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Background: Patients with in-hospital stroke (IHS) are discovered and treated with delays compared to community-onset stroke. This qualitative study explores current routines and clinical practices for IHS in Sweden, aiming to uncover factors influencing management and propose areas for future research and development. Methods: Six physicians in charge of stroke alerts at Swedish hospitals were individually interviewed in video calls. Informants were selected from The Swedish Stroke Register, based on the hospital-specific median processing time for delivering thrombolysis or thrombectomy to IHS patients, stratified by hospital size. Transcribed interviews were analysed using reflexive thematic analysis. Results: Three main themes were developed. The first emphasized the crucial step of discovering IHS and outlined possible workflow pathways, including defining the "key player" with stroke expertise and mandate to proceed with the stroke alert to immediate radiology. Subsequent themes addressed obstacles to optimal practice and suggested clear guidelines for contacting the "key player" to reduce delays, as well as offering IHS education to hospital staff. Conclusions: This study identified differences in workflows for IHS management across the six included sites. A "key player" emerged as a common denominator, who was called as the initiation of the stroke alert and had mandate to proceed with the alert to immediate radiology. Clear guidelines for contacting the "key player" and increased education about IHS were suggested as possible ways to mitigate delays to activate the stroke alert. [ABSTRACT FROM AUTHOR]

In software engineering, organizational debt (OD) is a crucial but little-researched phenomena. OD refers to the accumulation of outdated structures, policies, and processes that hinder an organization's advancement and adaptability. This multivocal literature review (MLR) synthesizes insights from software practitioners to elucidate OD causes, consequences, identification, and mitigation approaches that is considered a first step in illuminating the OD for software practitioners. After a thorough search, nine peer-reviewed articles and twenty-two recent blog posts on OD were included, indicating an emerging topic. Through inductive thematic analysis, four key topics emerged: definitions, causes like poorly managed change and siloed efforts, effects such as reduced innovation and agility, and mitigation strategies including agile principles, decentralized decision-making, and leveraging staff insights. While relying partly on non-peer-reviewed sources raises validity concerns, the review still provides a holistic and practical understanding of OD dynamics and complexities grounded in diverse perspectives. Further empirical research across diverse organizations would strengthen these preliminary findings. Effective OD management necessitates collaboration between academia and industry, considering technical debt (TD) best practices while tailoring interventions to OD's distinct socio-technical characteristics. [ABSTRACT FROM AUTHOR]

Introduction: Professionalism represents a contract between physicians and society, with humanism at its core. Humanism must be developed in medical education, especially in clinical settings, as students meet real-life professional situations. However, dynamic and unpredictable clinical settings might expose students to authentic yet unexpected far-from-ideal situations that might hinder the humanism and professionalism process. Furthermore, culture plays an influential role, highlighting the importance of developing an appropriate and contextual learning strategy. Hence, this study aims to conceptualize strategies to teach humanism and professionalism in high-power distance and collectivistic settings. Methods: This multicenter qualitative phenomenological study used maximum variation sampling to recruit participants, consisting of clinical students, teachers, and coordinators from three medical schools in Indonesia. Data were collected through focus group discussions (FGDs) and in-depth interviews. Thematic analysis was conducted using the steps of coding and theorization methods. Results: A total of 15 FGDs and one in-depth interview were conducted with 57 students, 39 teachers, and 18 coordinators. Socialization theory was used to analyze themes, leading to a culturally related approach to learning. Professional identity formation (PIF) was highlighted as the center of learning humanism and professionalism, with character building as the main principle. Designing a curriculum for humanism and professionalism for clinical learning should consider the longitudinal nature of PIF and ensure that professionalism explicitly exists in the curricula. As cultural impact might pose challenges, it must also be acknowledged and addressed. Meaningful integrated learning experiences, patient exposure, and reflection serve as the cornerstones of teaching–learning strategies while considering longitudinally explicit assessments. Conclusion: Nurturing humanism and professionalism in undergraduate clinical settings is a longitudinal character-building process, with PIF as its center. Longitudinal, explicit, and dynamic strategies should be considered as part of the framework of teaching–learning and assessment of humanism and professionalism, as well as faculty development efforts with close attention to cultural factors. [ABSTRACT FROM AUTHOR]

Introduction: Complex regional pain syndrome (CRPS) is a common complication following distal radius fractures that is difficult to diagnose and can lead to permanent disability. While various proposed prophylaxis and treatment modalities exist, high-quality evidence guiding practice is limited. This survey of Orthopaedic Trauma Association (OTA) and Canadian Orthopaedic Association (COA) members was conducted with the primary aim of assessing practice patterns in distal radius fractures complicated with CRPS. Methods: An electronic survey was distributed to practicing orthopaedic surgeons in the COA and OTA. Questions assessed practice setting, preference in management of distal radius fractures and CRPS, comfort level in managing CRPS, and identification of gaps in management. Responses were anonymized and collected over 8 months. Response data was analyzed using descriptive statistics; thematic analysis was used on free text response. Results: 134 survey responses were completed. 84% of respondents felt the incidence of CRPS in distal radius fractures was 1–10%, while 15% felt it was closer to 11–20%. 24% of respondents utilized the "Budapest Criteria" to diagnose CRPS. 40% offered prophylaxis in patients felt to be at high risk of developing CRPS. 66% of surgeons felt neutral, uncomfortable, or very uncomfortable managing CRPS in distal radius fractures. When asked to consider adopting a prophylactic therapy, 38% of surgeons indicated that a therapy that reduced the absolute risk of CRPS by 6–10% would change their practice. Gaps in current practice included lack of evidence-based treatment and prevention strategies and diagnostic uncertainty. Conclusion: This study identified that amongst orthopaedic surgeons in the COA and OTA, diagnosis, treatment, and prophylaxis strategies for CRPS in distal radius fractures are heterogeneous. Surgeons are not confident in their treatment of CRPS. Future studies using rigorous research methods are warranted to improve management. [ABSTRACT FROM AUTHOR]

Introduction: Implementing artificial intelligence (AI) in healthcare, particularly in primary care settings, raises crucial questions about practical challenges and opportunities. This study aimed to explore the perspectives of general practitioners (GPs) on the impact of AI in primary care. Methods: A convenience sampling method was employed, involving a hybrid workshop with 12 GPs and 4 GP registrars. Verbal consent was obtained, and the workshop was audio recorded. Thematic analysis was conducted on the recorded data and contemporaneous notes to identify key themes. Results: The workshop took place in 2023 and included 16 GPs aged 30 to 72 of diverse backgrounds and expertise. Most (93%) were female, and five (31%) self-identified as ethnic minorities. Thematic analysis identified two key themes related to AI in primary care: the potential benefits (such as help with diagnosis and risk assessment) and the associated concerns and challenges. Sub-themes included anxieties about diagnostic accuracy, AI errors, industry influence, and overcoming integration resistance. GPs also worried about increased workload, particularly extra, unnecessary patient tests, the lack of evidence base for AI programmes or accountability of AI systems and appropriateness of AI algorithms for different population groups. Participants emphasised the importance of transparency, trust-building, and research rigour to evaluate the effectiveness and safety of AI systems in healthcare. Conclusion: The findings suggest that GPs recognise the potential of AI in primary care but raise important concerns regarding evidence base, accountability, bias and workload. The participants emphasised the need for rigorous evaluation of AI technologies. Further research and collaboration between healthcare professionals, policymakers, and technology organisations are essential to navigating these challenges and harnessing the full potential of AI. [ABSTRACT FROM AUTHOR]

Background: Endometriosis is a common condition affecting 1–10% of all women. The condition is highly associated with pain. Most women with endometriosis are treated as elective outpatients, but these patients sometimes need to visit the emergency department. The aim of this study was to describe experiences and expectations related to repeated gynaecological emergency (GED) visits among women with endometriosis. Method: This qualitative study with semi structured interviews were conducted with ten patients diagnosed with endometriosis who visited the GED at a tertiary university hospital four or more times within a 12-month period. Data were analysed by thematic content analysis. Result: Two main themes was identified which embodied the women's overall experience, grouped into: "Living with pain" and "Patients´ needs when seeking GED", with six underlying themes. Several women described their visit to the GED as a "lottery", as they never knew what kind of treatment they would receive. Being listened to was most important for the women. Individualized care plans did not exist for most of the women in this study, although they repeatedly needed to visit the GED. [ABSTRACT FROM AUTHOR]

While research has suggested that addressing multiple needs simultaneously may increase the chances for positive labor force outcomes, few studies have explored a multi-pronged approach to assist individuals with jumping off the benefits cliff. The purpose of the current study is to explore the potential of a Career Pathway program designed to supplement benefits for those who "jump off the benefits cliff." This study will employ qualitative impact assessment protocol (QuIP) and observational methods to assess the implementation of the career pathway program through (1) observation, (2) focus groups with service providers and program stakeholders, and (3) semi-structured interviews with program participants. Qualitative thematic analysis will be employed to analyze responses disaggregated by the various service providers and program participants. Codes and themes generated from the analyses will be compared both within the groups of service providers and participants and between the groups. [ABSTRACT FROM AUTHOR]

