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BACKGROUND: At the onset of the COVID‐19 pandemic, schools closed across the United States. Given the impact of virtual learning and lost access to school resources, schools eventually reopened with COVID‐19 mitigation protocols in place. This qualitative study sought to understand parental perceptions of school‐based COVID‐19 mitigation strategies. METHODS: Using a phenomenology approach, nine focus groups were completed with 40 parents of children in grades K‐8 representing eight Maryland counties. Based on acceptance of masking policies (as indicated on a survey), parents were sorted into 2 groups—lower and higher masking acceptance. A thematic analysis was conducted for each group and themes were compared between the 2 groups. RESULTS: The main themes were related to parents' general sentiments regarding COVID‐19, compliance, pandemic‐related changes over time, changes in personal opinions, and in‐person learning. Both groups described challenges related to inconsistent COVID‐19 mitigation policies and practices, the challenges of rapid and frequent changes in guidelines during the pandemic, and the benefits of in‐person learning. CONCLUSIONS: Parents of elementary and middle school children, regardless of general acceptance of masking policies, shared concerns about implementation and guidance regarding school‐based mitigation strategies. [ABSTRACT FROM AUTHOR]

Aim: To explore the recognition of pregnant nurses on how they managed their health conditions to examine safe working strategies. Design: A qualitative study with a grounded theory approach. Methods: Twenty‐one nurses engaged in work during their pregnancy were recruited and interviewed using a semi‐structured questionnaire from January to June 2021. The data were analysed using a constant comparative method. Results: The core category 'duelling roles' and the four other categories emerged. Pregnant nurses understand the 'weight of one' of being a professional in the workplace. Therefore, despite their health concerns, they struggle to complete their work as one team member to avoid inconveniencing others. However, through experiencing various nursing situations, they 'perceive one's limits' of working as they had done before pregnancy and protect their health and patients. Nevertheless, interactions with patients and their colleagues bring 'delight in nursing', which encourages them to continue working. Pregnant nurses thus develop a 'prioritizing the foetus' working style to continue being nurses while protecting their health. Implications for the Profession and/or Patient Care: These results provide meaningful guidance in considering safe job retention strategies for pregnant nurses. Sharing and developing the 'prioritizing the foetus' mindset and management skills gained by the participants may be beneficial for the appropriate health management of pregnant nurses. The study may also facilitate nursing managers' understanding of the experiences of pregnant nurses and encourage them to consider reviewing nursing practices. Reporting Method: The Consolidated Criteria for Reporting Qualitative Studies checklist was used to ensure the quality of research reporting. Patient or Public Contribution: Members of the nursing team were involved in the design, conduct and interpretation of the data in this study. [ABSTRACT FROM AUTHOR]

Background: Living in the digital era, young adults with intellectual disabilities use diverse digital products, the Internet, and social media in their daily lives. However, they may need support in digital undertakings as in other aspects of life. In a disability service context, staff are primary support providers but are restricted and guided by organisational goals and strategies. Previous research has shown that staff have dual roles as support providers and executors of organisational ambitions. This study analyses the motivations and prerequisites, as well as the obstacles to the implementation of digitalisation at a strategic level of disability services. Method: Qualitative semi‐structured interviews were conducted with public officials and municipal politicians responsible for providing disability services. A thematic analysis was performed using a constructionist perspective. Findings: Three themes were identified: Intertwined ideals of digital infrastructures in disability contexts, culture of vertical governance, and developing competencies. These themes can be seen as pillars of the digitalisation of digital services at the organisation's strategic level. In addition to shedding light on specific issues, these themes reveal underlying issues relating to conceptions of support practices and organisational culture. Conclusion: Digitalisation is motivated by a desire to preserve the organisation's legitimacy and be a relevant service provider. Digital infrastructure is required for digitalisation but is lacking because of intertwined legal and moral issues. Digitalisation also appears to be hindered by organisational structures and organisational culture, whose impact greatly outweighs that of digital issues. Accessible summary: People with disabilities face problems arising from inaccessibility and lack of support with digital issues.We studied how disability organisations work on digitalisation at the strategic level.The creation of digitally inclusive disability organisations presents legal, moral, and institutional challenges.It is difficult to identify and plan for the digital competencies needed to support staff and persons with intellectual disability when implementing digitalisation.Digital competence among support staff and people with intellectual disabilities is difficult to measure and plan forImplementation at the strategic level is important because it strongly affects whether and how people with intellectual disabilities become digitally included. [ABSTRACT FROM AUTHOR]

