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Background: Many factors can decrease job productivity and cause physical and psychological complications for health care professionals providing maternal care. Information on challenges and coping strategies among healthcare professionals providing maternal healthcare services in rural communities is crucial. However, there needs to be more studies, especially qualitative research, to explore challenges and coping strategies for providing maternal health care services in Ethiopia among health care professionals, particularly in the Wolaita zone. Objective: To explore the challenges and coping strategies of professionals providing maternal health care in rural health facilities in Wolaita Zone, Southern Ethiopia, in 2023. Method: A phenomenological qualitative study design was applied from May 20 to June 20, 2023. The study was conducted in rural areas of the Wolaita Zone, southern Ethiopia. Healthcare professionals from rural areas were selected using purposive sampling, and in-depth interviews were conducted. A qualitative thematic analysis was employed to analyze the data. Field notes were read, recordings were listened to, and each participant's interview was written word for word and analyzed using ATLAS.ti 7 software. Result: Five main themes emerged from the data analysis. These themes included inadequate funding from the government, societal barriers to health and access to health care, professionals' personal life struggles, infrastructure related challenges and health system responsiveness, and coping strategies. Reporting to responsible bodies, teaching mothers about maternal health care services, and helping poor mothers from their pockets were listed among their coping strategies. Conclusion: Healthcare professionals have a crucial role in supporting women in delivering babies safely. This study revealed that they are working under challenging conditions. So, if women's lives matter, then this situation requires a call to action. [ABSTRACT FROM AUTHOR]

Abstract Background Many factors can decrease job productivity and cause physical and psychological complications for health care professionals providing maternal care. Information on challenges and coping strategies among healthcare professionals providing maternal healthcare services in rural communities is crucial. However, there needs to be more studies, especially qualitative research, to explore challenges and coping strategies for providing maternal health care services in Ethiopia among health care professionals, particularly in the Wolaita zone. Objective To explore the challenges and coping strategies of professionals providing maternal health care in rural health facilities in Wolaita Zone, Southern Ethiopia, in 2023. Method A phenomenological qualitative study design was applied from May 20 to June 20, 2023. The study was conducted in rural areas of the Wolaita Zone, southern Ethiopia. Healthcare professionals from rural areas were selected using purposive sampling, and in-depth interviews were conducted. A qualitative thematic analysis was employed to analyze the data. Field notes were read, recordings were listened to, and each participant’s interview was written word for word and analyzed using ATLAS.ti 7 software. Result Five main themes emerged from the data analysis. These themes included inadequate funding from the government, societal barriers to health and access to health care, professionals’ personal life struggles, infrastructure related challenges and health system responsiveness, and coping strategies. Reporting to responsible bodies, teaching mothers about maternal health care services, and helping poor mothers from their pockets were listed among their coping strategies. Conclusion Healthcare professionals have a crucial role in supporting women in delivering babies safely. This study revealed that they are working under challenging conditions. So, if women’s lives matter, then this situation requires a call to action.

Abstract Background Forward with Dementia is a co-designed campaign to improve communication of dementia diagnosis and post-diagnostic support. Methods Webinars, a website, social and traditional media, and promotions through project partners were used to disseminate campaign messages to health and social care professionals (primary audience) and people with dementia and carers (secondary audience). The campaign ran between October 2021 and June 2022, with 3-months follow-up. The RE-AIM framework was used for process evaluation. Measurements included surveys and interviews, a log of activities (e.g. webinars, social media posts) and engagements (e.g. attendees, reactions to posts), and Google Analytics. Results There were 29,053 interactions with campaign activities. More than three-quarters of professionals (n = 63/81) thought webinars were very or extremely helpful. Professionals and people with dementia and carers reported that the website provided appropriate content, an approachable tone, and was easy to use. Following campaign engagement, professionals planned to (n = 77/80) or had modified (n = 29/44) how they communicated the diagnosis and/or provided post-diagnostic information and referrals. Qualitative data suggested that the campaign may have led to benefits for some people with dementia and carers. Conclusions Forward with Dementia was successful in terms of reach, appropriateness, adoption and maintenance for professionals, however flow-through impacts on people with dementia are not clear. Targeted campaigns can potentially change health professionals’ communication and support around chronic diseases such as dementia.

Abstract Background Eldercare workers in nursing homes report high musculoskeletal disorders, stressful work, and sickness absence. Initiatives that can accommodate these issues are needed. Current studies point out that nature contact may offer a range of human health benefits, potentially promoting healthier work among eldercare workers. Therefore, this study aimed to investigate facilitators and barriers for using outdoor areas as part of the daily work among eldercare workers in Danish nursing homes. Methods In this multiple case study, we collected data from three nursing homes, conducting three semi-structured focus group interviews with eldercare workers and three individual interviews with nursing home managers. Furthermore, we conducted observations of the daily work and mappings of the nursing homes’ outdoor environments to gain in-depth knowledge of eldercare workers’ and managers’ perspectives on using outdoor areas in their daily work. The data was thematically analysed using ‘The Behaviour Change Wheel’ (BCW), more specifically the COM-B model, as a theoretical foundation for exploring facilitators and barriers for the use of outdoor areas. Results Frequently mentioned facilitators were facilities, traditions or repetitive events, positive experiences with residents (‘star moments’), and knowledge about the residents. Frequently mentioned barriers were insufficient staffing, hierarchy in the work tasks, professional identity, and lack of ideas. Conclusions The identified facilitators and barriers should be considered when designing initiatives for increased use of outdoor areas or activities of eldercare workers. Trial registration According to the Danish ethics committee (Law of committee, (komitéloven) paragraph 14, Sect. 2), qualitative interviews, which do not include human biological materials, do not need neither approval by ethical and scientific committee or informed consent (The Danish National Centre for Ethics).

Abstract Background Health care professionals play a central role in offering reproductive genetic carrier screening but face challenges when integrating the offer into practice. The aim of this study was to design, execute, and evaluate theory-informed implementation strategies to support health care professionals in offering carrier screening. Methods An exploratory multi-method approach was systematically employed based on the Theoretical Domain Framework (TDF). Implementation strategies were designed by aligning TDF barriers reported by health care professionals involved in a large carrier screening study, to behaviour change techniques combined with study genetic counsellors’ experiential knowledge. The strategies were trialled with a subset of health care professionals and evaluated against controls, using findings from questionnaires and interviews with healthcare professionals. The primary outcome measure was the number of couples who initiated enrolment. Results Health care professionals (n = 151) reported barriers in the TDF Domains of skills, e.g., lack of practice in offering screening, and challenges of environmental context and resources, e.g., lack of time, which informed the design of a skills video and a waiting room poster using the TDF-behaviour change technique linking tool. Following implementation, (Skills video n = 29 vs control n = 31 and Poster n = 46 vs control n = 34) TDF barrier scores decreased across all groups and little change was observed in the primary outcome measure. The skills video, though welcomed by health care professionals, was reportedly too long at seven minutes. The waiting room poster was seen as easily implementable. Conclusions As carrier screening moves towards mainstream healthcare, health care professionals report barriers to offering screening. To meet their needs, developing and testing experiential and theory-informed strategies that acknowledge contextual factors are essential.

Abstract Background In the spring of 2020, the Covid-19 outbreak sent a shock wave through the Swedish society and placed an extraordinary pressure on the health and social care system for older people. In the initial phase there were few guidelines for care providers to follow and staff in home care organisations often had to tackle challenges posed by the pandemic as they appeared. The aim of this study was to understand how the spread of Covid-19 was managed in organisations providing home care to older adults in different municipalities in Region Stockholm, and what actions were taken to minimise the spread of the disease among clients and staff. Method A descriptive qualitative study was performed based on eight interviews with managers of home care providers for older adults in three different municipalities in Region Stockholm.Three of the eight providers operate within an integrated care system. Data were analysed using conventional content analysis. Results Three themes were identified covering actions taken to handle the spread of the virus, feelings of insecurity and anxiety, and internal and external factors influencing how the pandemic was tackled. There was no single strategy followed by all municipalities or organisations, however, there were similarities between the organisations. One such example was the introduction of cohort care and the experience of lacking personal protective equipment. Providers in the integrated care system emphasized some advantages with their system that was seen as facilitators for minimising the risk of spreading the virus, like the joint meetings with managers from both health and social care and the close contact with healthcare professionals in relation to dissemination of hygiene instructions. Conclusion Social care workers providing home care to older persons are an important group in preventing dissemination of infectious diseases like Covid-19. For better readiness and preparedness for future pandemics, municipal home care services would need larger stocks of personal protective equipment, clear guidelines and more training on how to reduce dissemination of disease. Ways to achieve closer communication between health and social care providers should also be investigated.