Public and patient involvement (PPI) has been identified as an increasingly desired and, often, required component of trial methodology–leading to higher quality, more accessible and relevant clinical research, alongside increased recruitment, funding success and insight into research impact. However, despite the great variety of frameworks and checklists available for assessing PPI, most are limited with respect to important features (e.g. applicable in specific contexts only, fail to clarify what should be assessed and reported, lack the necessary comprehensiveness or are biased in favour of researcher reporting). Thus, the current research aimed to address such limitations through the development of a new checklist, the EPPIIC, through review, thematic analysis and 'meta-evaluation' in conjunction with PPI engagement. Upon completion of the EPPIIC, three thematic 'sub-scales' emerged: (1) Policy & Practice, (2) Participatory Culture and (3) Influence & Impact. All findings are presented and discussed in light of theory and research. Notably, findings recommend EPPIIC as a useful means of assessing PPI in future trials. [ABSTRACT FROM AUTHOR]

Background: Health-related quality of life (HRQOL) is an important and frequently used patient-reported outcome in health research. However, little qualitative research exists in this field in South Africa. This study was set in Khayelitsha, one of the largest informal settlements in South Africa, where the burden of HIV and tuberculosis (TB) co-infection are amongst the highest in the world and significantly affect HRQOL. Objective: To explore the experience of HRQOL among patients living with HIV-associated TB. Methods: We conducted sixteen interviews with male (n = 10) and female (n = 6) adult participants (ages 24–56; median age 35) to explore their HRQOL living with HIV-associated TB, related treatment and how this impacted on life domains they considered relevant for HRQOL. We used thematic analysis to analyse data, using both an inductive and deductive analysis using an interpretive phenomenological approach (IPA). Results: Experiences of HRQOL were identified along the predominantly emerging themes of physical, social, and mental aspects of HRQOL. Identified sub-themes included well-being, loss of strength, and self-care for the physical domain; usual activities and stigma for the social domain; concerns and coping for the mental domain. The findings illustrate that HRQOL domains are interconnected through social experience. The social experience of HRQOL was identified as the common denominator connecting all domains, around which HRQOL revolved for these participants. Conclusion: HRQOL is experienced socially. The interpersonal connections patients have with significant others present as key to high HRQOL among patients living with HIV-associated TB. This study adds to the existing literature of HRQOL and examines HRQOL using IPA which may help to inform future interventions to improve HRQOL among HIV/TB patients. [ABSTRACT FROM AUTHOR]

'Unmasking Pain' is an innovative artist-led project to explore creative approaches for telling stories of life with persistent pain. The purpose of this qualitative study was to explore and describe the lived experience of taking part in 'Unmasking Pain' from the perspectives of people living with pain (workshop attendees), artists (workshop facilitators) and pain rehabilitation specialists. Informed by descriptive phenomenology, data was collected via semi-structured interviews with three artists (workshop facilitators), five workshop attendees (all living with persistent pain) and one pain rehabilitation specialist. Data was analysed using thematic analysis for descriptive phenomenology. Three themes emerged from the analysis: Theme 1 Space to Breathe, reflects the context of 'Unmasking Pain' such as the conditions, environment and setting that people experienced; Theme 2 Flexibility to Participate, reflects the experience of the process of 'Unmasking Pain' such as the actions or internal workings/behaviours of the experience; and Theme 3 Possibility for Change, reflects the cognitive or emotional experience of 'Unmasking Pain'. There were nine sub-themes: 1(a) Dissolved hierarchy, 1(b) Human connection, and 1(c) Personally meaningful; 2(a) Go with the flow, 2(b) Enjoyable experience, and 2(c) Curiosity to step into the unknown; and 3(a) Reforming pain, 3(b) Liberating in the moment (now), and 3(c) Gives you a boost (future). In conclusion, the uniqueness of 'Unmasking Pain' was to creatively facilitate curiosity and exploration of pain in a non-clinical, sociocultural, humanised context, to enable the possibility of a different pain experience. The findings from this qualitative study exploring the lived experience of taking part in 'Unmasking Pain' demonstrates the power and opportunity of the Arts sector and artist-led activities to support people with chronic pain to have a better pain experience. [ABSTRACT FROM AUTHOR]

Innovative models of healthcare, such as telehealth, are required to meet the growing demand for orthotic/prosthetic (O&P) services. While O&P users report being very satisfied with telehealth, many clinical facilities have reverted to in-person modes of care as COVID-19 restrictions have eased. As such, there is a disconnect between benefits of telehealth to O&P users, and the clinical services being delivered in-person. The aim of this study was to explore the orthotist/prosthetist's perspective of the barriers and facilitators influencing use of telehealth in the United States of America (USA). O&P practitioners were recruited from across the USA. In-depth, semi-structured interviews were used to document practitioner demographics, the services being provided using telehealth, and practitioners' perspective of the barriers and facilitators influencing use of telehealth. Data describing participant demographics and services were summarised. Interviews were transcribed verbatim and analysed using thematic analysis. 30 practitioners from across the USA participated. Telehealth was used to deliver a range of O&P services including: initial evaluations, routine follow-ups, and delivery of a device in rare circumstances. Barriers to using telehealth included: poor phone/internet connection and lack of access to technology. Facilitators to using telehealth included: a patient-focussed attitude, and recognition of the benefit of telehealth. Telehealth is being used across the entire spectrum of O&P care. Once the significant barriers were resolved, like access to reliable internet/phone reception, telehealth was feasible. An outstanding telehealth experience was facilitated by practitioners who focused on the benefits that telehealth can provide (not the limitations), as well as giving O&P users agency over the choice to use telehealth. There are opportunities to improve access to safe and effective O&P telehealth services by adopting a right-touch approach to practitioner regulation, and advocating for reimbursement that supports better systems and procedures within clinical facilities. [ABSTRACT FROM AUTHOR]

Background: HPTN 084 compared the safety and efficacy of long-acting injectable cabotegravir (CAB) to daily oral TDF/FTC for prevention of HIV-1 in uninfected African women. Like a similar trial in MSM/TGW (HPTN 083), the trial was stopped early for efficacy, expediting the need to consider introduction strategies for different populations. We examine survey and qualitative data from a four-country sub-study to examine oral and injectable PrEP acceptability and considerations for CAB access among African women. Methods: Participants completed baseline and follow-up surveys on HIV risk perception, sexual behavior. product acceptability and adherence during the blinded trial. Additionally, up to two in-depth interviews each with 73 sub-study participants explored product use and trial-related experiences, during the blinded and unblinded study periods. Using survey data, we classified participants as: engaged in female sex work (FSW), having multiple non-transactional partners, or monogamous. A study statistician identified participants' assigned study arm. We followed a thematic analysis process to read transcripts, develop a codebook and apply codes in NVivo to transcripts with intermittent intercoder reliability checks; using Excel matrices to explore differences across risk categories and study arms. Findings: Participants overwhelmingly preferred injections to pills, appreciating the ease, convenience, and privacy of a long-acting formulation. Many participants described challenges with contraceptive and/or study pill adherence, impeded by late night work, unexpected travel, or heavy drinking. Women in the TDF/FTC arm were more likely to describe side effects, compared to those in the CAB arm. Pain also varied widely by study arm. When considering post-trial access to CAB, limited PrEP knowledge, cost and concerns around stigma and poor service quality were potential access barriers. Conclusion: Women's desire for privacy and ease of use outweighed injectable concerns, resulting in a strong preference for CAB. Cost and accessibility will need to be addressed by implementation programs. [ABSTRACT FROM AUTHOR]

Background: Menstrual hygiene management is a critical aspect of adolescent health. However, access to adequate menstrual hygiene products and sanitation facilities is severely restricted during times of war. There is a dearth of information about the menstrual hygiene needs of adolescent girls during humanitarian crises. This study investigated the menstrual hygiene management needs of the internally displaced adolescent girls in the war-torn region of Tigray, Ethiopia. Methods: A qualitative study was conducted in three centers for internally displaced people in Mekelle, Tigray Region. Four focus-group discussions and six in-depth interviews were conducted using the local language among 39 adolescent girls aged 13–19 years. The collected data were recorded, transcribed, translated, and analyzed using the ATLAS.ti-7.5.18 software through a qualitative thematic analysis approach. Results: Six primary themes were identified: 1) shortage of menstrual pads; 2) poor accommodation of latrine facilities; 3) silence around menstruation; 4) exchange of menstrual pads for life-saving commodities, 5) lack of privacy; 6) menstruation is a "curse" for adolescent girls living in displaced people's camps. The study highlights the significant challenges faced by internally displaced adolescent girls in managing their menstrual hygiene while living in camps for internally displaced people. Lack of access to adequate menstrual hygiene management supplies often leads them to use rags or worn-out clothing instead of menstrual pads. Conclusion: Access to adequate menstrual hygiene products and sanitation facilities is severely limited among displaced adolescent girls in Tigray. The findings emphasize the urgent need to address menstrual hygiene issues during emergencies. Supplying essential items such as sanitary pads, soap, water, sanitation infrastructure, and improved information on menstrual hygiene management should be prioritized. [ABSTRACT FROM AUTHOR]