Persons with major depressive disorder (PMDDs) often experience pernicious ramifications on the biopsychosocial aspects of their health. While community mental health services (CMHSs) in Singapore are increasingly leveraged to meet the escalating demand for mental healthcare, shortcomings such as a substantial treatment gap and the lack of holistic, culturally sensitive care have been highlighted. Of note, the perspectives of the service users, which have hardly been studied in the literature, are crucial to our understanding of their needs to continuously improve CMHSs. Accordingly, this qualitative descriptive study explored the perceptions and experiences of community‐dwelling adults with major depressive disorder in their use of CMHSs in Singapore. Seventeen adults with major depressive disorder purposefully sampled from a CMHS provider were interviewed through a semi‐structured guide between October and November 2021. Data analysis via Braun and Clarke's six‐step thematic framework yielded five themes corresponding to three different phases: pre‐CMHS encounter ((i) procrastination to seek help and (ii) factors influencing CMHS utilization); intra‐CMHS encounter ((iii) incongruous perceptions of the impacts on biopsychosocial health and (iv) differing perceptions and experiences of culturally sensitive care); and post‐CMHS encounter ((v) enhancing CMHSs for PMDDs based on end‐users' experiences). Our findings underscore the need to improve the delivery of personalized mental healthcare services, use of settings‐ and culturally‐specific anti‐stigma strategies, and nationwide mental health literacy in symptom recognition and awareness of help‐seeking resources. [ABSTRACT FROM AUTHOR]

Introduction: A multidisciplinary Bushfire Recovery Program was developed by Royal Far West focused on reducing the short‐ and medium‐term impacts of the 2019‐2020 bushfires in Australia on children's wellbeing and resilience. Objectives: To evaluate the impact of the Program's psychosocial groups on children's wellbeing and resilience. Design: A two‐phase mixed method approach was used, involving post‐intervention surveys and interviews of children impacted by the 2019‐2020 bushfires in Australia who participated in the Bushfire Recovery Program, their parents/carers, teachers, and the facilitators of the workshops. Statistical analysis was undertaken with quantitative data and content and thematic analysis of qualitative data. Findings: Children learnt to talk to and trust adults, share thoughts and experiences with others, recognise they were not alone in their experiences, build connections with peers, understand and manage feelings, and implement strategies that enabled them to cope with change. Discussion: Psychosocial groups delivered in preschools and schools as part of the Bushfire Recovery Program reportedly led to significant learning and positive impacts for children in the areas of coping, wellbeing, and peer connections. Similar themes occurred across surveys and interviews and findings reflected the perceptions of the children who participated in the groups, and key adults around the children. Conclusions: Community‐based psychoeducational interventions can provide effective support in the short‐ and medium‐term post‐bushfire for children to develop strategies and skills to enable them to cope with changes and their emotional reactions. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID‐19) pandemic and related restrictions globally impacted mental health, particularly for those with pre‐existing severe mental illness (SMI). This qualitative study examined how adults with SMI perceived the effects of the COVID‐19 pandemic and related restrictions in the Netherlands, focusing on their personal recovery, well‐being and daily life, including an exploration of factors influencing these effects. Methods: Semi‐structured interviews were conducted, audio‐recorded and transcribed verbatim. Reflexive thematic analysis was applied. Purposive sampling was used to ensure diversity of individuals with SMI (i.e., age, gender, diagnosis, cultural background and mental healthcare institution). Results: Twenty participants (median age: 45 years [SD: 12, 8]; 11 females) were interviewed between May and July 2023. Findings revealed a wide range of experiences: while some individuals reported a negative impact on their existing psychiatric symptoms, others described adaptability, resilience and even positive effects of COVID‐19 restrictions on their mental health and well‐being. Factors influencing the heterogeneic perceptions of the COVID‐19 pandemic and related restrictions include the availability of trusted social relationships and enduring interactions with health professionals. Conclusion: Personalised support, both socially and professionally, is crucial for addressing fears, building resilience, reducing isolation and encouraging positive coping strategies for individuals with SMI during external crises. In this project, a participatory research approach that integrated the lived experience perspective helped uncover the unique perceptions of people with SMI with regard to the pandemic and related restrictions. Patient or Public Contribution: The study used a participatory action research approach, with experts‐by‐experience involved in every stage of the project as part of the research team. This included engagement with the funding application process, recruitment strategies for interviews, developing the interview guide, piloting the interview, interpreting findings, and knowledge dissemination activities. [ABSTRACT FROM AUTHOR]