Background: ‘Most patients want to die at home’ is a familiar statement in palliative care. The rate of home deaths is therefore often used as a success criterion. However, providing palliative care and enabling patients to die at home in rural and remote areas may be challenging due to limited health care resources and geographical factors. In this study we explored health care professionals’ experiences and reflections on providing palliative care to patients at the end of life in rural Northern Norway. Methods: This is a qualitative focus group and interview study in rural Northern Norway including 52 health care professionals. Five uni-professional focus group discussions were followed by five interprofessional focus group discussions and six individual interviews. Transcripts were analysed thematically. Results: Health care professionals did their utmost to fulfil patients’ wishes to die at home. They described pros and cons of providing palliative care in rural communities, especially their dual roles as health care professionals and neighbours, friends or even relatives of patients. Continuity and carers’ important contributions were underlined. When home death was considered difficult or impossible, nurses expressed a pragmatic attitude, and the concept of home was extended to include ‘home place’ in the form of local health care facilities. Conclusions: Providing palliative care in patients’ homes is professionally and ethically challenging, and health care professionals’ dual roles in rural areas may lead to additional pressure. These factors need to be considered and addressed in discussions of the organization of care. Nurses’ pragmatic attitude when transfer to a local health care facility was necessary underlines the importance of building on local knowledge and collaboration. Systematic use of advance care planning may be one way of facilitating discussions between patients, family carers and health care professionals with the aim of achieving mutual understanding of what is feasible in a rural context. [ABSTRACT FROM AUTHOR]

Background: Eldercare workers in nursing homes report high musculoskeletal disorders, stressful work, and sickness absence. Initiatives that can accommodate these issues are needed. Current studies point out that nature contact may offer a range of human health benefits, potentially promoting healthier work among eldercare workers. Therefore, this study aimed to investigate facilitators and barriers for using outdoor areas as part of the daily work among eldercare workers in Danish nursing homes. Methods: In this multiple case study, we collected data from three nursing homes, conducting three semi-structured focus group interviews with eldercare workers and three individual interviews with nursing home managers. Furthermore, we conducted observations of the daily work and mappings of the nursing homes' outdoor environments to gain in-depth knowledge of eldercare workers' and managers' perspectives on using outdoor areas in their daily work. The data was thematically analysed using 'The Behaviour Change Wheel' (BCW), more specifically the COM-B model, as a theoretical foundation for exploring facilitators and barriers for the use of outdoor areas. Results: Frequently mentioned facilitators were facilities, traditions or repetitive events, positive experiences with residents ('star moments'), and knowledge about the residents. Frequently mentioned barriers were insufficient staffing, hierarchy in the work tasks, professional identity, and lack of ideas. Conclusions: The identified facilitators and barriers should be considered when designing initiatives for increased use of outdoor areas or activities of eldercare workers. Trial registration: According to the Danish ethics committee (Law of committee, (komitéloven) paragraph 14, Sect. 2), qualitative interviews, which do not include human biological materials, do not need neither approval by ethical and scientific committee or informed consent (The Danish National Centre for Ethics). [ABSTRACT FROM AUTHOR]

Background: In the spring of 2020, the Covid-19 outbreak sent a shock wave through the Swedish society and placed an extraordinary pressure on the health and social care system for older people. In the initial phase there were few guidelines for care providers to follow and staff in home care organisations often had to tackle challenges posed by the pandemic as they appeared. The aim of this study was to understand how the spread of Covid-19 was managed in organisations providing home care to older adults in different municipalities in Region Stockholm, and what actions were taken to minimise the spread of the disease among clients and staff. Method: A descriptive qualitative study was performed based on eight interviews with managers of home care providers for older adults in three different municipalities in Region Stockholm.Three of the eight providers operate within an integrated care system. Data were analysed using conventional content analysis. Results: Three themes were identified covering actions taken to handle the spread of the virus, feelings of insecurity and anxiety, and internal and external factors influencing how the pandemic was tackled. There was no single strategy followed by all municipalities or organisations, however, there were similarities between the organisations. One such example was the introduction of cohort care and the experience of lacking personal protective equipment. Providers in the integrated care system emphasized some advantages with their system that was seen as facilitators for minimising the risk of spreading the virus, like the joint meetings with managers from both health and social care and the close contact with healthcare professionals in relation to dissemination of hygiene instructions. Conclusion: Social care workers providing home care to older persons are an important group in preventing dissemination of infectious diseases like Covid-19. For better readiness and preparedness for future pandemics, municipal home care services would need larger stocks of personal protective equipment, clear guidelines and more training on how to reduce dissemination of disease. Ways to achieve closer communication between health and social care providers should also be investigated. [ABSTRACT FROM AUTHOR]

Abstract Background Families of children and adolescents with cancer strive to maintain routines and normalcy during the child’s treatment trajectory that requires frequent hospital visits. Intravenous chemotherapy at home can reduce time spent on the frequent hospital visits and mitigate disruption in daily life. Studies on home chemotherapy for children and adolescents with cancer are limited, as is knowledge of family and health care professionals’ needs, and knowledge required to inform adaptation or replication of interventions in other settings. The aim of this study was to develop and describe an evidence-based home chemotherapy intervention that is feasible and safe for children and adolescents and suitable for future feasibility testing. Methods The Medical Research Council’s guidance for developing complex interventions in health care and the framework of action developed by O’Cathain et al. was used as theoretical frameworks to structure the development process. A literature search, an ethnographic study, and interviews with clinical nurse specialists from adult cancer departments formed the evidence base. Educational learning theory to support and understand the intervention was identified. Stakeholder perspectives were explored in workshops with health care professionals and parent-adolescent interviews. Reporting was qualified using the GUIDED checklist. Results A stepwise educational program to teach parents how to administer low-dose chemotherapy (Ara-C) to their child at home and a simple and safe administration procedure were developed. Key uncertainties were identified, including barriers and facilitators impacting future testing, evaluation, and implementation. Causal assumptions and reasoning for how the intervention leads to short-term outcomes and long-term impact were clarified in a logic model. Conclusions The iterative and flexible framework allowed for integration of existing evidence and new data and was successfully applied to the development process. The detailed report on the development process of the home chemotherapy intervention can enhance adaptation or replication of the intervention to other settings and thereby mitigate family disruption and stress of frequent hospital visits for these treatments. The study has informed the next phase of the research project that aims to test the home chemotherapy intervention in a prospective single-arm feasibility study. Trial registration ClinicalTrials.gov ID: NCT05372536.

Abstract Background Postpartum depression is a risk factor for suicide and maltreatment of children, and its early detection and appropriate intervention are issues to be resolved. In Japan, local governments are working to detect postpartum depression early by conducting home visits to families with infants within 4 months postpartum, but home-visit professionals have faced new difficulties due to the coronavirus disease 2019 (COVID-19) pandemic that started in 2020. The purpose of this study was to clarify the difficulties experienced by health care professionals who perform home visits to screen for postpartum depression. Methods Focus-group interviews were conducted during the COVID-19 pandemic with health care professionals (n = 13) who make postpartum home visits to families with infants within 4 months. Data were analyzed using thematic analysis. Results Four main categories were identified that describe the difficulties experienced by health care professionals: “Lack of support for partners,” “Difficulty in talking face-to-face,” “Inability to offer family assistance,” and “Anxiety about being a source of infection.” Conclusions This study shed light on the difficulties faced by professionals in supporting mothers and children in the community during the COVID-19 pandemic. Although these difficulties were considered to have become apparent during the pandemic, the results may offer an important perspective for postpartum mental health support even after the pandemic ends. Accordingly, it may be necessary for these professionals to receive supported through multidisciplinary collaboration in order to improve postpartum care in the community.

Abstract Background The person-centred practice framework represents the cornerstone of a middle-range theory. Internationally, person-centredness has become an increasingly common topic. The measurement of the existence of a person-centred culture is complex and subtle. The Person-Centred Practice Inventory—Staff (PCPI-S) measures clinicians’ experience of a person-centred culture in their practice. The PCPI-S was developed in English. Therefore, the aims of this study were (1) to translate the PCPI-S into German and to cross-culturally adapt and test in the acute care setting (PCPI-S aG Swiss) and (2) to investigate the psychometric properties of the PCPI-S aG Swiss. Methods The two-phase investigation of this cross-sectional observational study followed the guidelines and principles of good practice for the process of translation and cross-cultural adaptation of self-reporting measures. Phase 1 involved an eight-step translation and cultural adaptation of the PCPI-S testing in an acute care setting. In Phase 2, psychometric retesting and statistical analysis based on a quantitative cross-sectional survey were undertaken. To evaluate the construct validity, a confirmatory factor analysis was implemented. Cronbach’s alpha was used to determine the internal consistency. Results A sample of 711 nurses working in a Swiss acute care setting participated in testing the PCPI-S aG Swiss. Confirmatory factor analysis indicated a good overall model fit, validating the strong theoretical framework, which underpins the PCPI-S aG Swiss. Cronbach’s alpha scores demonstrated excellent internal consistency. Conclusion The chosen procedure ensured cultural adaptation to the German-speaking part of Switzerland. The psychometric results were good to excellent and comparable with other translations of the instrument.