Within a changing research and media landscape, misconceptions and misinformation about microorganisms and microbiomes can arise, necessitating improvements in science communication practices through insights in public perceptions of the microbial world. Yet, little is known about public perceptions of microorganisms and microbiomes, making it difficult to develop tailored messaging. Here we perform an inductive thematic analysis with interviews and surveys from thirty adults across the United States to identify key factors to enhance microbial science communication efforts. Together, our results underscore the importance of 1) recognizing the existing and desired future knowledge of an audience, 2) aligning with broader socio-scientific issues that resonate with people in relevant channels using social networks, 3) fostering collaboration between microbiologists, social scientists, and communicators to improve messaging, and 4) appealing to people's values and emotions to establish meaningful connections. This study concludes that non-microbial interests, such as an interest in health and wellness, may lead to acquisition of microbial knowledge and that people want scientists to share microbial messages preferably on platforms like social media. Additionally, we identified confusion about microbial terms and a desire to understand human-centric benefits of microorganisms and microbiomes. We suggest that microbiologists partner with science communicators to develop microbial messaging, capitalizing on connections to non-microbial interests and appealing to people's microbial worldview. [ABSTRACT FROM AUTHOR]

This is a qualitative study exploring the perceptions of mental health among Somali women living in London. Participants, over the age of 18, female and identifying as Somali, were recruited from a community centre in West London. Seven participants were recruited and semi-structured interviews were conducted to better understand perceptions of mental health, care-seeking, treatment and different understandings of these issues within the Somali community in London. Interview transcripts were imported into NVIVO version 14 to be coded, and description-focussed coding and thematic analysis were used to interpret key themes. Concerns around judgement, shame and stigma are key issues affecting attitudes towards mental health in this group. Other important issues affecting conceptualisations and attitudes towards mental health were intergenerational differences, isolation from the community, stigma and secrecy. Participants also reported the importance of protective factors, particularly faith and family in their lives. This research adds to existing literature in exploring perceptions of mental health in Somali communities in the UK and such research is helpful in identifying cultural barriers to recognition and treatment of mental health within this community. [ABSTRACT FROM AUTHOR]

Background: Nepal established the health partner coordination for COVID-19 response based on national and international plans and framework to support information-sharing for decision- making and course correction. This paper aims to assess the performance of COVID-19 Health Partner Coordination response in Nepal by adopting coordination best practices and tools from the international humanitarian cluster system. Methods: Secondary data from unpublished documents on health partner coordination for COVID-19 response in Nepal was collected and analysed from April 2023 to May 2023. The secondary data were from the review of the health partner coordination meetings conducted for COVID-19 response using a researcher-developed document review tool, responses of health partners on a survey tool adapted from the cluster coordination performance monitoring tool from the Global Health Cluster, and transcript of Focused Group Discussion among health partners. Descriptive analysis of quantitative information and thematic analysis with predefined themes of qualitative information were performed using MS Excel and MS Word respectively. A written approval from the Ministry of Health and Population and an ethical clearance from the Nepal Health Research Council was obtained before conducting the study. Results: More than three-fifths of the meetings showed good results in conduction, process, participation, and documentation of meeting action points with improvement required for follow-up (22.2%). Assessment of health partner coordination subfunctions resulted in either 'good' (>75.0%) or 'satisfactory' (50.1%-75.0%) except for prioritization based on analyses, which was 'unsatisfactory' (<50%). Partners admired good practices of health partner coordination, pointed out some issues, and provided recommendations. Conclusion: COVID-19 has highlighted the importance of effective coordination of health sector for response to a pandemic. Continuation of this practice after addressing the areas for improvement will contribute to health preparedness and readiness for future disasters or public health emergencies. [ABSTRACT FROM AUTHOR]

Objective: This study aims to identify the most recommended components of creative art therapy (CAT) to improve the mental health of refugee adolescents. Design: A three-round Delphi design is proposed. The first round will include semi-structured interviews with a panel of 12 CAT professionals worldwide and 12 refugee adolescents aged 10–24 in Jordan with a history of participating in creative arts interventions. The hybrid approach of coding and thematic analysis will be conducted to develop statements on recommended CAT components from the interview narratives. In the second round, the same and newly enrolled 24 professionals and 24 refugee adolescents will be asked to rate the statements according to their importance, propose new statements, and add comments. A similar procedure will be followed in the third round, where panellists will rate new and old statements after perusing the feedback from the second round. Main outcome measure: A statement will gain consensus and indicate essential components when rated 'essential' or 'very important' by > = 80% of panellists. Very important components are those with the same ratings by 60–79.9% of panellists. Results: A list of essential and very important components, perspectives and suggestions will be provided to guide practice and intervention development. [ABSTRACT FROM AUTHOR]

Background: Peer support programs demonstrate numerous benefits, including emotional, instrumental, informational, and affirmational social support. Since the COVID-19 pandemic, many peer support stroke programs in Canada have been delivered virtually. Compassion must be consistently applied to build meaningful interactions, but the shift to virtual services may have changed the quality of interaction and compassion in virtual services. While compassion is recommended in health and social services to improve outcomes, satisfaction, and service quality, compassion in virtual peer support stroke programs remains understudied. We aimed to describe compassionate support in virtual peer support stroke programs from peer support providers' and recipients' perspectives. Methods: This qualitative descriptive study was guided by Sinclair & colleagues' model of compassion. Peer support recipients or peer support providers participated in interviews transcribed and analyzed using a hybrid thematic analysis. Results: Sixteen were peer support recipients, six were peer support providers, and two were both peer support providers and recipients. Participants agreed that compassion was essential in these programs. Participants perceived compassion to be a result of the virtues of compassionate facilitators (i.e., genuineness, passion, and empathy), relational space, and communication within the virtual peer support stroke program (e.g., sense of awareness or intuition of compassion, aspects of engaged peer support provision), virtuous response (e.g., knowing the person and actions that made the peer support recipient feel like a priority). Compassion was facilitated by listening and understanding peer support recipients' needs as they relate to stroke (i.e., seeking to understand peer support recipients and their needs), attending to peer support recipients' needs (e.g., timely actions to address their needs), and achieving compassion-related program outcomes (e.g., alleviating challenges and enhancing wellbeing). The absence of these components (e.g., lacking genuineness, passion and empathy) was a barrier to compassion in virtual peer support stroke programs. Conclusions: Study findings describe facilitators and barriers to perceived compassion in virtual peer support stroke programs and provide practical recommendations that can be adapted into programs to improve program quality. [ABSTRACT FROM AUTHOR]

Unstructured play is characterized as play that is child initiated and determined, allowing children the freedom and flexibility to engage in activities, including taking risks, without adult intervention. However, playworkers and caregivers are important mediators of children's unstructured play. Studies have investigated playworker and caregiver perspectives regarding play, yet few have done so within the context of community based unstructured play interventions. Our qualitative study explored knowledge, attitudes and perspectives regarding play among playworkers ("play ambassadors") and caregivers exposed to a community based unstructured play intervention implemented in Calgary, Canada. The intervention aimed to encourage unstructured and risky play in local parks via loose parts. Between August and October 2020, ten caregivers and four play ambassadors completed individual semi-structured interviews. Using thematic analysis, we identified four overarching themes. The importance of play (theme 1) reflected play ambassador and caregiver perspectives about how unstructured and risky play promoted health and development and offered opportunities for enjoyment, exploration, and social interaction. Perceptions of the play environment (theme 2) reflected play ambassador and caregiver experiences of the play hubs including the role of loose parts in shaping play. Challenges and triumphs in promoting play (theme 3) reflected play ambassador experiences in facilitating play as well as interactions between caregivers and play ambassadors. Play hub impacts on the community (theme 4) reflected play ambassador and caregiver perspectives on the role of the play hubs in facilitating social interactions and community engagement. Play Ambassadors and caregivers shared common beliefs about the benefits of unstructured and risky play and about the play hubs affects on facilitating social interactions. Community based unstructured play interventions may support play and promote a sense of community. [ABSTRACT FROM AUTHOR]

An oral two-drug regimen (O2DR) in the form of a once-a-day single tablet is now recommended for treatment switching and treatment initiation for HIV. In clinical care, the process of treatment change refers to adaptation issues, both individual and within the care relationship. The study aim is to present the determinants involved in the acceptability of switching to O2DR in the PROBI (Patient-Reported Outcomes BItherapy) qualitative study. The study includes 30 interviews: 15 were conducted with doctors caring for people living with HIV, 15 were conducted with patients who had been offered a change of treatment. A double analysis was carried out: lexicometric analysis to highlight the structuring of the discourse around the change in treatment and a thematic analysis to understand the associated issues more precisely. The results highlighted common concerns with respect to switching to O2DR. Also, the caregiver-patient relationship was a central determinant in treatment switching. Information, knowledge and representations of O2DR are also factors facilitating treatment change and should be taken into account for doctors' and patients' adherence. [ABSTRACT FROM AUTHOR]