Introduction: Effective consumer engagement practices can enhance patient safety. This is important for consumers from ethnic minority backgrounds who are exposed to increased risk of patient safety events. Using the Systems Engineering Initiative for Patient Safety model, this study explored staff experiences of creating opportunities for engagement with consumers from ethnic minority backgrounds to contribute to their cancer care safety. Method: A qualitative study was conducted using semistructured interviews with cancer service staff from four cancer services across two states in Australia. Purposive sampling was used to recruit healthcare staff from a diverse range of professions. Data were analysed using the Framework Analysis method. Results: Fifty‐four interviews were conducted with healthcare staff. Analysis of the qualitative interview data identified enablers and associated challenges that contributed to creating a shared understanding between consumers and staff of the information, processes, expectations and problems arising in care. Enablers and challenges are reported in relation to four themes: (1) co‐creating safety through shared understanding of care processes; (2) tools and technologies support planned communication; (3) organisational policy levers exist but lack implementation in direct care and (4) formal tasks incorporate consumer engagement more readily than informal interactions. Conclusion: The availability of infrastructure and resources to support communication with consumers from ethnic minority backgrounds was limited to specific tasks across the cancer care continuum. Strategies implemented by health services to foster effective communication during formal interactions now require expansion to support and create conditions for effective consumer engagement during informal and everyday care tasks. The use of innovative language support tools and cultural considerations are required at the service and system level to support consumer engagement in all types of care interactions. Public and Patient Involvement: The study was embedded within a larger project that included a consumer investigator and was guided by a consumer advisory group (CAG). These consumer team members have lived experience of cancer and are from diverse ethnic backgrounds. CAG members provided feedback on the draft interview guide and participant information for this study. [ABSTRACT FROM AUTHOR]

Background: Patient and public involvement (PPI) is a critical priority in research, policy, academia and advocacy organizations. PPI in dementia research is gaining momentum. However, these efforts are missing in international projects aimed at those living with advanced dementia in long‐term care (LTC) homes. Additional complexities can arise in enacting PPI within the context of integration of a palliative approach to care and experiences around end‐of‐life in (EOL) dementia. The mySupport study involved implementing the Family Carer Decision Support (FCDS) intervention for care partners of those living with advanced dementia in LTC in six countries. Research Design and Objective: An interpretive description study was conducted to explore the perspectives of international researchers from six countries on engaging people with lived experiences of dementia and EOL care in research processes. The findings from this study informed the development of a PPI strategy and a subsequent toolkit for the FCDS intervention. Findings: Thirty‐eight interviews were completed with project researchers: 12 from the United Kingdom, 8 from Canada, 7 from Ireland, 4 each from Italy and The Netherlands and 3 from the Czech Republic. Four broad themes describe international researchers' perspectives on advancing methods of engagement for people with lived experiences of dementia and EOL in international PPI activities: (1) Groundwork to engage in research; (2) planning for research activities is key; (3) focus on meaningful engagement and (4) having foresight for practical issues shaping PPI. Discussion and Implications: International projects that involve PPI can present many sources of challenges. The findings in this study highlight important considerations for foundational work for incorporating PPI in international projects. Learning from world leaders and those with lived experiences in various regions can be insightful and help share tools and resources. Patient or Public Contribution: PPI was envisioned as a critical part of conducting the mySupport study. The findings from this study informed the development of a PPI strategy and an international Strategic Guiding Council that included family carers of those living with advanced dementia in LTC homes in six countries. This manuscript focused on the perspectives of researchers on their engagement with people with lived experiences of dementia and EOL. The perspectives of persons with lived experiences on engaging in the mySupport research study will be reported in a forthcoming manuscript. [ABSTRACT FROM AUTHOR]