Background: Postpartum depression is a risk factor for suicide and maltreatment of children, and its early detection and appropriate intervention are issues to be resolved. In Japan, local governments are working to detect postpartum depression early by conducting home visits to families with infants within 4 months postpartum, but home-visit professionals have faced new difficulties due to the coronavirus disease 2019 (COVID-19) pandemic that started in 2020. The purpose of this study was to clarify the difficulties experienced by health care professionals who perform home visits to screen for postpartum depression. Methods: Focus-group interviews were conducted during the COVID-19 pandemic with health care professionals (n = 13) who make postpartum home visits to families with infants within 4 months. Data were analyzed using thematic analysis. Results: Four main categories were identified that describe the difficulties experienced by health care professionals: "Lack of support for partners," "Difficulty in talking face-to-face," "Inability to offer family assistance," and "Anxiety about being a source of infection." Conclusions: This study shed light on the difficulties faced by professionals in supporting mothers and children in the community during the COVID-19 pandemic. Although these difficulties were considered to have become apparent during the pandemic, the results may offer an important perspective for postpartum mental health support even after the pandemic ends. Accordingly, it may be necessary for these professionals to receive supported through multidisciplinary collaboration in order to improve postpartum care in the community. [ABSTRACT FROM AUTHOR]

Background: Families of children and adolescents with cancer strive to maintain routines and normalcy during the child's treatment trajectory that requires frequent hospital visits. Intravenous chemotherapy at home can reduce time spent on the frequent hospital visits and mitigate disruption in daily life. Studies on home chemotherapy for children and adolescents with cancer are limited, as is knowledge of family and health care professionals' needs, and knowledge required to inform adaptation or replication of interventions in other settings. The aim of this study was to develop and describe an evidence-based home chemotherapy intervention that is feasible and safe for children and adolescents and suitable for future feasibility testing. Methods: The Medical Research Council's guidance for developing complex interventions in health care and the framework of action developed by O'Cathain et al. was used as theoretical frameworks to structure the development process. A literature search, an ethnographic study, and interviews with clinical nurse specialists from adult cancer departments formed the evidence base. Educational learning theory to support and understand the intervention was identified. Stakeholder perspectives were explored in workshops with health care professionals and parent-adolescent interviews. Reporting was qualified using the GUIDED checklist. Results: A stepwise educational program to teach parents how to administer low-dose chemotherapy (Ara-C) to their child at home and a simple and safe administration procedure were developed. Key uncertainties were identified, including barriers and facilitators impacting future testing, evaluation, and implementation. Causal assumptions and reasoning for how the intervention leads to short-term outcomes and long-term impact were clarified in a logic model. Conclusions: The iterative and flexible framework allowed for integration of existing evidence and new data and was successfully applied to the development process. The detailed report on the development process of the home chemotherapy intervention can enhance adaptation or replication of the intervention to other settings and thereby mitigate family disruption and stress of frequent hospital visits for these treatments. The study has informed the next phase of the research project that aims to test the home chemotherapy intervention in a prospective single-arm feasibility study. Trial registration: ClinicalTrials.gov ID: NCT05372536. [ABSTRACT FROM AUTHOR]

Background: The person-centred practice framework represents the cornerstone of a middle-range theory. Internationally, person-centredness has become an increasingly common topic. The measurement of the existence of a person-centred culture is complex and subtle. The Person-Centred Practice Inventory—Staff (PCPI-S) measures clinicians' experience of a person-centred culture in their practice. The PCPI-S was developed in English. Therefore, the aims of this study were (1) to translate the PCPI-S into German and to cross-culturally adapt and test in the acute care setting (PCPI-S aG Swiss) and (2) to investigate the psychometric properties of the PCPI-S aG Swiss. Methods: The two-phase investigation of this cross-sectional observational study followed the guidelines and principles of good practice for the process of translation and cross-cultural adaptation of self-reporting measures. Phase 1 involved an eight-step translation and cultural adaptation of the PCPI-S testing in an acute care setting. In Phase 2, psychometric retesting and statistical analysis based on a quantitative cross-sectional survey were undertaken. To evaluate the construct validity, a confirmatory factor analysis was implemented. Cronbach's alpha was used to determine the internal consistency. Results: A sample of 711 nurses working in a Swiss acute care setting participated in testing the PCPI-S aG Swiss. Confirmatory factor analysis indicated a good overall model fit, validating the strong theoretical framework, which underpins the PCPI-S aG Swiss. Cronbach's alpha scores demonstrated excellent internal consistency. Conclusion: The chosen procedure ensured cultural adaptation to the German-speaking part of Switzerland. The psychometric results were good to excellent and comparable with other translations of the instrument. [ABSTRACT FROM AUTHOR]

Abstract Background In low to middle income countries (LMICs) with limited health care providers (HCPs) and health infrastructure, digital technologies are rapidly being adopted to help augment service delivery. In this sphere, sexual and reproductive health (SRH) services are increasingly leveraging mobile health (mHealth) technologies to improve service and information provision in rural areas. This systematic review aimed to identify HCPs perspectives on barriers to, and facilitators of, mobile phone based SRH services and information in rural areas of LMICs from current literature. Methods Searches were conducted using the following databases: Medline, Scopus, PsychINFO, CINAHL and Cochrane Library. Based on the inclusion and exclusion criteria, twelve full text qualitative studies published in English between January 2000 and December 2020 were included. The methodological quality of papers was assessed by two authors using the critical skills appraisal programme and synthesized using the narrative thematic analysis approach. Results Positive HCPs experiences surrounding the provision of mHealth based SRH services in LMICs included saving consultation time, ability to shift tasks, reduction in travel costs, easy referrals and follow up on clients, convenience in communicating health information confidentially, and the ability to consult groups of clients remotely rather than face-to-face. Barriers to the provision of mHealth reported by HCPs included lack of technological infrastructure, unreliable networks, limited power, the cost of mobile airtime/data and mobile phones and limited technological literacy or skills. Conclusions Implementing innovative mHealth based SRH services could bridge a service provision and access gap of SRH information and services in rural areas of LMICs. Despite the advantages of this technology, several challenges associated with delivering mHealth SRH services need to be urgently addressed to enable scale-up and integration of sexual and reproductive mHealth into rural health systems.

Abstract Background The number of patients with one or more chronic conditions is increasing globally. One strategy to achieve more sustainable care for these patients is by implementing use of home-based eHealth applications. Such services support patients to take on a more active role as value-creating co-producers of their own care, in collaboration with health care professionals. Health care professionals have a key role in the value creation process, but little is known about value formation within eHealth interactions, especially from their perspective. Therefore, this study aimed to provide a deeper understanding of how an eHealth application can function as a value-creating resource from the perspective of health care professionals. Methods Semi-structured interviews were conducted with thirteen health care professionals (nurses, physicians and first-line managers). Qualitative content analysis was used to analyze the interviews. Results The findings indicate that value formation processes are strongly influenced by the organizational preconditions and by the usability and functionality of technology. The experiences of the health care professionals indicated that value was conceptualized in dimensions of meaningfulness, building of relationships, building safety and feelings of trust. Although these dimensions were mainly expressed in a positive way, such as perceived improvement of medical care, accessibility and continuity, they also had a negative side that caused value destruction. This was primarily due to patient difficulties in using the application or making measurements. Subsequent efforts at value recovery resulted in value creation, but were often time-consuming for the professionals. Conclusions This study contributes by extending conceptualizations of value to the role of health care professionals and by highlighting technology as sometimes facilitating and sometimes hampering value formation processes. The findings indicate that the eHealth application was a value-creating resource, facilitating proactive communication and supporting patients’ engagement and control over their self-care. However, for the application to become a more valuable resource in practice and counteract inequity in care, it needs to be further developed to be adapted to the needs and preconditions of patients.