Background: Belonging is closely associated with well-being, yet individuals with experiences of being unhoused are likely to experience social exclusion and challenges with developing a sense of belonging. Engagement in meaningful activity has been linked to belonging; however, there are no focused studies exploring experiences of how engaging in meaningful activities influences belonging. Meaningful activities are things we do that bring value to our lives. Purpose: To explore how engaging in meaningful activities may influence experiences of belonging following homelessness through a secondary analysis of qualitative interviews. Method: Using interviews conducted in a community-based participatory action study exploring the transition to housing following homelessness (n = 19), we conducted a thematic analysis using the method described by Braun and Clarke. Participants were recruited through communication with local organizations supporting individuals with lived and living experiences of being unhoused as well as through presentations at drop-in organizations. An intentional effort was made to recruit diverse participants regarding housing status, age, and gender. Inductive analysis was used to conduct initial coding, focusing on belonging and engaging in meaningful activities. We then analyzed the codes abductively, using Bourdieu's Social Capital Theory to inform this analysis. Findings: The overarching essence generated in our analysis was: "I don't feel like I belong...everything in the world is not for me...it's for people with...enough money to...enjoy those things". Within this overall essence, we generated three themes: 1) Human connection: "being where I am with people who care about me, I actually feel good"; 2) Social exclusion: being a "regular member of society"; and 3) Non-human connection: "my cats...are like my kids to me." Participants described numerous contextual factors that challenged them as they sought belonging following homelessness, including financial limitations and other societal factors. Conclusion: Our findings suggest that meaningful activity was an important pathway to belonging for participants in this study. [ABSTRACT FROM AUTHOR]

Background: Gastro-oesophageal reflux (GOR) affects nearly half of infants. Parents play a crucial role in management but more understanding of their attitudes and experiences is needed to inform future education, support and research. This study aims to explore parental experiences, attitudes and understanding of the symptoms, diagnosis and management of infant GOR. Methods: Qualitative semi-structured interviews with 9 parents of infants with GOR in the UK, analysed by thematic analysis. Results: 8 participants were mothers and median age was 34 years. Over half identified as White ethnicity. Parents described that GOR can affect all aspects of life, including mental wellbeing and bonding with their baby. Medications are time-consuming to prepare and can cause challenging side effects such as constipation. It is crucial that health professionals manage parental expectations in that treatments are not curative and symptoms do not last forever. Attitudes about healthcare professionals varied: some were perceived as dismissive, whilst some showed understanding. There were differences depending on whether the child was a first or second born child, with more understanding shown where the child was not the parents' first born. Parents felt more education could be beneficial for parents and clinicians. Conclusions: Infant GOR can affect infants and parents in a variety of ways, impacting both physical and mental health. Parents play a vital role in the management of infant reflux, but there is lack of consistency of information and levels of knowledge among healthcare professionals vary. More education could be beneficial, and further research is needed into health professionals' perceptions and fathers' experiences. [ABSTRACT FROM AUTHOR]

Background: Almost half of all women in the US experience intimate partner violence (IPV) in their lifetime. The US Preventive Services Task Force recommends IPV screening paired with intervention for women of reproductive age. We aim to understand clinical practices and policies that are beneficial, detrimental, or insufficient to support survivors of IPV in a safety-net healthcare system. Methods: We sampled 45 women who were 18–64 years old, had experienced IPV within the prior year and were patients in the San Francisco Health Network. We conducted in-depth, semi-structured interviews to elicit their perspectives on disclosing IPV and obtaining support within the healthcare system. We analyzed our data using thematic analysis and grounded theory practices informed by ecological systems theory. Findings: We identified four themes regarding factors that impeded or facilitated discussing and addressing IPV across interpersonal and systemic levels relating to relationship-building, respect, autonomy and resources. (1) Interpersonal barriers included insufficient attention to relationship-building, lack of respect or concern for survivor circumstances, and feeling pressured to disclose IPV or to comply with clinicians' recommended interventions. (2) Interpersonal facilitators consisted of patient-centered IPV inquiry, attentive listening, strength-based counseling and transparency regarding confidentiality. (3) Systemic barriers such as visit time limitations, clinician turn-over and feared loss of autonomy from involvement of governmental systems leading to separation from children or harm to partners, negatively affected interpersonal dynamics. (4) Systemic facilitators involved provision of resources through IPV universal education, on-site access to IPV services, and community partnerships. Conclusions: Women experiencing IPV in our study reported that relationship-building, respect, autonomy, and IPV-related resources were essential components to providing support, promoting safety, and enabling healing in the healthcare setting. Successful trauma-informed transformation of healthcare systems must optimize interpersonal and systemic factors that improve survivor wellbeing while eliminating barriers. [ABSTRACT FROM AUTHOR]

The first hours, days, and weeks following childbirth are critical for the well-being of both the mother and newborn. Despite this significance, the postnatal period often receives inadequate attention in terms of quality care provision. In Nepal, the utilization of postnatal care (PNC) services remains a challenging issue. Employing a facility-based concurrent triangulation mixed-method approach, this study aimed to identify factors associated with PNC service utilization, as well as its facilitators and barriers. A quantitative survey involved 243 mothers who had given birth in the six months preceding the survey, selected using a multistage sampling technique from six health facilities of two randomly selected local levels of the Pyuthan district. Weighted multivariate logistic regression was employed to identify predictors of PNC service utilization. Additionally, qualitative analysis using Braun and Clarke's six-step thematic analysis elucidated facilitators and barriers. The study revealed a weighted prevalence of PNC service utilization as per protocol at 38.43% (95% CI: 32.48–44.74). Notably, Socioeconomic status (AOR-3.84, 95% CI: 2.40–6.15), place of delivery (AOR-1.86, 95% CI: 1.16–3.00), possessing knowledge of postnatal care (AOR = 6.75, 95% CI: 3.39–13.45) and access to a motorable road (AOR = 6.30, 95% CI: 3.94–10.08) were identified as predictors of PNC service utilization. Triangulation revealed knowledge on PNC, transportation facilities, PNC home visits, and postpartum weaknesses to visit health facility as areas of convergence. Conversely, divergent areas included the proximity of health facilities and the effect of COVID-19. The study identified a low prevalence of PNC service utilization in the district. To enhance utilization, targeted interventions to increase awareness about postnatal care, appropriate revision of existing policies, addressing wider determinants of service utilization, and ensuring effective implementation of PNC home-visit programs are of utmost importance. [ABSTRACT FROM AUTHOR]

Background: People with lived experience have had limited opportunities to meaningfully contribute to the design of caring contacts interventions. The objective of this study was to co-design text messages with peer support specialist staff to determine optimal language and delivery, within a cultural context. Methods: In this qualitative study, participants were professional peer support specialist staff with lived experience employed by specialist mental health services. They were asked to evaluate the initial series of text messages by taking part in a focus group using a semi-structured interview. This was audiotaped, transcribed and analysed using reflexive thematic analysis with specific coding of cultural themes. Results: Three main themes were identified: upholding a person's autonomy; establishing connection as a bridge to safety; and, words as healing rongoā (remedy). The last theme contained a cultural subtheme: Māori language providing entry to the Māori world. Conclusion: People with lived experience breathe empowerment and hope into caring contacts interventions and should be considered vital partners in developing any suicide prevention initiative. Feeling genuinely cared for promotes connection and may enable an internal sense of safety. Tailoring of texts can be enhanced by culturally nuanced language. [ABSTRACT FROM AUTHOR]