Background: Fibromyalgia is a chronic pain condition which has recently been linked with eating, drinking and swallowing difficulties (dysphagia). However, to date, sample sizes within completed research are small and study designs heterogeneous, and therefore, little is known about the lived experiences of dysphagia among people with fibromyalgia. To go some way towards addressing this gap in the literature, this study collected and analysed the first‐hand experiences of the physical symptoms, the psychosocial impacts and environmental factors that influenced the lived experience of a sample of people living with fibromyalgia‐associated dysphagia. Methods: Qualitative semi‐structured interviews were conducted with adults with dysphagia and fibromyalgia. Reflexive thematic analysis was employed and themes were identified regarding the reported experience and impact of swallowing problems. The same researcher conducted the interviews and extracted all data, and a second researcher analysed a random sample of 5% of the data for accuracy, with no disagreements arising between the two researchers. Results: All participants (n = 8) reported the negative psychosocial impact of their dysphagia. Participants reported managing their dysphagia independently, primarily using compensatory strategies. Participants discussed feeling unsupported in healthcare interactions due to clinicians not understanding the occurrence, nature or impact of eating, drinking and swallowing difficulties. Participants also reported that they did not have access to evidence‐based management strategies that adequately addressed their fibromyalgia‐related swallowing problems. Conclusions: Despite minimal previous research in this area, findings here highlight the impact that dysphagia has on people with fibromyalgia. A broad range of physical symptoms were reported to have negative consequences across both social and emotional domains. The reported symptoms often required complex coping strategies and sometimes impeded participants from seeking suitable medical intervention from healthcare providers. There are both broad‐ranging implications of fibromyalgia‐associated dysphagia and reported poor perceptions of medical interactions for this cohort of patients. Therefore, there is evidently a need for clinical research into the management of this condition to develop patient‐centred care delivery options and to equip healthcare professionals with the knowledge and skills necessary to provide efficacious management to this group. Patient or Public Contribution: Before initiation of the qualitative interviews, the interview schedule was piloted with an individual living with fibromyalgia and dysphagia, with feedback provided on the appropriate wording and format of semi‐structured questioning. [ABSTRACT FROM AUTHOR]

Background: Recruitment of cancer clinical trial (CCT) participants, especially participants representing the diversity of the US population, is necessary to create successful medications and a continual challenge. These challenges are amplified in Phase I cancer trials that focus on evaluating the safety of new treatments and are the gateway to treatment development. In preparation for recruitment to a Phase I recurrent head and neck cancer (HNC) trial, we assessed perceived barriers to participation or referral and suggestions for recruitment among people with HNC and community physicians (oncologist, otolaryngologist or surgeon). Methods: Between December 2020 and February 2022, we conducted a qualitative needs assessment via semistructured interviews with a race and ethnicity‐stratified sample of people with HNC (n = 30: 12 non‐Hispanic White, 9 non‐Hispanic African American, 8 Hispanic and 1 non‐Hispanic Pacific Islander) and community physicians (n = 16) within the University of Florida Health Cancer Center catchment area. Interviews were analyzed using a qualitative content analysis approach to describe perspectives and identify relevant themes. Results: People with HNC reported thematic barriers included: concerns about side effects, safety and efficacy; lack of knowledge and systemic and environmental obstacles. Physicians identified thematic barriers of limited physician knowledge; clinic and physician barriers and structural barriers. People with HNC and physicians recommended themes included: improved patient education, dissemination of trial information and interpersonal communication between community physicians and CCT staff. Conclusions: The themes identified by people with HNC and community physicians are consistent with research efforts and recommendations on how to increase the participation of people from minoritized populations in CCTs. This community needs assessment provides direction on the selection of strategies to increase CCT participation and referral. Patient or Public Contribution: This study focused on people with HNC and community physicians' lived experience and their interpretations of how they would consider a future Phase I clinical trial. In addition to our qualitative data reflecting community voices, a community member reviewed the draft interview guide before data collection and both people with HNC and physicians aided interpretation of the findings. [ABSTRACT FROM AUTHOR]