Background: In low to middle income countries (LMICs) with limited health care providers (HCPs) and health infrastructure, digital technologies are rapidly being adopted to help augment service delivery. In this sphere, sexual and reproductive health (SRH) services are increasingly leveraging mobile health (mHealth) technologies to improve service and information provision in rural areas. This systematic review aimed to identify HCPs perspectives on barriers to, and facilitators of, mobile phone based SRH services and information in rural areas of LMICs from current literature.Methods: Searches were conducted using the following databases: Medline, Scopus, PsychINFO, CINAHL and Cochrane Library. Based on the inclusion and exclusion criteria, twelve full text qualitative studies published in English between January 2000 and December 2020 were included. The methodological quality of papers was assessed by two authors using the critical skills appraisal programme and synthesized using the narrative thematic analysis approach.Results: Positive HCPs experiences surrounding the provision of mHealth based SRH services in LMICs included saving consultation time, ability to shift tasks, reduction in travel costs, easy referrals and follow up on clients, convenience in communicating health information confidentially, and the ability to consult groups of clients remotely rather than face-to-face. Barriers to the provision of mHealth reported by HCPs included lack of technological infrastructure, unreliable networks, limited power, the cost of mobile airtime/data and mobile phones and limited technological literacy or skills.Conclusions: Implementing innovative mHealth based SRH services could bridge a service provision and access gap of SRH information and services in rural areas of LMICs. Despite the advantages of this technology, several challenges associated with delivering mHealth SRH services need to be urgently addressed to enable scale-up and integration of sexual and reproductive mHealth into rural health systems. [ABSTRACT FROM AUTHOR]

Abstract Background Persons with stroke are susceptible to psychosocial problems, and express disappointment at how health care professionals fail to meet their psychosocial needs following discharge to home. The responsibility of nurses and occupational therapists in stroke rehabilitation is to assist the persons and their families during the recovery and adjustment process. A home-based dialogical intervention aiming to enhance psychosocial support was therefore developed and tested in a randomized controlled trial. This study is a part of the process evaluation conducted alongside the trial. The aim was to explore the nurses’ and occupational therapists’ experiences of conducting the intervention. Methods Eighteen nurses and four occupational therapists participated in six focus groups to explore their experiences when providing the intervention. The themes discussed in the focus groups were the aspects that facilitated the delivering of the intervention and the challenges they encountered during the study period. The interviews were analysed using qualitative content analysis. Results The analysis generated two themes. The theme Developing a supportive relationship to facilitate the adjustment process following stroke had two subthemes: Getting personally involved and Handling challenges. This theme reveals how the nurses and occupational therapists experienced their relationship with the persons with stroke and potential threats which challenged them while conducting the intervention. The theme Developing professional skills in providing psychosocial support had two subthemes: Becoming confident in conducting dialogues and Integrating psychosocial topics. This theme reveals the aspects that the nurses and occupational therapists perceived as facilitating the development of their professional skills in conducting the dialogues. Conclusion Delivering the psychosocial intervention was perceived as deeply meaningful and increased the nurses’ and occupational therapists’ understanding of how to support stroke survivors to live with the consequences of stroke. However, balancing the professional and the personal relationship was challenging. A basic educational programme, training, supervision and having dedicated time were crucial elements to instil confidence in professionals conducting theme-based dialogues to promote post-stroke psychosocial well-being. Individual clinical experience and knowledge of stroke care were considering important to enable professionals to integrate psychosocial rehabilitation into community health care. Trial registration ClinicalTrials.gov, NCT 02338869 , registered 10/04/2014.

Abstract Background In well-resourced countries, comprehensive care programs have increased life expectancy of patients with sickle cell disease, with almost all infants surviving into adulthood. However, families affected by sickle cell disease are more likely to be economically disenfranchised because of their racial or ethnic minority status. As every individual child has the right to the highest attainable standard of health under the United Nations Convention on the Rights of the Child, it is essential to identify both barriers and facilitators with regard to the delivery of adequate healthcare. Optimal healthcare accessibility will improve healthcare outcomes for children with sickle cell disease and their families. Healthcare professionals in the field of sickle cell care have first-hand experience of the barriers that patients encounter when it comes to effective care. We therefore hypothesised that these medical professionals have a clear picture of what is necessary to overcome these barriers and which facilitators will be most feasible. Therefore, this study aims to map best practises and lessons learnt in order to attain more optimal healthcare accessibility for paediatric patients with sickle cell disease and their families. Methods Healthcare professionals working with young patients with sickle cell disease were recruited for semi-structured interviews. An interview guide was used to ensure the four healthcare accessibility dimensions were covered. The interviews were transcribed and coded. Based on field notes, initial codes were generated, to collate data (both barriers and solutions) to main themes (such as “transportation”, or “telecommunication”). Through ongoing thematic analysis, definitive themes were formulated and best practices were reported as recommendations. Quotations were selected to highlight or illustrate the themes and link the reported results to the empirical data. Results In 2019, 22 healthcare professionals from five different university hospitals in the Netherlands were interviewed. Participants included (paediatric) haematologists, nurses and allied health professionals. Six themes emerged, all associated with best practices on topics related to the improvement of healthcare accessibility for children with sickle cell disease and their families. Firstly, the full reimbursement of invisible costs made by caregivers. Secondly, clustering of healthcare appointments on the same day to help patients seeing all required specialists without having to visit the hospital frequently. Thirdly, organisation of care according to shared care principles to deliver specialised services as close as possible to the patient’s home without compromising quality. Fourthly, optimising verbal and written communication methods with special consideration for families with language barriers, low literacy skills, or both. Fifthly, improving the use of eHealth services tailored to users’ health literacy skills, including accessible mobile telephone contact between healthcare professionals and caregivers of children with sickle cell disease. Finally, increasing knowledge and interest in sickle cell disease among key stakeholders and the public to ensure that preventive and acute healthcare measures are understood and safeguarded in all settings. Conclusion This qualitative study describes the views of healthcare professionals on overcoming barriers of healthcare accessibility that arise from the intersecting vulnerabilities faced by patients with sickle cell disease and their families. The recommendations gathered in this report provide high-income countries with a practical resource to meet their obligations towards individual children under the United Nations Convention on the Rights of the Child.

Abstract Background Overweight and obesity are problems that are increasing globally in both children as well as adults, and may be prevented by adopting a healthier lifestyle. Lifestyle coaches counsel overweight and obese children (and their parents) as well as adults in initiating and maintaining healthier lifestyle behaviours. It is currently unclear whether this novel professional in the Dutch health care system functions as a linchpin in networks that evolve around lifestyle-related health problems. The aim of the present study is to investigate the formation and development of networks of lifestyle coaches and their positions within these networks. Methods In this longitudinal study, key professionals and professionals within relevant organisations in the Coaching on Lifestyle (CooL) care networks were asked to fill in three online questionnaires. Respondents were asked to indicate whether they collaborated with each of the specified professionals in the context of CooL. The overall network structures and the central role of the lifestyle coaches were examined by using network analysis. Results The results showed that the networks in three out of four regions were relatively centralised, but that none of the networks were dense, and that the professionals seemed to collaborate less with others over time. Half of the lifestyle coaches had a high number of collaborations and a central position within their networks, which also increased over time. In half of the regions, the lifestyle coaches had increased their role as consultants, while their role as gatekeeper and liaison decreased over time. In most regions, the sector of lifestyle coaches had a central position in their networks in just one measurement. Other central sectors were the local sports organisation, public health services, youth health care and the municipal government. Conclusions Overall, we cannot conclude that more central and denser networks were formed during the study period. In addition, the lifestyle coaches were not often positioned as a central sector within these networks. Entrepreneurial, network and brokering competences are required for lifestyle coaches to build up denser networks. Trial registration NTR6208 ; date registered: 13–01-2017; retrospectively registered; Netherlands Trial Register.