Introduction: Children in boarding schools spend most of their time without their parents or caregivers, causing concerns about the suitability of such schools for children with asthma. This study assessed individuals' opinions regarding the suitability of boarding secondary schools for children with asthma. Methods: A qualitative design was adopted for this study using a focus group discussion held on a social media platform (WhatsApp®) of the Asthma Awareness and Care Group (AACG), The group comprised 150 registered members. The study was guided by a structured protocol and based on a vignette comprising three questions. Data were analysed via thematic analysis using framework principles. Results: Out of the 150 eligible members, there were responses from only 19 participants. Majority of the respondents were aged ≤ 30 years (n = 17, 89.5%). The three main themes generated from the thematic analysis include the appropriateness of boarding schools for children with asthma; facilities necessary for boarding schools to cater to children with asthma; and outright rejection of children with asthma by boarding schools. Respondents conceptualised the appropriateness of boarding schools for students with asthma in six distinct sub-themes: asthma severity and extent of control, child's self-efficacy and assertiveness, child equipped with tools (knowledge, inhalers, and asthma control diary), school awareness, facilities, and active support, availability of a guardian, and the knowledge and perception of teachers and schoolmates about asthma. The sub-themes associated with the themes were presented, alongside exemplar quotes from respondents. The majority of the respondents (61.5%) were in support of allowing children with asthma attend boarding schools but with some caveats such as without liability to the school, if facilities are unavailable. Conclusion: Children's age, autonomy, asthma management status, and the school's readiness were identified as important considerations for the safe attendance of children with asthma at boarding schools. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic has raised concerns about the global capacity for timely outbreak reporting. However, gaps remain in our understanding of barriers and enablers to outbreak reporting, particularly at the local level. Field epidemiology training program (FETP) fellows often participate in the outbreak reporting process as part of both their training and the public health roles they assume after graduating; they therefore represent a potentially valuable source of information for better understanding these barriers and enablers. This study will investigate the barriers and enablers to outbreak reporting through a mixed methods approach that will encompass a review of the existing literature as well as surveying and interviewing FETP trainees and graduates from the Asia-Pacific region. Methods: This study will begin with a scoping review of the literature to identify existing evidence of barriers and enablers to outbreak reporting. Based on our findings from the scoping review, we will administer a survey to FETP trainees and graduates from the World Health Organization Western Pacific and South-East Asian Regions and conduct interviews with a subset of survey respondents to investigate the survey findings in more detail. We will summarise and compare the survey results according to various country-level economic and political indicators, and we will employ thematic analysis to evaluate the interview responses. Based on the findings from the scoping review, survey, and interviews, we will construct a model to comprehensively describe the various barriers and enablers to outbreak reporting. Conclusion: This study will contribute to our understanding of the determinants of outbreak reporting across several geographic, political, and economic contexts by eliciting the viewpoints and experiences of persons involved with outbreak reporting, particularly at the local level. This information will help improve the outbreak reporting process, allowing for more timely reporting and helping prevent future outbreaks from becoming pandemics. [ABSTRACT FROM AUTHOR]

Background: Vaccination remains one of the most successful public health interventions in preventing severe disease and death. The roll-out of Covid-19 vaccination programmes has helped protect billions of people around the world against Covid-19. Most of these programmes have been unprecedented in terms of scale and resources, and have been implemented at times of significant humanitarian crisis. This study aims to outline the lessons learnt from the implementation of a regional Covid-19 vaccination programme. These will help inform emergency preparedness and future crisis management. Methods: This qualitative study sought to explore the key drivers to the successful implementation of the Covid-19 vaccination programme in a region in the Southwest of England, applying the Normalisation Process Theory lens (NPT) to examine multi-stakeholder perspectives. Data collection involved semi-structured interviews with 75 participants. Document analysis was also used to corroborate the findings emerging from the interviews. Inductive thematic analysis of the data was used to identify the key drivers for the successful implementation of the programme. The NPT lens was then applied to map the themes identified to the domains and constructs of the framework. Results: Ten key drivers to the successful implementation of the Covid-19 vaccination programme locally were identified, including: the clarity and consistency of the programme's goal; the diverse representation of stakeholders within the programme leadership team and the mechanisms created by this team to ensure psychological safety, autonomy, operational flexibility and staff empowerment; Communication and data specialists' input, and collaboration with local communities to maximise the reach of the programme; and allocating funding to tackle health inequalities. Conclusions: This study highlights the lessons learnt from the implementation of the Covid-19 vaccination programme at a local level, and the mechanisms that can be used in future crises to respond efficiently to the needs of individuals, communities and governments. [ABSTRACT FROM AUTHOR]

Provider adherence to the integrated antenatal care (ANC) procedure is an important indicator of high-quality ANC. The procedure is intended to avoid missed opportunities to detect the risk of abnormalities in pregnancy. This study aims to assess the provider's adherence to integrated ANC in Basic Emergency Obstetric and Newborn Care (BEmONC) and non-BEmONC Primary Health Center (PHC). This study employed an explanatory sequential mixed-method design. The quantitative phase reviewed 149 medical records of pregnant women in the four PHCs in Semarang from January until February 2020. The findings were used to describe the provider's adherence to the integrated ANC and lead to the contributing factors which should be explored in the qualitative phase. The study involved four in-depth interviews with midwife coordinators in four PHCs. The Mann-Whitney and Chi-square test was employed to analyse the quantitative data, while the thematic analysis was undertaken on the qualitative data. The provider's adherence to the guideline did not differ between BEmONC and non-BEmONC PHC. The general physical examination of the patients (18.81%) and dentist visits (84.6%) were not done in either BEmONC or non-BEmONC PHC. Incomplete laboratory tests were haemoglobin (28.2%) and urine protein (38.9%). The barriers to adherence to the integrated ANC guideline were related to an imbalance of resources, role and responsibility issues among doctors and midwives, and policy issues. This study found low BEmONC nor non-BEmONC PHC adherence to the integrated ANC guideline. A Periodic evaluation of the implementation of integrated ANC to ensure its high-quality implementation in Indonesia is needed. [ABSTRACT FROM AUTHOR]

Background: The planet's population is aging at an incredible speed. Poor dietary practices are a major problem among the elderly. However, literature is scarce on dietary practices among elders in the study area. Therefore, the results of this study may give information to decision-makers. Objective: This study aimed to assess dietary practices and associated factors among elderly people in Northwest Ethiopia, in 2022. Methods: A community-based mixed study design was employed among elderly people from May 20 to July 2, 2022. Systematic random sampling and purposive sampling techniques were used for selecting study participants in quantitative and qualitative studies, respectively. Data were collected using an interviewer-administered structured questionnaire for the quantitative part and an interview guide for the qualitative part. Binary logistic regression analysis was used. A P-value less than or equal to 0.05 was used to declare statistically significant variables. A crude odds ratio and an adjusted odds ratio with a 95% confidence interval were used to measure the strength of the association. Thematic analysis was used for qualitative data analysis. Results: A total of 422 participants were recruited for the study. Twenty-six in-depth interviews were done. The prevalence of adequate dietary practice was only 54.5% [95% CI: (49.8, 59.2)]. It was significantly associated with being aged between 65 to 74 years (AOR: 8.32; 95 CI: 3.9, 18.1), being aged between 75 to 84 years (AOR: 2.90; 95% CI: 1.1, 7.9), eating sometimes alone (AOR: 1.86; 95% CI: 1.03, 3.4), eating always with family members (AOR: 4.96; 95% CI: 2.6, 9.4), and food security (AOR: 3.13; 95% CI: 1.8, 5.4). Thematic analysis revealed three themes that interfere with the dietary practices of elders. A majority of in-depth interviewees mentioned that there were taboos and cultural beliefs which favor inadequate dietary practices of the elderly; the study participants reported that individual, economic, societal, and physiological factors are barriers affecting the dietary practices of the elderly, and all respondents have no experiences regarding elderly dietary practices. Conclusion: The prevalence of adequate dietary practice was low. It was significantly associated with age, with whom feeding, and household food security status. Taboos and cultural beliefs, barriers, and experiences hampered the dietary practices of elders. Therefore, improving the dietary practices of elders focusing on advanced age, loneliness, food security, taboos, cultural beliefs, barriers, and experiences regarding dietary practices should be done. [ABSTRACT FROM AUTHOR]

The collective intelligence of crowds could potentially be harnessed to address global challenges, such as biodiversity loss and species' extinction. For wisdom to emerge from the crowd, certain conditions are required. Importantly, the crowd should be diverse and people's contributions should be independent of one another. Here we investigate a global citizen-science platform—iNaturalist—on which citizens report on wildlife observations, collectively producing maps of species' spatiotemporal distribution. The organization of global platforms such as iNaturalist around local projects compromises the assumption of diversity and independence, and thus raises concerns regarding the quality of such collectively-generated data. We spent four years closely immersing ourselves in a local community of citizen scientists who reported their wildlife sightings on iNaturalist. Our ethnographic study involved the use of questionnaires, interviews, and analysis of archival materials. Our analysis revealed observers' nuanced considerations as they chose where, when, and what type of species to monitor, and which observations to report. Following a thematic analysis of the data, we organized observers' preferences and constraints into four main categories: recordability, community value, personal preferences, and convenience. We show that while some individual partialities can "cancel each other out", others are commonly shared among members of the community, potentially biasing the aggregate database of observations. Our discussion draws attention to the way in which widely-shared individual preferences might manifest as spatial, temporal, and crucially, taxonomic biases in the collectively-created database. We offer avenues for continued research that will help better understand—and tackle—individual preferences, with the goal of attenuating collective bias in data, and facilitating the generation of reliable state-of-nature reports. Finally, we offer insights into the broader literature on biases in collective intelligence systems. [ABSTRACT FROM AUTHOR]