This study aimed to understand the strategies elementary‐school‐aged children used to influence mothers' food purchasing decisions. Semi‐structured qualitative interviews were conducted with 40 children aged 6–11 years and their mothers living in South Carolina. Strategies to influence mothers' food purchases were collected from children and their mothers separately. The interviews were audio‐recorded, transcribed verbatim, and open‐coded. The constant comparative method was used for data analysis. Coding matrices were used to compare children's and mothers' responses on the children's strategies. Children reported 157 instances of 25 distinct strategies to influence mothers' purchasing decisions. Mothers had concordance with 83 instances of these strategies. Mothers were more concordant with sons than daughters. The most common and successful strategies reported by children and mothers were repeated polite requests, reasoned requests and referencing friends. Other strategies included offers to contribute money or service, using other family members to pursue mothers for the item, writing a list and grabbing desired items. Mothers perceived that children had a large influence on food purchasing decisions. Children were aware of the strategies that would get positive reactions from mothers. They (children) could get their desired items a lot of times, often, or several times in a month from their mothers irrespective of the healthfulness of the items. Children's influence can be used as a change agent for improving mothers' food purchases if children prefer healthy foods. Efforts are needed for mothers and children to help address children's strategies to influence mothers to purchase unhealthy foods and make healthy foods more appealing to children. Key messages: Repeated polite requests, reasoned requests, and referencing friends were children's most common and successful strategies to influence mothers.Mothers perceived that children had a large influence on their (mothers') food purchasing decisions.Children perceived that their mothers purchased their requested items a lot of time or often.Location did not contribute much to children's initiation of requests to influence mothers to purchase their (children's) desired itemsMost items mothers purchased, being actively or passively influenced by children's requests, were EDNP foods and drinks. [ABSTRACT FROM AUTHOR]

Aim: To understand the work status of nurses in long‐term care institutions in China for elderly care to provide a reference for further formulating management strategies and promoting the development of long‐term care teams. Methods: Using qualitative descriptive research methods, 31 nurses from three long‐term care institutions were selected through purposive sampling for in‐depth interviews, and a three‐week participatory observation was conducted on the daily work of nurses in the above three long‐term care institutions. Content analysis was used to analyse data. Results: In our sample, nurses in long‐term care institutions had insufficient manpower, generally had low academic qualifications, and lacked professional ability. Their work enthusiasm and initiative need to be further improved. Long‐term care nurses were moderately paid, and their salary satisfaction was lower than in other trades. At the same time, the social understanding of the long‐term care industry was insufficient, and the social identity of nurses in long‐term care institutions was low. Conclusion: The development of long‐term care requires the joint efforts of nurses, medical institutions, and society. By improving the system, cultivating talents and building a harmonious atmosphere, we aim to enhance the work enthusiasm of long‐term care nurses and promote the stable and orderly development of the long‐term care team. Implications for nursing management: Nurses in long‐term care institutions are at the core of the ageing age and play a vital role in coping with the ageing problem, meeting long‐term care needs, improving the quality of life of old people and reducing the cost of long‐term care. The training and management of nurses in long‐term care institutions and the construction of the entire long‐term care system should be based on China's national conditions and actual needs. [ABSTRACT FROM AUTHOR]

Aim: To describe healthcare professionals' experiences of adverse event reporting in relation to the fundamental tasks of managers. Design: Qualitative interview study. Method: Twenty‐four semi‐structured interviews including six managers, six medical doctors, six Registered Nurses and six Enrolled Nurses were carried out in Slovenia from January to May 2019. The data were analysed using a multi‐stage qualitative content analysis procedure. The COREQ checklist guided the reporting in this study. Results: The researchers found that all four fundamental tasks of managers, namely planning, organising, leading and controlling, influence the safety culture and thus adverse events reporting by employees. For each function, the researchers have identified the key factors that either promote or inhibit adverse events reporting in a healthcare institution. The results have implications for all those involved in adverse event reporting from the perspective of the fundamental tasks of managers and can contribute to the improvement of the reporting system and subsequently safer treatment. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to reveal the experiences of healthcare professionals regarding a structured Virtual Patient Visit (sVPV) program implemented in an ICU during the coronavirus disease 2019 (COVID‐19) pandemic and to share the process of establishing the program. Design: This qualitative, exploratory study was conducted using a semi‐structured, in‐depth interview method. Setting: The study was conducted in a university hospital ICU in Turkey (where a sVPV program was implemented) and comprised one physician, eight nurses, and one clerk who volunteered to participate in the study. The data were evaluated with content analysis, and themes and sub‐themes were determined. Findings: Five themes and 13 subthemes were obtained: (1) an essential program during the pandemic, (2) contributing to patient's recovery, (3) family‐centered care, (4) innovativeness, and (5) sustainability. Conclusion: The results show that the sVPV program is highly innovative and effective and contributed to positive patient outcomes and family‐centered care practices during the COVID‐19 pandemic. In addition, it was revealed that in order to conduct sVPVs effectively, organizational planning, such as legal processes, and the employment of experienced and competent healthcare professionals, should be well managed. Clinical relevance: A well‐designed sVPV program specific to the setting alleviates anxiety among patients and family members, increases patient motivation and healing, and decreases the workloads of healthcare professionals. It is recommended that the sVPV program, which can be easily used during not only COVID‐19 pandemics but also during other crises, be adopted in all ICUs and carried out by a dedicated nurse or healthcare provider. [ABSTRACT FROM AUTHOR]