Background: The number of patients with one or more chronic conditions is increasing globally. One strategy to achieve more sustainable care for these patients is by implementing use of home-based eHealth applications. Such services support patients to take on a more active role as value-creating co-producers of their own care, in collaboration with health care professionals. Health care professionals have a key role in the value creation process, but little is known about value formation within eHealth interactions, especially from their perspective. Therefore, this study aimed to provide a deeper understanding of how an eHealth application can function as a value-creating resource from the perspective of health care professionals.Methods: Semi-structured interviews were conducted with thirteen health care professionals (nurses, physicians and first-line managers). Qualitative content analysis was used to analyze the interviews.Results: The findings indicate that value formation processes are strongly influenced by the organizational preconditions and by the usability and functionality of technology. The experiences of the health care professionals indicated that value was conceptualized in dimensions of meaningfulness, building of relationships, building safety and feelings of trust. Although these dimensions were mainly expressed in a positive way, such as perceived improvement of medical care, accessibility and continuity, they also had a negative side that caused value destruction. This was primarily due to patient difficulties in using the application or making measurements. Subsequent efforts at value recovery resulted in value creation, but were often time-consuming for the professionals.Conclusions: This study contributes by extending conceptualizations of value to the role of health care professionals and by highlighting technology as sometimes facilitating and sometimes hampering value formation processes. The findings indicate that the eHealth application was a value-creating resource, facilitating proactive communication and supporting patients' engagement and control over their self-care. However, for the application to become a more valuable resource in practice and counteract inequity in care, it needs to be further developed to be adapted to the needs and preconditions of patients. [ABSTRACT FROM AUTHOR]

Abstract Background Transitions of care are often risky, particularly for older people, and shorter hospital stays mean that patients can go home with ongoing care needs. Most previous research has focused on fundamental system flaws, however, care generally goes right far more often than it goes wrong. We explored staff perceptions of how high performing general practice and hospital specialty teams deliver safe transitional care to older people as they transition from hospital to home. Methods We conducted a qualitative study in six general practices and four hospital specialties that demonstrated exceptionally low or reducing readmission rates over time. Data were also collected across four community teams that worked into or with these high-performing teams. In total, 157 multidisciplinary staff participated in semi-structured focus groups or interviews and 9 meetings relating to discharge were observed. A pen portrait approach was used to explore how teams across a variety of different contexts support successful transitions and overcome challenges faced in their daily roles. Results Across healthcare contexts, staff perceived three key themes to facilitate safe transitions of care: knowing the patient, knowing each other, and bridging gaps in the system. Transitions appeared to be safest when all three themes were in place. However, staff faced various challenges in doing these three things particularly when crossing boundaries between settings. Due to pressures and constraints, staff generally felt they were only able to attempt to overcome these challenges when delivering care to patients with particularly complex transitional care needs. Conclusions It is hypothesised that exceptionally safe transitions of care may be delivered to patients who have particularly complex health and/or social care needs. In these situations, staff attempt to know the patient, they exploit existing relationships across care settings, and act to bridge gaps in the system. Systematically reinforcing such enablers may improve the delivery of safe transitional care to a wider range of patients. Trial registration The study was registered on the UK Clinical Research Network Study Portfolio (references 35272 and 36174 ).

Abstract Background Visual impairments (VIs) have a negative impact on life and affect up to 60% of stroke survivors. Despite this, VIs are often overlooked. This paper explores how persons with VIs experience vision care within stroke health services and how VIs impact everyday life the first 3 months post stroke. Methods Individual semi-structured interviews were conducted with 10 stroke survivors 3 months post stroke, and analyzed using qualitative content analysis. Results The main theme, “Invisible” visual impairments, represents how participants experience VIs as an unknown and difficult symptom of stroke and that the lack of attention and appropriate visual care leads to uncertainty about the future. VIs were highlighted as a main factor hindering the participants living life as before. The lack of acknowledgement, information, and systematic vision rehabilitation leads to feelings of being unsupported in the process of coping with VIs. Conclusion VIs are unknown symptoms pre stroke and sequelas after stroke that significantly affect everyday life. VIs and vision rehabilitation needs more attention through all phases of stroke health services. We request a greater awareness of VIs as a presenting symptom of stroke, and that visual symptoms should be included in stroke awareness campaigns. Further, we suggest increased competence and standardized evidence-based clinical pathways for VIs to advance all stroke health services including rehabilitation in order to improve outcomes and adaptation to future life for stroke survivors with VIs.

Abstract Background Breast cancer (BC) and related treatment are associated with the risk of developing a wide range of persistent disabling impairments. Despite extensive research in the field and an enhanced focus on BC rehabilitation, up to 34–43% of these patients are at risk of developing chronic distress. In addition, it is known that these patients repeatedly report unmet needs, which are strongly associated with reduced quality of life. However, despite knowledge that patients’ needs for support during BC rehabilitation varies greatly, individualized rehabilitation is often lacking. Therefore, this study aimed to explore health care professionals’ (HCPs) experiences of current rehabilitation practice and describe current barriers and facilitators for individualized rehabilitation for patients following BC treatment. Methods A total of 19 HCPs were included, representing various professions in BC care/rehabilitation within surgical, oncological and specialized cancer rehabilitation units at a university hospital in Sweden. Five semi structured focus group interviews were conducted and inductively analysed using conventional qualitative content analysis. Results Three categories were captured: (1) varying attitudes towards rehabilitation; (2) incongruence in how to identify and meet rehabilitation needs and (3) suboptimal collaboration during cancer treatment. The results showed a lack of consensus in how to optimize individualized rehabilitation. It also illuminated facilitators for individualized rehabilitation in terms of extensive competence related to long-term experience of working with patients with BC care/rehabilitation. Further, the analysis exposed barriers such as a great complexity in promoting individualized rehabilitation in a medically and treatment-driven health care system, which lacked structure and knowledge, and overarching collaboration for rehabilitation. Conclusion This study suggests that the cancer trajectory is medically and treatment-driven and that rehabilitation plays a marginal role in today’s BC trajectory. It also reveals that structures for systematic screening for needs, evidence-based guidelines for individualized rehabilitation interventions and structures for referring patients for advanced rehabilitation are lacking. To enable optimal and individualized recovery for BC patients’, rehabilitation needs to be an integrated part of the cancer trajectory and run in parallel with diagnostics and treatment.

Background: Persons with stroke are susceptible to psychosocial problems, and express disappointment at how health care professionals fail to meet their psychosocial needs following discharge to home. The responsibility of nurses and occupational therapists in stroke rehabilitation is to assist the persons and their families during the recovery and adjustment process. A home-based dialogical intervention aiming to enhance psychosocial support was therefore developed and tested in a randomized controlled trial. This study is a part of the process evaluation conducted alongside the trial. The aim was to explore the nurses' and occupational therapists' experiences of conducting the intervention.Methods: Eighteen nurses and four occupational therapists participated in six focus groups to explore their experiences when providing the intervention. The themes discussed in the focus groups were the aspects that facilitated the delivering of the intervention and the challenges they encountered during the study period. The interviews were analysed using qualitative content analysis.Results: The analysis generated two themes. The theme Developing a supportive relationship to facilitate the adjustment process following stroke had two subthemes: Getting personally involved and Handling challenges. This theme reveals how the nurses and occupational therapists experienced their relationship with the persons with stroke and potential threats which challenged them while conducting the intervention. The theme Developing professional skills in providing psychosocial support had two subthemes: Becoming confident in conducting dialogues and Integrating psychosocial topics. This theme reveals the aspects that the nurses and occupational therapists perceived as facilitating the development of their professional skills in conducting the dialogues.Conclusion: Delivering the psychosocial intervention was perceived as deeply meaningful and increased the nurses' and occupational therapists' understanding of how to support stroke survivors to live with the consequences of stroke. However, balancing the professional and the personal relationship was challenging. A basic educational programme, training, supervision and having dedicated time were crucial elements to instil confidence in professionals conducting theme-based dialogues to promote post-stroke psychosocial well-being. Individual clinical experience and knowledge of stroke care were considering important to enable professionals to integrate psychosocial rehabilitation into community health care.Trial Registration: ClinicalTrials.gov, NCT02338869 , registered 10/04/2014. [ABSTRACT FROM AUTHOR]

Abstract Background Extensive research documents that child abuse is widespread and that it has detrimental effects on victims’ physical, psychological and social well-being. Efforts to help abused children by removing stressors and administering restorative care can reverse these negative effects, but the evidence suggests that professionals often fail to expose child abuse. This study aims to generate insight into professionals’ experiences with facilitators in handling the challenges of addressing abuse in child interviews. We expect that this knowledge can improve interventions that qualify professionals in the identification, protection and care of abused children. Methods Within the qualitative approach and an Interpretive Description framework, we performed in-depth interviews with nineteen participants from southern Norway, specifically ten social workers from child protective services and nine psychologists from child mental health services. Then, Interpretive Description analysis was performed by using constant comparison, reflexive and critical examinations, and contextualized theoretical interpretations. Results The participants’ accounts revealed that various facilitators relative to the stages of the skill development and intrinsic motivation of the practitioner enhance the explorative work of the professional. We identified the following five main themes: (a) alleviating personal choice; (b) collective accountability; (c) sharing vulnerability; (d) finding your own way; and (e) doing it for the right reasons. Conclusions To facilitate explorative work, our findings suggest that competence development should apply goal-directed reflective practice combined with positive feedback on performance. Furthermore, our results indicate that developing personal competence is contingent on supporting individual choice and volition while decreasing demands towards following rules and guidelines. To promote the relatedness and the emotion regulation of professionals, we suggest endorsing shared vulnerability with colleagues and promoting an organizational culture that supports openness and allows professionals to discuss their emotions when addressing difficult and complex issues. It is also advisable to promote autonomy by helping professionals to find meaning in their work that is compatible with their personal values.