Introduction: Relapse among individuals with serious mental illnesses in resource-limited contexts, including South Africa, is a significant concern. To date, the risks for relapse among this population is well documented, but little is known about prevention strategies to reduce its occurrence in these resource-limited settings. Therefore, this qualitative study explores the risk factors and strategies for relapse prevention from the patients' and caregivers' perspectives. Methods: We conducted audio-recorded face-to-face in-depth interviews to capture the lived experience of relapse of inpatient study participants with serious mental illness (N = 24) at a public specialized psychiatry hospital in South Africa and their caregivers (N = 6). We conducted an inductive thematic analysis with two pre-specified themes (risk factors for relapse and strategies for prevention), with the codes devised from the data. Results: Six sub-themes were identified from the analysis within the two pre-specified themes(Risk factors and strategies for relapse prevention): personal-related, family-related, and health system-related risk factors and strategies for preventing relapse, respectively. To highlight some essential findings, the importance of motivation for drug adherence, family involvement, and availability of anti-psychotic drugs in public health care were noted. More importantly, this study identified important cultural complexities where traditional healers play a significant role in some cultural understanding and treatment of mental illness, affecting medication adherence. Conclusion: This study calls for people-centered mental health care delivery in a public health system that listens to the voice of concern, including cultural challenges, and implements meaningful support that matters most to the patient and their family/caregivers. [ABSTRACT FROM AUTHOR]

Introduction: There is a lack of community-based rehabilitation for stroke in the Philippines, and research on this topic is limited. Different challenges may be encountered in urban and rural settings. The aim of the Tulong, Ugnayan ng Lingap At gabaY (TULAY) project is to develop a context-appropriate, community-based stroke support programme, consisting of self-management and training resources to augment the rehabilitation and recovery process. An important stage in the development of this programme is to qualitatively explore the experiences and needs of all stakeholders. Materials and methods: Using co-designed and evidence-based topic guides, in-depth semi-structured interviews will be conducted with people living with stroke, household carers and care providers. We will aim to gain a representation of different regions (within Luzon, Visayas, and Northern Mindanao), socioeconomic levels, and urban and rural locations. For people with stroke and household carers, interviews will be supplemented by auto-photography and visual elicitation to widen access for those that prefer to share their experiences visually or have communication problems. An interpretivist paradigm will be applied across all interview data and the consolidated criteria for reporting qualitative research (COREQ) will be followed. Thematic analysis will be undertaken using guidance by Braun and Clarke. Discussion: To our knowledge, this study is the first of its kind in the Philippines. It has several methodological strengths, including the capture of perspectives from multiple stakeholders in diverse settings, the inclusion of people with communication difficulties, use of visual methods, and analysis in the native language. The findings will have various applications, including the potential to influence policy, practice and guidelines, and to inform the development of the TULAY stroke support programme. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has negatively impacted the mental health and wellbeing of post-secondary students. Resilience has been found to serve as a protective factor against mental distress among students during the pandemic. Despite the plethora of research that exists on post-secondary students during this crisis, most studies exploring students' health and resilience are quantitative and lack diversity. To date, the lived experiences of health-related quality of life (HRQOL) and resilience among graduate students representing diversity in age, gender, ethnicity, parental status, university, degree, and faculty during the COVID-19 pandemic remain unknown. As a part of a larger study, the purpose of this qualitative paper was to understand the lived experiences of resilience and HRQOL among a diverse sample of graduate students approximately 18 months into the COVID-19 pandemic in Ontario, Canada. A total of 14 students participated in semi-structured interviews exploring HRQOL domains, factors that supported/undermined participants' resilience, challenges/barriers to being resilient, and participants' inner strength. Thematic analysis revealed 5 themes: (1) cultural influences on resilience; (2) the role of privilege/power in shaping resilience; (3) how life stage and past experiences support resilience; (4) how the COVID-19 pandemic has undermined the resilience of equity-deserving groups; and (5) the role of disability/chronic pain. This work presents a unique dichotomy between how the COVID-19 pandemic has disrupted the lives of some graduate students, while simultaneously creating opportunities for others to thrive. Findings from this work underscore the importance of creating inclusive and accessible educational spaces to support graduate students' resilience and HRQOL currently, and in times of crisis. [ABSTRACT FROM AUTHOR]

Introduction: Residents of rural regions may have higher and unique suicide risks. Newfoundland and Labrador (NL) is a Canadian province replete with rural regions. Despite an abundance of rural suicide research, heterogeneity in rural regions may preclude amalgamating findings to inform prevention efforts. Thus, exploring the unique needs of NL is needed. Importantly, health care providers (HCP) may afford unique perspectives on the suicide-related needs or concerns of rural life. We asked HCPs of residents of rural NL their perceived suicide risk factors, concerns, and needs for rural NL. Method: Twelve HCPs of rural residents of NL completed virtual semi-structured interviews. Interviews were analysed using reflexive thematic analysis [13,14]. Results: HCPs noted individual, psychological, social, and practical factors linked to rural-suicide risk and subsequent needs. Findings highlight the unique challenges of residing and providing health care in rural NL and inform prevention and intervention efforts. [ABSTRACT FROM AUTHOR]

Background: Human Papilloma Virus (HPV) vaccination can prevent more than 90% of cancers caused by HPV. Although this vaccination is recommended and provided at no cost to all adolescent girls aged 9 to19 years in Uganda, its uptake remains low. We sought to determine the uptake of, and factors associated with HPV vaccination among adolescent girls living with HIV in Uganda. Methods: We conducted an explanatory sequential mixed methods study, among adolescent girls living with HIV, attending HIV care at the Mulago ISS HIV clinic in Kampala, Uganda. We administered a structured questionnaire to elicit data on HPV vaccination and its covariates to a systematic random sample of 264 adolescent girls with HIV. A participant who had received all the three recommended HPV vaccine doses was classified as fully vaccinated. We then conducted four focus group discussions among adolescent girls living with HIV (n = 32), eight in-depth interviews among their parents and five Key informant interviews among their healthcare providers. We conducted descriptive statistics and logistic regression analyses for the quantitative data before thematic analysis for the qualitative data. Result: Of 264 adolescent girls, 31% (83/264) had at least one HPV vaccine dose; 22% (59/264) two doses, while 8.0% (21/264) were fully vaccinated (received three doses). While most participants received their first and second doses (48% (40/83)) and 57.6% (34/59), respectively) from school, the largest number of participants (47.1% (12/21)) received their third dose at community outreaches. Participants who received counseling from community members were three times more likely to get fully vaccinated compared to those who did not receive counseling (aOR 3.28, Cl:1.07–10.08, P = 0.038). From the qualitative follow-up, three major themes were identified: (1): Limited information about HPV vaccination, which gave room for misconceptions and doubts about the vaccine; (2) Parental influence on adolescent decisions was strong despite parents having limited knowledge about HPV vaccination and (3) Inadequacy of HPV vaccination services at the hospital and in the schools. Conclusion: Full HPV vaccination was low among adolescent girls living with HIV. Counseling of the adolescents by community members, alongside HPV vaccination community outreaches, provided a platform for vaccination. There should be strategies to provide adequate information about HPV vaccine to health workers, parents, and the adolescents. In addition to schools, community-based initiatives, including outreaches and lay-health workers can be utilized to improve HPV vaccine uptake among girls with HIV. [ABSTRACT FROM AUTHOR]

This study aimed to explore the views of healthcare professionals regarding the barriers and facilitators for a Fracture Liaison Service (FLS) in Malaysia. The qualitative study was conducted from February to December 2021 at a tertiary hospital in Malaysia. Doctors, nurses, pharmacists, and policymakers were recruited via purposive sampling. Semi-structured in-depth interviews were conducted until thematic saturation was achieved. Data were transcribed verbatim and analysed using thematic analysis. Thirty participants [doctors (n = 13), nurses (n = 8), pharmacists (n = 8), and policymakers (n = 1)] with 2–28 years of working experience were recruited. Three themes emerged: 1) Current delivery of secondary fracture prevention; 2) Importance of secondary fracture prevention, and 3) FLS sustainability. Some participants reported that the current post-hip fracture care was adequate, whilst some expressed concerns about the lack of coordination and continuity of care, especially in non-hip fragility fracture care. Most participants recognised the importance of secondary fracture prevention as fracture begets fracture, highlighting the need for a FLS to address this care gap. However, some were concerned about competing priorities. To ensure the sustainability of a FLS, cost-effectiveness data, support from relevant stakeholders, increased FLS awareness among patients and healthcare professionals, and a FLS coordinator were required. Training and financial incentives may help address the issue of low confidence and encourage the nurses to take on the FLS coordinator role. Overall, all participants believed that there was a need for a FLS to improve the delivery of secondary fracture prevention. Addressing concerns such as lack of confidence among nurses and lack of awareness can help improve FLS sustainability. [ABSTRACT FROM AUTHOR]

This study explores the topics searched by first-time Indonesian fathers during the pregnancy journey. Data were collected through semi-structured interviews with a representative sample of first-time expectant fathers in Indonesia. Thematic analysis was employed to identify common themes and patterns in fathers' search topics and reasons behind the searches. The results reveal that fathers predominantly focus on finding topics related to their partners' well-being with particular emphasis on health-related topics. Interestingly, the study highlights a lower engagement with topics related to cultural practices, traditions, and religion among first-time Indonesian fathers. Additionally, understanding the situation and finding the solutions to a problem is one of the main popular reasons for first-time fathers to seek a particular topic related to pregnancy. This study provides valuable insights into the topics searched and motivations of first-time Indonesian fathers during the pregnancy journey which have similarities and differences to fathers' practices in developed countries. The findings underscore the necessity for tailored intervention programs to promote paternal involvement during this transformative period which addresses the unique information needs of Indonesian fathers. [ABSTRACT FROM AUTHOR]