Introduction: Involuntary relocation when care homes close can be detrimental to residents' health and well‐being and is associated with increased mortality. There is little formal evidence to support whether planning can mitigate the impact of such moves. This study aimed to understand the experiences of a whole care home relocation where staff and residents relocated together using existing published guidance. Methods: A longitudinal qualitative research study using individual face‐to‐face semi‐structured interviews was conducted between August 2018 and August 2019. Baseline interviews were conducted 6–8 weeks after relocation with follow‐up interviews 10–12 months later. Interviews were recorded, transcribed and analysed using framework analysis. Results: 27 interviews were conducted; 19 baseline interviews (4 residents, 7 family members, 8 staff) and 8 follow‐up interviews (2 residents, 2 family members, 4 staff). Participants' feelings about the relocation were mixed: some reported apprehension before the move but others excitement. Residents and families felt variably involved in planning the move, whereas staff expressed lack of involvement. Time, family support and continuity of care helped participants settle in. The new environment shaped participants' experiences and abilities to adjust, especially the lack of a homely feeling with the new home, the larger size and changes in staff organisation and management. Conclusions: Despite implementation of existing guidance, relocation was still challenging for residents, staff and family members. Future relocations should increase involvement of staff in the planning and design of the home; offer continuous support to those involved; and ensure continuity of care and management style. [ABSTRACT FROM AUTHOR]

Purpose: To explore the experiences of nurses working in emergency departments in selecting and triaging patients during the COVID‐19 pandemic. Design: Descriptive phenomenology was applied in this study. Methods: Data were collected from nurses working at hospitals in Indonesia using snowball sampling and telephone interviews. A total of 10 emergency nurses participated, and Colaizzi's method of data analysis was applied. Findings: Six themes and 10 subthemes emerged. The main themes were "extreme challenges in triage," "feeling of responsibility under uncontrolled spread and infection," "physical and psychological exhaustion," "discovering strategies under difficult circumstances," "looking for positive reinforcement," and "optimism in togetherness." Nurses had to deal with the challenge of COVID‐19 in the ED triage, interestingly so, the nurses they have shown the development of professional responsibility. Nurses are also experienced in finding patient selection and triage strategies and the sense of optimism that may influence strategy and practice during the COVID‐19 pandemic. Conclusions: This findings identify nurses' experiences in dealing with the extreme challenges of emergency department triage as well as their associated strategies and optimism. Clinical relevance: Providing support to emergency nurses, improving emergency department triage, and community empowerment are suggested as strategies to improve nursing care during the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Multisectoral approaches are central to the global Scaling Up Nutrition (SUN) movement and the Sustainable Development Goals. Nepal joined SUN in 2011 and approved the first 5‐year Multisectoral Nutrition Plan (MSNP) in 2012, covering 2013–2017. This mixed methods study draws on organizational network analysis (ONA) and qualitative interviews with a sample of 22 organizations to examine (1) levels of engagement and network dynamics among government sectors and development organizations and (2) milestones and processes in the development and implementation of Nepal's MSNP. Findings suggest that the development of the MSNP was related to the high density of organizational connections; the leadership role of the Nepal's National Planning Commission and the National Nutrition and Food Security Secretariat; and the bridging roles played by a few government ministries and UN agencies that linked organizations that did not have direct relationships with each other. Specialized roles were observed for the three types of working relationships: policy dialogue, strategic planning and implementation. Partners were less connected on MSNP implementation than for policy dialogue and strategic planning, which may have constrained collaborative scale‐up efforts. The Ministry of Agricultural Development, in particular, was the conduit for connecting non‐health sectors into the broader network. Our study offers insights into the structure and dynamics of multisectoral planning in Nepal. It also contributes to a small but growing literature that illustrates how ONA can be applied to measure and use network results to elucidate the processes for strengthening multisectoral planning and implementation of nutrition‐specific and nutrition‐sensitive interventions. [ABSTRACT FROM AUTHOR]