Background: Overweight and obesity are problems that are increasing globally in both children as well as adults, and may be prevented by adopting a healthier lifestyle. Lifestyle coaches counsel overweight and obese children (and their parents) as well as adults in initiating and maintaining healthier lifestyle behaviours. It is currently unclear whether this novel professional in the Dutch health care system functions as a linchpin in networks that evolve around lifestyle-related health problems. The aim of the present study is to investigate the formation and development of networks of lifestyle coaches and their positions within these networks.Methods: In this longitudinal study, key professionals and professionals within relevant organisations in the Coaching on Lifestyle (CooL) care networks were asked to fill in three online questionnaires. Respondents were asked to indicate whether they collaborated with each of the specified professionals in the context of CooL. The overall network structures and the central role of the lifestyle coaches were examined by using network analysis.Results: The results showed that the networks in three out of four regions were relatively centralised, but that none of the networks were dense, and that the professionals seemed to collaborate less with others over time. Half of the lifestyle coaches had a high number of collaborations and a central position within their networks, which also increased over time. In half of the regions, the lifestyle coaches had increased their role as consultants, while their role as gatekeeper and liaison decreased over time. In most regions, the sector of lifestyle coaches had a central position in their networks in just one measurement. Other central sectors were the local sports organisation, public health services, youth health care and the municipal government.Conclusions: Overall, we cannot conclude that more central and denser networks were formed during the study period. In addition, the lifestyle coaches were not often positioned as a central sector within these networks. Entrepreneurial, network and brokering competences are required for lifestyle coaches to build up denser networks.Trial Registration: NTR6208 ; date registered: 13-01-2017; retrospectively registered; Netherlands Trial Register. [ABSTRACT FROM AUTHOR]

Background: In well-resourced countries, comprehensive care programs have increased life expectancy of patients with sickle cell disease, with almost all infants surviving into adulthood. However, families affected by sickle cell disease are more likely to be economically disenfranchised because of their racial or ethnic minority status. As every individual child has the right to the highest attainable standard of health under the United Nations Convention on the Rights of the Child, it is essential to identify both barriers and facilitators with regard to the delivery of adequate healthcare. Optimal healthcare accessibility will improve healthcare outcomes for children with sickle cell disease and their families. Healthcare professionals in the field of sickle cell care have first-hand experience of the barriers that patients encounter when it comes to effective care. We therefore hypothesised that these medical professionals have a clear picture of what is necessary to overcome these barriers and which facilitators will be most feasible. Therefore, this study aims to map best practises and lessons learnt in order to attain more optimal healthcare accessibility for paediatric patients with sickle cell disease and their families.Methods: Healthcare professionals working with young patients with sickle cell disease were recruited for semi-structured interviews. An interview guide was used to ensure the four healthcare accessibility dimensions were covered. The interviews were transcribed and coded. Based on field notes, initial codes were generated, to collate data (both barriers and solutions) to main themes (such as "transportation", or "telecommunication"). Through ongoing thematic analysis, definitive themes were formulated and best practices were reported as recommendations. Quotations were selected to highlight or illustrate the themes and link the reported results to the empirical data.Results: In 2019, 22 healthcare professionals from five different university hospitals in the Netherlands were interviewed. Participants included (paediatric) haematologists, nurses and allied health professionals. Six themes emerged, all associated with best practices on topics related to the improvement of healthcare accessibility for children with sickle cell disease and their families. Firstly, the full reimbursement of invisible costs made by caregivers. Secondly, clustering of healthcare appointments on the same day to help patients seeing all required specialists without having to visit the hospital frequently. Thirdly, organisation of care according to shared care principles to deliver specialised services as close as possible to the patient's home without compromising quality. Fourthly, optimising verbal and written communication methods with special consideration for families with language barriers, low literacy skills, or both. Fifthly, improving the use of eHealth services tailored to users' health literacy skills, including accessible mobile telephone contact between healthcare professionals and caregivers of children with sickle cell disease. Finally, increasing knowledge and interest in sickle cell disease among key stakeholders and the public to ensure that preventive and acute healthcare measures are understood and safeguarded in all settings.Conclusion: This qualitative study describes the views of healthcare professionals on overcoming barriers of healthcare accessibility that arise from the intersecting vulnerabilities faced by patients with sickle cell disease and their families. The recommendations gathered in this report provide high-income countries with a practical resource to meet their obligations towards individual children under the United Nations Convention on the Rights of the Child. [ABSTRACT FROM AUTHOR]

Abstract Background Routine health information systems (RHIS) are vital for the acquisition of data for health sector planning, monitoring, and evaluation. However, in developing countries the insufficient quality of the data produced by RHIS limits their usefulness in decision-making. As routine health information utilization is still low in Ethiopia, this study aimed to assess the magnitude of routine health data utilization and associated factors among health care professionals in some public health institutions in North Gondar, northwest Ethiopia. Methods An institution based cross-sectional study was conducted from March to April2017, at public health institutions of North Gondar Zone, northwest Ethiopia. A total of 720 health care professionals were selected from public health institutions using the multi-stage sampling technique. Data were collected using a structured self-administered questionnaire and an observational checklist, cleaned, coded, and entered into Epi-info version 3.5.3 and transferred into SPSS version 20 for further statistical analysis. In the multiple logistic regression analysis, a less than 0.05 P-vale was considered statistically significant. Result In this study, the level of good routine health information utilization among health professionals was 78.5% (95% CI: 73.2%, 84.3%). According to the multivariable logistic regression analysis, sex (AOR = 2.19, 95% CI: 1.47, 3.27), type of institution (AOR = 3.57, 95% CI: 2.39, 5.32), standard indicators (AOR = 3.28, 95% CI: 1.90, 5.65), data analysis skills (AOR = 1.90, 95% CI: 1.12, 3.23), and good governance (AOR = 1.97, 95% CI: 1.31, 2.95), were found significantly associated with a good level of health information utilization. Conclusion Over three-fourths of the health care professionals working at public health institutions of North Gondar utilized health information better than the respondents in previous studies. Sex, type of institution, standard indicators, data analysis skills, and governance were factors related to routine health information utilization. Therefore, standard indicators, data analysis skills and good governance are highly recommended for improving routine health data utilization of health care professionals working at public health institutions.

Abstract Background Results from a previous study showed that 40 to 60% of the price of off-patent medicines in Vietnam was typically spent to induce prescribers to use the medicines, and to persuade procurement officers within hospitals to buy them. In this article we examine how and why inducements were paid by the pharmaceutical industry to health care providers in Vietnam. Methods We use a theoretically informed analysis to understand pharmaceutical companies’ account of giving inducements and prescribers’ account of taking them, elicited through in-depth interviews. Results Analysis of the emergent concepts derived from our qualitative data led to viewing the constructs from the theoretical framework of opportunities; pressures; and rationalization within a hierarchy of systemic factors and individual factors. Economic survival pressures in an imperfectly competitive market reportedly encouraged pharmaceutical companies and prescribers to be linked financially. Although individual factors such as professional ethics and personal values influenced doctors’ responses to corrupt practices, entrenched systemic issues, including lack of transparency, accountability, poor enforcement of legislation and prevalence of corruption emerged as important factors supporting corrupt practice or even making it very difficult for individuals to opt out of corrupt practices. Conclusions Our theoretically informed analysis of inducements provides an in-depth understanding of an angle of corruption in Vietnam’s health sector, showing the need for multifaceted strategies in the fight against corruption in the health sector. Remedial strategies need to address both systemic and individual factors including interventions to relieve dependencies for survival of health care services on the corrupt system.