Online health misinformation commonly includes persuasive strategies that can easily deceive lay people. Yet, it is not well understood how individuals respond to misinformation with persuasive strategies at the moment of exposure. This study aims to address the research gap by exploring how and why older adults fall into the persuasive trap of online health misinformation and how they manage their encounters of online health misinformation. Using a think-aloud protocol, semi-structured interviews were conducted with twenty-nine older adults who were exposed to articles employing twelve groups of common persuasive strategies in online health misinformation. Thematic analysis of the transcripts revealed that some participants fell for the persuasive strategies, yet the same strategies were detected by others as cues to pin down misinformation. Based on the participants' own words, informational and individual factors as well as the interplay of these factors were identified as contributors to susceptibility to misinformation. Participants' strategies to manage misinformation for themselves and others were categorized. Implications of the findings are discussed. [ABSTRACT FROM AUTHOR]

Background: While a few studies have examined barriers to school re-entry among adolescent mothers, studies focusing on the experiences of girls in low-income informal settlements are scarce. We examined the factors that hindered parenting girls living in a resource-constrained urban setting from re-enrolling in school. Study setting: We conducted the study in Korogocho, a low-income urban informal settlement in Nairobi, Kenya. Methods: Barriers to school re-entry were documented through inductive thematic analysis of 32 in-depth interviews with pregnant and parenting adolescent girls aged 15 to 19 years (N = 22), parents/guardians (N = 10), and 10 key informant interviews with teachers (N = 4), and community leaders (N = 6). Results: Interviewed girls blamed their being out of school on their childcare responsibilities, poverty, stigmatizing and discriminatory attitudes from students and teachers, and withdrawal of parental support. While parents, teachers, and community leaders agreed that poverty and lack of childcare support hindered parenting girls from returning to school, they contended that robust support systems encompassing childcare and financial support, and less hostile school environments constituted facilitators of school re-entry among parenting adolescents. Conclusion: While the 2020 National Guidelines for School Re-entry in Kenya seek to deter the exclusion of adolescent mothers from education thereby ensuring retention, transition and completion at all basic education levels, the findings underscore the need for programs that ensure that pregnant and parenting adolescents have the requisite financial, material, and childcare support to facilitate their retention or re-enrollment in school in line with the Guidelines. School administrators and the Ministry of Education should develop and implement interventions that make the school environment less hostile for parenting girls. [ABSTRACT FROM AUTHOR]

Background: The pharmaceutical sector in Pakistan has grown over a period with export potential, however, there are certain barriers in the framework that regulate the growth and export of domestically manufactured pharmaceuticals. The purpose of this study was to highlight the current challenges that hinder the export of pharmaceuticals, especially to the countries with stringent regulatory authorities (SRA), as perceived by the domestic pharmaceutical industry experts, and to highlight the facilitators that may help to resolve the identified challenges. Methods: In a qualitative study, the data were collected from the consented experts from the pharmaceutical industries in Lahore, Karachi, Peshawar, and Quetta. Industrial experts with a minimum of 10 years of experience and who were serving at managerial levels or above were recruited through purposive sampling. The semi-structured interviews were conducted for the collection of data from industrial experts. Thematic content analysis was applied to conclude the data. Results: Data analysis generated 4 themes and 16 codes. The export of pharmaceuticals, despite having greater potential was regarded as poor, which was attributed to the following: (a) inadequate industrial research and development, particularly on new molecules (b) non-compliance with the cGMP standards, (c) absence of high-tech equipment, (d) unwillingness of the pharmaceutical companies for bioequivalence studies on their generics, (e) unavailability of locally manufactured active pharmaceutical ingredients, (f) disruption in the supply of imported raw material, (g) poor international market perception about local pharmaceutical products and (h) lack of support from regulatory in process expedition. The respondents also suggested the measures for overcoming the above challenges to boost the export of domestic pharmaceuticals and expand their international market share in countries with SRA. Conclusion: Export from Pakistan to the SRA countries can be enhanced with mandatory bioequivalence studies during generic registration. The pharmaceuticals export could effectively contribute to the national economy. [ABSTRACT FROM AUTHOR]

Background: Lead exposure at any concentration can adversely impact health, with children being more vulnerable to its effects. In England, children with an elevated blood lead concentration (BLC) are reported to Health Protection Teams (HPTs) for public health investigation. A detailed review of these cases has not yet been conducted. Objectives: The objectives of this study were to describe the demographics, likely setting and sources of lead exposure, risk behaviours, public health investigations and outcomes for children aged <16 years with a BLC requiring public health action reported to HPTs between 2014–2022 in England. Methods: Data were collected via a lookback questionnaire and a live enhanced surveillance questionnaire. Data were deduplicated, cleaned and results summarised as numbers and percentages using R studio. A thematic analysis was conducted on qualitative responses to a question relating to problems experienced during case investigation. Results: There were 340 cases in our study: the majority were aged 1–4 years old (53%) and male (69%). Ethnicity data was poorly recorded. A higher than expected proportion (31%) lived in the most deprived areas. Pica (76%) and learning difficulties (60%) were often present. Cases were primarily exposed to lead in the domestic setting (92%) with paint (43%) and soil (29%) the most common exposures. Most cases lived in rented accommodation (63%), with a higher proportion in social rentals (48%) than privately rented (37%). Case investigations were resource intensive and poor stakeholder engagement/response was most frequently identified as challenging by HPTs. Conclusions: Lead exposure is harmful to children and requires public health and clinical management, which can be complex and challenging. Prevention of lead exposure in children should be the focus of intervention efforts. Outreach, engagement and preventative work should focus on both renters and homeowners. Collecting ethnicity data consistently may enable identification of more specific groups at increased risk of lead exposure in England. [ABSTRACT FROM AUTHOR]

Background: Patients' education along with a motivation for developing self-care management skills is an essential component in the management of heart failure(HF). Self-care management education has been practiced by nurses in many hospitals. However, there is inadequate evidence for the provision of self-care management education in low-income countries including Tanzania. Lack of self-care management education to patients with HF during discharge is the most common reason for re-admission to hospitals. Aim: This study aimed to explore nurses' perspectives focusing on facilitators and barriers to the provision of self-care management education to patients with heart failure at Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania. Materials and methods: This study used a qualitative descriptive design. Purposive sampling was used to recruit 12 study participants. In-depth interviews were used to collect the data. We used thematic analysis to come up with the themes and sub-themes. Results: The two major themes emerged from this study; The first theme is "Improved patient quality of life and health outcome" which describes factors that motivate nurses to continue giving self-care management education to heart failure patients. The second theme is "Reduced effective uptake of self-care management education" which describes nurses'perspectives on barriers for providing self-care management education to heart falure patients. Nurses highlight some barriers while providing self-care management education to patients with heart failure including;inadequate knowledge of self-care management among nurses, lack of privacy during the provision of self-care education, poor communication skills among nurses, and lack of learning materials. Also, nurses pointed out facilitators that influence the provision of self-care management education such as increased involvement of family members and the use of peer educators. Conclusions and recommendations: Poor self-care management for patients with heart failure results in readmission and prolonged hospital stay. Family involvement and the use of peer educators are the key steps in the improvement of self-care management for patients with HF. However, patient cognitive impairment and poverty which contribute to poor health outcomes, should be taken into consideration when planning for discharge for patients with HF. Self-care management education should be part of routine health care. [ABSTRACT FROM AUTHOR]

Background: Digital transformation (DT) involves integrating digital technologies into organizations to improve productivity, efficiency, and quality. Investing in the workforce's skillsets is essential for successful DT. However, it remains unclear which skillsets are essential. Objectives: This study aims to identify and define the essential skillsets needed for exploiting the full potential of DT, and to consolidate the identified skills into a comprehensive framework of DT skills. Method: A systematic literature review was conducted using the PRISMA approach for selecting studies. This led to the selection of 36 articles that were examined using thematic analysis for identifying and consolidating skills into a framework. Results: The Digital Transformation Skills Framework (DTSF) was developed, which contains six overarching skillsets and 44 underlying skills. The framework covers key skillsets in the areas of digital work, entrepreneurship, evidence-based work, collaboration, communication, and adaptation. Conclusion and discussion: The DTSF offers a comprehensive understanding of essential skills for today's evolving organizations, addressing a critical gap in existing literature. It is valuable for organizations and HR professionals, serving as a foundation for re- and upskilling initiatives. Ongoing research should expand the framework to include domain-specific DT skills and emerging digital technologies. [ABSTRACT FROM AUTHOR]

