12 practices agreed to take part. The analysis is based on interviews with 11 practice nurses and one assistant practitioner; all were female with between 2 and 21 years' experience of working in general practice. Methods: A qualitative design involving face-to-face, semi-structured interviews audio- recorded and transcribed. Normalisation Process Theory framework allowed a systematic evaluation of the factors influencing the work required to implement the tools. Findings: The guidebooks were embedded in daily practice but the shared decision- making tools were not. Guidebooks were considered to enhance patient-centredness and were minimally disruptive. Practice nurses were reluctant to engage with behaviour change discussions. Self-management support was not formulated as a practice priority and there was minimal support for this activity within the practice: it was not auditable; [ABSTRACT FROM AUTHOR]

Objectives: Cancer treatment can impair fertility. The aim of this review was to investigate (1) fertility information needs, receipt and provision, (2) fertility information preferences, and (3) factors associated with receiving/providing fertility information. Cancer patients' and professional caregivers' perspectives were considered. Design: Mixed-methods systematic review. Data sources: Six electronic databases (PubMed, Web of Science, CINAHL, CRD, Embase) were systematically screened to retrieve articles published between January 2001 and March 2012. Reference lists and conference abstracts were checked for additional publications. Review methods: The principles outlined in the Cochrane Handbook for Systematic Reviews of Intervention were applied. Publications were included if they explored fertility-related information/communication in cancer patients/survivors of reproductive age or professional caregivers. The Critical Appraisal Skills Programme for Qualitative Studies and the Quality Assessment Tool for Quantitative Studies were used to assess the methodological quality. A standardised form based on the Cochrane guidelines for systematic reviews was used to extract the data. Two independent reviewers performed all methodological steps. Results: Of the 1872 papers found, 27 were included in this review. The majority (66- 100%) of the cancer patients wanted information about the impact of cancer therapy on fertility. The need and importance were higher in younger and childless patients, and in patients having childbearing plans. The number of patients receiving this information ranged from 0% to 85%. Several factors were associated with the lack of information receipt, including female gender and age 35 years or older. Patients preferred information via an individual consultation. In the diagnostic phase patients needed information about the impact of the treatment on fertility and preservation options. At the end or after the treatment, information needs shifted towards long term effects. Professional caregivers experienced several barriers in providing fertility information, including caregiver-, patient- and institutional-related factors. Nurses in particular, perceived difficulty in providing fertility-related information due to additional barriers associated with limited responsibility and opportunity in fertility information provision. Conclusion: Professional caregivers experienced multiple barriers that hinder information provision. Further exploration of the role of Advanced Nurse Practitioners/Midwifes and the development of an evidence based intervention to overcome caregiver-related barriers are recommended to improve information provision. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus is one of the most common non-communicable long-term conditions in the world and is linked to high mortality, morbidity, loss of quality of life and high social and economic cost. Diabetes presents a serious health challenge, as it is a significant cause of ill health and premature death. Identification of barriers to self-care is critical for finding ways to reduce the adverse effects of this long-term condition. Objective: This review identified issues that influence ability to self-care for adults living with diabetes types 1 or 2. Design: A systematic review of qualitative research studies using the Joanna Briggs Institute (JBI) approach. Data sources: An electronic search of Health Sciences databases for primary published qualitative studies was conducted April 2011. Reference lists of included articles were reviewed to identify other potential papers. Review methods: Studies that investigated issues identified by individuals living with diabetes type 1 or 2 that influenced ability to self-care were analysed using a process of meta-aggregation. Meta-aggregation involves the extraction of findings, the synthesis of findings through grouping or aggregating similar findings into themes and labelling with appropriate names and a statement that defines the theme and meta-aggregating the themes into overarching syntheses. Methodological quality was assessed by two reviewers against the JBI quality appraisal criteria for qualitative studies. Results: Thirty-seven qualitative studies were reviewed. The main issues impacting on an individual's ability to self-care were 'communication', 'education', 'personal factors', 'provider issues' and 'support'. Multiple barriers were found to influence the day-to-day management of diabetes. Key issues related to communication with health care providers, an education programme that allowed for incremental knowledge gain and experiential and vicarious learning and the provision of culturally sensitive care. Conclusions: People living with diabetes face many issues in their day-to-day manage- ment of the disease, compounded by vulnerability to wider situational, cultural and social issues. Self-care ability is a dynamic, evolutionary process that varies from person to person and involves moving from a disease focused existence to maximising life. [ABSTRACT FROM AUTHOR]

This paper investigates the impact of the Stepping Stones Creating Futures (SSCF) intervention on young women in informal settlements in eThekwini, South Africa. Specifically, whether following participation in the intervention the young women experienced a reduction in intimate partner violence, strengthened agency and shifted gender relations. Where changes occurred, it examines how they occurred, and barriers and enablers to change. SSCF is a gender transformative and livelihoods strengthening intervention using participatory, reflective small groups. Qualitative research was undertaken with fifteen women participating in the SSCF randomised control trial between 2015 and 2018. The women were followed over 18 months, participating in in-depth interviews at baseline, 12- and 18-months post intervention. To supplement these, eight women were involved in Photovoice work at baseline and 18 months and seven were included in ongoing participant observation. Data were analysed inductively. Data revealed many women changed their behaviours following SSCF, including: having more power within relationships, improved communication and relationship skills, increased resistance to controlling partners, shifting relationship expectations, emergence of new femininities and improved livelihoods. Despite these important shifts many women did not report a reduction in IPV. Nonetheless we argue most of the women, following the intervention, became more agentic. Drawing on the notion of 'distributed agency' as developed by Campbell and Mannell (2016), we show that SSCF bolstered the women's distributed agency. Distributed agency recognizes small agentic acts that women take, acts which to them are significant, it further notes that agency is temporal, fluid, dynamic and context specific. Women do not 'either have agency or not', rather being agentic depends on time, context and the particular incident. These findings provide an important contribution to the limited application of distributed agency and femininities work in informal settlements and are critical for policy and intervention science to reduce IPV and support women's agency. • South African informal settlements have high rates of intimate partner violence. • The Stepping Stones Creating Futures intervention strengthened young women's agency. • Women developed new skills, reduced violent confrontations and improved livelihoods. • However, many women remained in violent relationships. • Participatory, group-based, gender transformative interventions can reduce violence. [ABSTRACT FROM AUTHOR]