Abstract Background Beginning in 2012, Lean was introduced to improve health care quality and promote patient-centredness throughout the province of Saskatchewan, Canada with the aim of producing coordinated, system-wide change. Significant investments have been made in training and implementation, although limited evaluation of the outcomes have been reported. In order to better understand the complex influences that make innovations such as Lean “workable” in practice, Normalization Process Theory guided this study. The objectives of the study were to: a) evaluate the implementation processes associated with Lean implementation in the Saskatchewan health care system from the perspectives of health care professionals; and b) identify demographic, training and role variables associated with normalization of Lean. Methods Licensed health care professionals were invited through their professional associations to complete a cross-sectional, modified, online version of the NoMAD questionnaire in March, 2016. Analysis was based on 1032 completed surveys. Descriptive and univariate analyses were conducted. Multivariate multinomial regressions were used to quantify the associations between five NoMAD items representing the four Normalization Process Theory constructs (coherence, cognitive participation, collective action and reflexive monitoring). Results More than 75% of respondents indicated that neither sufficient training nor resources (collective action) had been made available to them for the implementation of Lean. Compared to other providers, nurses were more likely to report that Lean increased their workload. Significant differences in responses were evident between: leaders vs. direct care providers; nurses vs. other health professionals; and providers who reported increased workload as a result of Lean vs. those who did not. There were no associations between responses to normalization construct proxy items and: completion of introductory Lean training; participation in Lean activities; age group; years of professional experience; or employment status (full-time or part-time). Lean leader training was positively associated with proxy items reflecting coherence, cognitive participation and reflexive monitoring. Conclusions From the perspectives of the cross-section of health care professionals responding to this survey, major gaps remain in embedding Lean into healthcare. Strategies that address the challenges faced by nurses and direct care providers, in particular, are needed if intended goals are to be achieved.

Background: Transitions of care are often risky, particularly for older people, and shorter hospital stays mean that patients can go home with ongoing care needs. Most previous research has focused on fundamental system flaws, however, care generally goes right far more often than it goes wrong. We explored staff perceptions of how high performing general practice and hospital specialty teams deliver safe transitional care to older people as they transition from hospital to home.Methods: We conducted a qualitative study in six general practices and four hospital specialties that demonstrated exceptionally low or reducing readmission rates over time. Data were also collected across four community teams that worked into or with these high-performing teams. In total, 157 multidisciplinary staff participated in semi-structured focus groups or interviews and 9 meetings relating to discharge were observed. A pen portrait approach was used to explore how teams across a variety of different contexts support successful transitions and overcome challenges faced in their daily roles.Results: Across healthcare contexts, staff perceived three key themes to facilitate safe transitions of care: knowing the patient, knowing each other, and bridging gaps in the system. Transitions appeared to be safest when all three themes were in place. However, staff faced various challenges in doing these three things particularly when crossing boundaries between settings. Due to pressures and constraints, staff generally felt they were only able to attempt to overcome these challenges when delivering care to patients with particularly complex transitional care needs.Conclusions: It is hypothesised that exceptionally safe transitions of care may be delivered to patients who have particularly complex health and/or social care needs. In these situations, staff attempt to know the patient, they exploit existing relationships across care settings, and act to bridge gaps in the system. Systematically reinforcing such enablers may improve the delivery of safe transitional care to a wider range of patients.Trial Registration: The study was registered on the UK Clinical Research Network Study Portfolio (references 35272 and 36174 ). [ABSTRACT FROM AUTHOR]

Background: Visual impairments (VIs) have a negative impact on life and affect up to 60% of stroke survivors. Despite this, VIs are often overlooked. This paper explores how persons with VIs experience vision care within stroke health services and how VIs impact everyday life the first 3 months post stroke.Methods: Individual semi-structured interviews were conducted with 10 stroke survivors 3 months post stroke, and analyzed using qualitative content analysis.Results: The main theme, "Invisible" visual impairments, represents how participants experience VIs as an unknown and difficult symptom of stroke and that the lack of attention and appropriate visual care leads to uncertainty about the future. VIs were highlighted as a main factor hindering the participants living life as before. The lack of acknowledgement, information, and systematic vision rehabilitation leads to feelings of being unsupported in the process of coping with VIs.Conclusion: VIs are unknown symptoms pre stroke and sequelas after stroke that significantly affect everyday life. VIs and vision rehabilitation needs more attention through all phases of stroke health services. We request a greater awareness of VIs as a presenting symptom of stroke, and that visual symptoms should be included in stroke awareness campaigns. Further, we suggest increased competence and standardized evidence-based clinical pathways for VIs to advance all stroke health services including rehabilitation in order to improve outcomes and adaptation to future life for stroke survivors with VIs. [ABSTRACT FROM AUTHOR]

Background: Breast cancer (BC) and related treatment are associated with the risk of developing a wide range of persistent disabling impairments. Despite extensive research in the field and an enhanced focus on BC rehabilitation, up to 34-43% of these patients are at risk of developing chronic distress. In addition, it is known that these patients repeatedly report unmet needs, which are strongly associated with reduced quality of life. However, despite knowledge that patients' needs for support during BC rehabilitation varies greatly, individualized rehabilitation is often lacking. Therefore, this study aimed to explore health care professionals' (HCPs) experiences of current rehabilitation practice and describe current barriers and facilitators for individualized rehabilitation for patients following BC treatment.Methods: A total of 19 HCPs were included, representing various professions in BC care/rehabilitation within surgical, oncological and specialized cancer rehabilitation units at a university hospital in Sweden. Five semi structured focus group interviews were conducted and inductively analysed using conventional qualitative content analysis.Results: Three categories were captured: (1) varying attitudes towards rehabilitation; (2) incongruence in how to identify and meet rehabilitation needs and (3) suboptimal collaboration during cancer treatment. The results showed a lack of consensus in how to optimize individualized rehabilitation. It also illuminated facilitators for individualized rehabilitation in terms of extensive competence related to long-term experience of working with patients with BC care/rehabilitation. Further, the analysis exposed barriers such as a great complexity in promoting individualized rehabilitation in a medically and treatment-driven health care system, which lacked structure and knowledge, and overarching collaboration for rehabilitation.Conclusion: This study suggests that the cancer trajectory is medically and treatment-driven and that rehabilitation plays a marginal role in today's BC trajectory. It also reveals that structures for systematic screening for needs, evidence-based guidelines for individualized rehabilitation interventions and structures for referring patients for advanced rehabilitation are lacking. To enable optimal and individualized recovery for BC patients', rehabilitation needs to be an integrated part of the cancer trajectory and run in parallel with diagnostics and treatment. [ABSTRACT FROM AUTHOR]

Abstract Background Transition programs in health care for young persons with special health care needs aim to maximize lifelong functioning. Exploring health care professionals’ perspective may increase the possibility of successful implementation of transition programs. The aim was to survey health care professionals’ attitudes towards components and barriers on transition and transfer in young people with long-term medical conditions with special health care needs. Methods A cross-sectional web-based survey was sent by e-mail to 529 physicians and nurses in Swedish pediatric and adult outpatient clinics. Response rate was 38% (n = 201). The survey consisted of 59 questions regarding different aspects of components and barriers on transition and transfer. Descriptive statistics were computed to summarize demographic data and categorized responses. The Chi square test was used for comparison between proportions of categories. Results Most respondents agreed on the destinations of care for adolescents within their specialty. Age and psychosocial aspects such as maturity and family situations were considered the most important initiators for transfer. Joint meeting with the patient (82%); presence of a transition coordinator (76%) and a written individualized transfer plan (55%) were reported as important transition components. Pediatric care professionals found the absence of a transition coordinator to be more of a transition barrier than adult care professionals (p = 0.018) and also a more important transfer component (p = 0.017). Other barriers were lack of funding (45%) and limited clinical space (19%). Transition programs were more common in university hospitals than in regional hospitals (12% vs 2%, p =

Background: Extensive research documents that child abuse is widespread and that it has detrimental effects on victims' physical, psychological and social well-being. Efforts to help abused children by removing stressors and administering restorative care can reverse these negative effects, but the evidence suggests that professionals often fail to expose child abuse. This study aims to generate insight into professionals' experiences with facilitators in handling the challenges of addressing abuse in child interviews. We expect that this knowledge can improve interventions that qualify professionals in the identification, protection and care of abused children.Methods: Within the qualitative approach and an Interpretive Description framework, we performed in-depth interviews with nineteen participants from southern Norway, specifically ten social workers from child protective services and nine psychologists from child mental health services. Then, Interpretive Description analysis was performed by using constant comparison, reflexive and critical examinations, and contextualized theoretical interpretations.Results: The participants' accounts revealed that various facilitators relative to the stages of the skill development and intrinsic motivation of the practitioner enhance the explorative work of the professional. We identified the following five main themes: (a) alleviating personal choice; (b) collective accountability; (c) sharing vulnerability; (d) finding your own way; and (e) doing it for the right reasons.Conclusions: To facilitate explorative work, our findings suggest that competence development should apply goal-directed reflective practice combined with positive feedback on performance. Furthermore, our results indicate that developing personal competence is contingent on supporting individual choice and volition while decreasing demands towards following rules and guidelines. To promote the relatedness and the emotion regulation of professionals, we suggest endorsing shared vulnerability with colleagues and promoting an organizational culture that supports openness and allows professionals to discuss their emotions when addressing difficult and complex issues. It is also advisable to promote autonomy by helping professionals to find meaning in their work that is compatible with their personal values. [ABSTRACT FROM AUTHOR]