Purpose: A lifestyle front office (LFO) in the hospital is a not yet existing, novel concept that can refer patients under treatment in the hospital to community-based lifestyle interventions (CBLI). The aim of this study was to identify implementation barriers and facilitators regarding the implementation of an LFO in the hospital from the perspective of CBLI-professionals and to develop evidence-based implementation strategies to reduce these identified barriers. Methods: We conducted semi-structured interviews until data saturation, with 23 lifestyle professionals working in the community. A semi-structured topic guide was used, inquiring about (1) community-based lifestyle interventions; (2) their views about referral from the LFO; and (3) their preferences, needs and recommendations for collaboration with the LFO in the hospital. The online interviews lasted on average 46 minutes, were audio-recorded and transcribed verbatim. A thematic content analysis was conducted. Found barriers and facilitators regarding the LFO where mapped using the consolidated framework for implementation research (CFIR) whereafter evidence based strategies were developed using the CFIR-Expert Recommendations for Implementing Change Strategy Matching Tool V.1.0 (CFIR-ERIC). Results: Barriers and facilitators were divided into two main themes: 1) barriers and facilitators related to the referral from LFO to CBLI (i.e. financial, cultural, geographical, quality) and 2) barriers and facilitators related to the collaboration between LFO and CBLI (i.e. referral, communication platform and partnership). Thirty-seven implementation strategies concerning 15 barriers were developed and clustered into six overarching strategies: identify referral options, determine qualifications lifestyle professionals, develop support tools, build networks, facilitate learning collaboratives, and optimize workflow. Conclusions: In this study, barriers and facilitators for the development of the LFO were found and matching implementation strategies were developed. Practical improvements, like identifying specific referral options or develop support tools, can be implemented immediately. The implementation of other strategies, like connecting care pathways in basic services, primary, secondary and tertiary care, will take more time and effort to come to full potential. Future research should evaluate all implemented strategies. [ABSTRACT FROM AUTHOR]

Background: The birth plan is a document expressing a pregnant woman's childbirth preferences, enabling communication of expectations and facilitating discussions among women, their partners, and healthcare providers for key birthing decisions. There has been limited research on the role of birth plans in shared decision-making (SDM). Our study aims to explore how the use of birth plans can contribute to SDM from women's, partners, and healthcare providers' perspectives. Methods: We conducted in-depth interviews with women, their partners, and their healthcare providers. We used a thematic analysis to identify themes and subthemes. Furthermore, we created a grounded theory about the role of birth plans as a tool in SDM. Results: Three main themes were created: "Creating a birth plan", "Getting all on board" and "Birth plans in the daily practice of decision-making". Most women, partners, and healthcare providers agreed that birth plans can facilitate communication and SDM. Women and their partners viewed the birth plan as a tool to prepare for birth. Most healthcare providers mentioned the birth plan as a tool to get to know the women, their partners, and their preferences. Barriers are the attitude of healthcare providers toward birth plans, such as their evident resistance to the birth plan itself or to certain preferences. Another barrier is the assumption women and their partners may have that these plans can accurately predict the childbirth experience, enhancing the chance of a disappointing, negative experience. Some healthcare providers view birth plans as barriers to SDM. Conclusion: The use of a birth plan seems to promote women's, partners', and healthcare providers' involvement in the birth process, and seems suitable to facilitate SDM. Further research is required to explore strategies for overcoming barriers, including healthcare providers' attitudes toward birth plans and the expectations of women and their partners regarding their role. [ABSTRACT FROM AUTHOR]

Background: There is limited understanding of how social determinants of health (SDOH) impact family decision-making when seeking surgical care for children. Our objectives of this study are to identify key family experiences that contribute to decision-making when accessing surgical care for children, to confirm if family experiences impact delays in care, and to describe differences in family experiences across populations (race, ethnicity, socioeconomic status, rurality). Methods: We will use a prospective, cross-sectional, mixed methods design to examine family experiences during access to care for children with appendicitis. Participants will include 242 parents of consecutive children (0–17 years) with acute appendicitis over a 15-month period at two academic health systems in North Carolina and Virginia. We will collect demographic and clinical data. Parents will be administered the Adult Responses to Children's Symptoms survey (ARCS), the child and parental forms of the Adverse Childhood Experiences (ACE) survey, the Accountable Health Communities Health-Related Social Needs Screening Tool, and Single Item Literacy Screener. Parallel ARCS data will be collected from child participants (8–17 years). We will use nested concurrent, purposive sampling to select a subset of families for semi-structured interviews. Qualitative data will be analyzed using thematic analysis and integrated with quantitative data to identify emerging themes that inform a conceptual model of family-level decision-making during access to surgical care. Multivariate linear regression will be used to determine association between the appendicitis perforation rate and ARCS responses (primary outcome). Secondary outcomes include comparison of health literacy, ACEs, and SDOH, clinical outcomes, and family experiences across populations. Discussion: We expect to identify key family experiences when accessing care for appendicitis which may impact outcomes and differ across populations. Increased understanding of how SDOH and family experiences influence family decision-making may inform novel strategies to mitigate surgical disparities in children. [ABSTRACT FROM AUTHOR]

Science journalists, traditionally, play a key role in delivering science information to a wider audience. However, changes in the media ecosystem and the science-media relationship are posing challenges to reliable news production. Additionally, recent developments such as ChatGPT and Artificial Intelligence (AI) more generally, may have further consequences for the work of (science) journalists. Through a mixed-methodology, the quality of news reporting was studied within the context of AI. A content analysis of media output about AI (news articles published within the time frame 1 September 2022–28 February 2023) explored the adherence to quality indicators, while interviews shed light on journalism practices regarding quality reporting on and with AI. Perspectives from understudied areas in four European countries (Belgium, Italy, Portugal, and Spain) were included and compared. The findings show that AI received continuous media attention in the four countries. Furthermore, despite four different media landscapes, the reporting in the news articles adhered to the same quality criteria such as applying rigour, including sources of information, accessibility, and relevance. Thematic analysis of the interview findings revealed that impact of AI and ChatGPT on the journalism profession is still in its infancy. Expected benefits of AI related to helping with repetitive tasks (e.g. translations), and positively influencing journalistic principles of accessibility, engagement, and impact, while concerns showed fear for lower adherence to principles of rigour, integrity and transparency of sources of information. More generally, the interviewees expressed concerns about the state of science journalism, including a lack of funding influencing the quality of reporting. Journalists who were employed as staff as well as those who worked as freelancers put efforts in ensuring quality output, for example, via editorial oversight, discussions, or memberships of associations. Further research into the science-media relationship is recommended. [ABSTRACT FROM AUTHOR]

The most dominant model of hope is cognitive, in which hope is defined as goal-directed thinking, comprising self-agency and goal route identification. Nonetheless, competing theories about the fundamental nature of hope remain and further exploration of the construct is warranted. Little is known about whether the cognitive model aligns with how higher education students themselves think about hope. Understanding how "lay" populations conceptualise and experience psychological phenomena is as important as applying scientific theory. Personal beliefs impact on how people make sense of their life experiences and on their wellbeing. Research is specifically needed to explore the conceptualisation and experience of hope within diverse student populations. A systematic review was conducted to identify published scientific research and grey literature presenting qualitative accounts of hope from higher education students. A qualitative meta-synthesis of the eight eligible reports was conducted using thematic analysis and synthesis approaches to identify conceptualisations of hope and its associations with mental health and well-being. Nine themes were identified, reflecting that hope is: fundamental; self-construal over time; goal-directed; cognitive-emotional-behavioural; connection; resilience; dynamic and reciprocal; the inverse of depression; positive. These findings were identified as reflecting conclusions in which at least a moderate level of confidence may be placed. These findings clearly align with the cognitive model of hope, but emphasise the additional facets of fundamentality, self-construal, and negative origins. The implications for higher education institutions include to promote growth mindsets, to support students to learn skills for identifying and pursuing goals, and to provide hope-enhancing interventions as part of their student support provision. [ABSTRACT FROM AUTHOR]

Introduction: Birth is a normal physiological process, and many women want a natural birth. Women use a range of non-pharmacological pain relief methods to reduce labour pain intensity, to help manage labour pain and to induce relaxation. The purpose of this study was to explore the experiences of women using Virtual Reality as a non-pharmacological method of pain relief in labour. Virtual Reality has been shown to be an effective distraction technique in other acute pain settings which also reduces anxiety. Methods: This study conducted qualitative in-depth interviews postnatally with women who used Virtual Reality in labour. Thematic analysis was used to analyse the qualitative data. Results: Nineteen women used Virtual Reality in labour. Results from interviews with nineteen women in the postnatal period identified three main themes: impact of virtual reality on experience of labour, managing the pain of labour and challenges of using virtual reality in labour. Conclusion: This study identified that Virtual Reality was effective as a relaxation technique and helped in pain management by the use of self-efficacy techniques. Women in this study also identified preferred virtual environments specifically to use during labour and birth. This study provides a unique and original contribution to the field of Virtual Reality in labour and birth. It also identifies Virtual Reality as an acceptable and positive experience in the management of anxiety and labour pain. [ABSTRACT FROM AUTHOR]