Background: Although a 'person‐centred focus' is a legislated objective for both aged‐care and disability services sectors in Australia, evidence suggests limited translation into systems and practices due to entrenched silos. This paper proposes a Best Practice Framework to mitigate these silos. Methods: Mixed‐methods research comprising key informant interviews with major stakeholders across both sectors; a survey of people with/without intellectual disability aged 60+ years; qualitative in‐depth interviews; and survey of health professionals. Results: There is an urgent need to develop inter‐sectoral 'integrated care systems'. Key components include choice in accommodation; regular assessment of health and well‐being indicators; development and adoption of nationally consistent policies/standards across integrated aged‐ and disability‐care sectors; improved strategies for workforce planning; and upskilling of existing staff including place‐based collaboration. Conclusions: An integrated service model requires collaboration on broader public policy instruments, appropriate planning and resourcing. A strategic shift is required to ensure better quality person‐centred support systems. [ABSTRACT FROM AUTHOR]

While there is a growing body of research on information behavior during nonroutine events such as natural disasters, the research has largely neglected older persons as a specific group despite their identification as a demographic that suffers disproportionately during disasters. To address this gap, this article reports on the study of the information behavior and related activities of older persons during natural disasters. Based on a qualitative study, we draw on the theory of information worlds to study the key activities of preparing, responding, and recovering from disasters. The article contributes to the information behavior literature by developing a more informed understanding of both the interrelationship between the information worlds and activities of older persons, and how older persons seek and share information during disasters. [ABSTRACT FROM AUTHOR]

BACKGROUND School‐based health centers (SBHCs) increase access to health care and improve academic achievement for underserved students. We report on the test of a strategy to take SBHCs to scale by addressing the issues of community need and support and financial sustainability. METHODS: Using mixed methods, we collected data on student enrollment, utilization, health outcomes, seat time, patient revenues, surveys and key informant interviews from SBHCs located in 3 geographically and demographically different communities over a 2‐year period. RESULTS: The 3 health centers were comparable in their capacity to implement their operations and achieve quality outcomes but varied considerably in their abilities to achieve sustainability after 2 years of operation. All participated in a planning phase and were able to achieve community buy in and support which impacted their implementation. Only one of the SBHCs which had the highest patient utilization was able to generate enough revenue from patient billings to become sustainable after the second year. CONCLUSION: Expanding SBHCs requires a period of planning to generate community buy in and support which is required for successful implementation. Sustainability requires sustained high clinic utilization and is enhanced by health centers that are able to receive high Medicaid reimbursements. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: The US Department of Veterans Affairs (VA) Home‐Based Primary Care (HBPC) Program provides interdisciplinary, long‐term primary care for frail, disabled, or chronically ill veterans. This research identifies strategies used by HBPC teams to support veterans in their homes, rather than in institutionalized care. DESIGN: Focus groups and semistructured interviews were conducted with HBPC interdisciplinary team (IDT) members, including program directors, medical directors, and key staff, from September 2017 to March 2018. Field observations were gathered during visits to veterans' homes and IDT meetings. SETTING: In‐person site visits were conducted at eight HBPC Programs across the United States. Sites varied in location, setting, and primary care model. PARTICIPANTS: A total of 105 HBPC professionals. MEASUREMENT: Qualitative thematic content analysis. RESULTS: Four main strategies drive and support the shared mission of IDTs to support veterans at home: fostering frequent communication among IDT members, veterans, caregivers, and outside agencies; development of longitudinal, trusting, reliable relationships within IDTs and with veterans and caregivers; ongoing, consistent education for IDT members and veterans and caregivers; and collaboration within and outside IDTs. Adhering to this mission meant providing timely and efficient care that kept veterans in their homes and minimized the need for acute hospitalizations and nursing home placement. CONCLUSION: HBPC IDTs studied worked together across disciplines to effectively create a dedicated culture of caring for veterans, caregivers, and themselves, leading to keeping veterans at home. Focusing on the strategies identified in this research may be useful to achieve similar positive outcomes when caring for medically complex, homebound patients within and outside the VA. J Am Geriatr Soc 67:2511–2518, 2019 [ABSTRACT FROM AUTHOR]