Background: Beginning in 2012, Lean was introduced to improve health care quality and promote patient-centredness throughout the province of Saskatchewan, Canada with the aim of producing coordinated, system-wide change. Significant investments have been made in training and implementation, although limited evaluation of the outcomes have been reported. In order to better understand the complex influences that make innovations such as Lean "workable" in practice, Normalization Process Theory guided this study. The objectives of the study were to: a) evaluate the implementation processes associated with Lean implementation in the Saskatchewan health care system from the perspectives of health care professionals; and b) identify demographic, training and role variables associated with normalization of Lean. Methods: Licensed health care professionals were invited through their professional associations to complete a cross-sectional, modified, online version of the NoMAD questionnaire in March, 2016. Analysis was based on 1032 completed surveys. Descriptive and univariate analyses were conducted. Multivariate multinomial regressions were used to quantify the associations between five NoMAD items representing the four Normalization Process Theory constructs (coherence, cognitive participation, collective action and reflexive monitoring). Results: More than 75% of respondents indicated that neither sufficient training nor resources (collective action) had been made available to them for the implementation of Lean. Compared to other providers, nurses were more likely to report that Lean increased their workload. Significant differences in responses were evident between: leaders vs. direct care providers; nurses vs. other health professionals; and providers who reported increased workload as a result of Lean vs. those who did not. There were no associations between responses to normalization construct proxy items and: completion of introductory Lean training; participation in Lean activities; age group; years of professional experience; or employment status (full-time or part-time). Lean leader training was positively associated with proxy items reflecting coherence, cognitive participation and reflexive monitoring. Conclusions: From the perspectives of the cross-section of health care professionals responding to this survey, major gaps remain in embedding Lean into healthcare. Strategies that address the challenges faced by nurses and direct care providers, in particular, are needed if intended goals are to be achieved. [ABSTRACT FROM AUTHOR]

Background: Transition programs in health care for young persons with special health care needs aim to maximize lifelong functioning. Exploring health care professionals' perspective may increase the possibility of successful implementation of transition programs. The aim was to survey health care professionals' attitudes towards components and barriers on transition and transfer in young people with long-term medical conditions with special health care needs.Methods: A cross-sectional web-based survey was sent by e-mail to 529 physicians and nurses in Swedish pediatric and adult outpatient clinics. Response rate was 38% (n = 201). The survey consisted of 59 questions regarding different aspects of components and barriers on transition and transfer. Descriptive statistics were computed to summarize demographic data and categorized responses. The Chi square test was used for comparison between proportions of categories.Results: Most respondents agreed on the destinations of care for adolescents within their specialty. Age and psychosocial aspects such as maturity and family situations were considered the most important initiators for transfer. Joint meeting with the patient (82%); presence of a transition coordinator (76%) and a written individualized transfer plan (55%) were reported as important transition components. Pediatric care professionals found the absence of a transition coordinator to be more of a transition barrier than adult care professionals (p = 0.018) and also a more important transfer component (p = 0.017). Other barriers were lack of funding (45%) and limited clinical space (19%). Transition programs were more common in university hospitals than in regional hospitals (12% vs 2%, p = <0.001) as well as having a transition coordinator (12% vs 3%, p = 0.004).Conclusion: The findings highlight a willingness to work on new transition strategies and provide direction for improvement, taking local transition components as well as potential barriers into consideration when implementing future transition programs. Some differences in attitudes towards transitional care remain among pediatric and adult care professionals. [ABSTRACT FROM AUTHOR]

Background: Introducing new technology in health care is inevitably a challenge. More knowledge is needed to better plan future telemedicine interventions. Our aim was therefore to explore health care professionals' experience in the initial phase of introducing telemedicine technology in caring for people with diabetic foot ulcers.Methods: Our methodological strategy was Interpretive Description. Data were collected between 2014 and 2015 using focus groups (n = 10). Participants from home-based care, primary care and outpatient hospital clinics were recruited from the intervention arm of an ongoing cluster randomized controlled trial (RCT) (Clinicaltrials.gov: NCT01710774). Most were nurses (n = 29), but the sample also included one nurse assistant, podiatrists (n = 2) and physicians (n = 2).Results: The participants reported experiencing meaningful changes to their practice arising from telemedicine, especially associated with increased wound assessment knowledge and skills and improved documentation quality. They also experienced more streamlined communication between primary health care and specialist health care. Despite obstacles associated with finding the documentation process time consuming, the participants' attitudes to telemedicine were overwhelmingly positive and their general enthusiasm for the innovation was high.Conclusions: Our findings indicate that using a telemedicine intervention enabled the participating health care professionals to approach their patients with diabetic foot ulcer with more knowledge, better wound assessment skills and heightened confidence. Furthermore, it streamlined the communication between health care levels and helped seeing the patients in a more holistic way. [ABSTRACT FROM AUTHOR]

Background: Healthcare professionals engage in discharge planning of people with dementia during hospitalisation, however plans for transitioning the person into community services can be patchy and ineffective. The aim of this study was to report acute, community and residential care health professionals' (HP) perspectives on the discharge process and transitional care arrangements for people with dementia and their carers.Methods: A qualitative descriptive study design and purposive sampling was used to recruit HPs from four groups: Nurses and allied health practitioners involved in discharge planning in the acute setting, junior medical officers in acute care, general practitioners (GPs) and Residential Aged Care Facility (RACF) staff in a regional area in NSW, Australia. Focus group discussions were conducted using a semi-structured schedule. Content analysis was used to understand the discharge process and transitional care arrangements for people with dementia (PWD) and their carers.Results: There were 33 participants in four focus groups, who described discharge planning and transitional care as a complex process with multiple contributors and components. Two main themes with belonging sub-themes derived from the analysis were: Barriers to effective discharge planning for PWD and their carers - the acute care perspective: managing PWD in the acute care setting, demand for post discharge services exceeds availability of services, pressure to discharge patients and incomplete discharge documentation. Transitional care process failures and associated outcomes for PWD - the community HP perspective: failures in delivery of services to PWD; inadequate discharge notification and negative patient outcomes; discharge-related adverse events, readmission and carer stress; and issues with medication discharge orders and outcomes for PWD.Conclusions: Although acute care HPs do engage in required discharge planning for people with dementia, participants identified critical issues: pressure on acute care health professionals to discharge PWD early, the requirement for JMOs to complete discharge summaries, the demand for post discharge services for PWD exceeding supply, the need to modify post discharge medication prescriptions for PWD, the need for improved coordination with RACF, and the need for routine provision of medication dose decision aids and home medicine reviews post discharge for PWD and their carers. [ABSTRACT FROM AUTHOR]

Background: The republic of Trinidad and Tobago (T&T) is a middle income country with a comparatively high prevalence of diabetes mellitus (DM) compared to others in the Caribbean. To date, there have been no studies on health care professionals' (HCP) perspectives regarding the barriers to achieving optimal care of patients with DM in this country and few previous studies in the Caribbean, yet such perspectives are imperative to develop strategies that reduce the global burden of this disease.Methods: An electronic invitation was sent to prospective HCP in T&T inviting them to attend a symposium on DM and cardiovascular disease. A total of 198 HCP participants attended of whom approximately 100 participants completed an Audience Response Survey at the completion of the conference. The Audience Response Survey included questions regarding access to resources, need for prevention and education, and coordination of care for to diabetes care in T&T. Responses were analyzed in aggregate.Results: The 198 HCP participants attending the symposium included mostly nurses (40 %) and physicians (43 %). The most common specialty indicated by the 198 HCP participants was Internal and Family Medicine (28 %), followed by Anesthesiology (7 %), Emergency Medicine (6 %), Endocrinology and Diabetes (5 %) and Cardiology (3 %). Among the ~100 HCP who completed the Audience Response Survey, multiple barriers to achieving optimal care of patients with diabetes were reported such as: limited access to blood testing (75 %), ophthalmological evaluations (96 %), ECGs (69 %), and cardiac stress tests (92 %); inadequate time to screen and evaluate DM complications (95 %); poor access to consultants for referral of difficult cases (77 %); and lack of provider education regarding cardiovascular complications of DM (57 %). HCP agreed that nurses could potentially be considered to have a more active role in the care and prevention of cardiovascular disease and diabetes through leading patient education efforts (98 %), screening patients for complications (91 %), coordinating care efforts (99 %) and educating family members (98 %).Conclusions: The HCP in our study reported significant barriers to achieving optimal diabetes care in T&T. In the future, such barriers to care will need to be addressed in order to respond to the projected growth of diabetes in developing countries both within the Caribbean and globally. [ABSTRACT FROM AUTHOR]