Objective(s): Prenatal home visiting programs are a strategy to promote positive birth outcomes. Ongoing evaluations of these programs are important to promote fidelity and quality. The goal of this program evaluation was to gain clients' perspectives of their experiences in one Wisconsin Health Department's Prenatal Care Coordination program including: (a) why clients entered the program, (b) whether client expectations were met, and (c) how expectations impacted client retention. Design: A Health Department in Wisconsin undertook a three‐part program evaluation of their Prenatal Care Coordination program in 2014–2015. Highlighted here is the final phase of this evaluation. The evaluation was guided by the CDC's (1999) Framework for Program Evaluation in Public Health. Sample: Clients meeting eligibility criteria were divided into representative clusters using k‐means clustering model. Twenty semi‐structured interviews with former clients of the Wisconsin Health Department's Prenatal Care Coordination program were conducted. Results: Most clients had no expectations coming into the program and were satisfied with the services they received. Participants named the nurse–client relationship and support from this relationship as a key benefit of the program, while a secondary benefit was the information and resources received. The Health Department used these findings for program improvement and strategic planning. [ABSTRACT FROM AUTHOR]

Background: Hospital at home (HaH) is a model of care that provides acute‐level services in the home. HaH has been shown to improve quality and patient satisfaction, and reduce iatrogenesis and costs. Uptake of HaH in the United States has been limited, and little research exists on how to implement it successfully. Objectives: This study examined facilitators and barriers to implementation of an HaH program. Design: A HaH program that included a 30‐day transitional care bundle following the acute stay was implemented through a Centers for Medicare & Medicaid Services Innovations Award. Informants completed a priming table describing initial implementation components, their barriers, and facilitators. These were followed up with semistructured focus groups and individual interviews that were transcribed and independently coded using thematic analysis by two independent investigators. Setting: Large urban academic health system. Participants: Clinical and administrative personnel from Mount Sinai, the Visiting Nurse Service of New York, and executive leaders at partner organizations (laboratory, pharmacy, radiology, and transportation). Results: To facilitate successful development and implementation of a high‐quality HaH program, a number of barriers needed to be overcome through significant teamwork and communication internally with policymakers and external partners. Areas of paramount importance include facilitating work‐arounds to regulatory barriers and health system policies; altering an electronic health record that was not designed for HaH; developing the necessary payment and billing mechanisms; and building effective and collaborative partnerships and communication with outside vendors. Conclusion: Development of HaH programs in the United States are feasible but require strategic planning and development of strong, tightly coordinated partnerships. J Am Geriatr Soc 67:588–595, 2019. [ABSTRACT FROM AUTHOR]

Aim: To explore educators' perspectives on the implementation of goal‐setting and action‐planning strategies within a structured diabetes self‐management education programme. Methods: Ten semi‐structured interviews were conducted with diabetes self‐management education providers delivering the 'Dose Adjustment for Normal Eating' (DAFNE) programme to people with Type 1 diabetes throughout Ireland. A pre‐designed topic guide, focused on exploring educators' experiences of delivery and application and views on usefulness of goal‐setting strategies, was used in all interviews. The interviews were recorded, transcribed and analysed using thematic analysis. Results: Five main themes were identified: 'people need a plan', discussing perspectives on goal‐setting's value; 'the power of the group', highlighting the impact a group format has on goal‐setting practices; 'diversity and individuality', discussing differences in DAFNE participants' and educators' engagement with goal‐setting; 'goal‐setting's fit', exploring perspectives on how well goal‐setting fits within diabetes self‐management education and follow‐up care; and 'feelings of inadequate psychological knowledge', addressing challenges experienced in the delivery of goal‐setting components. Conclusion: While educators saw benefits in the implementation of goal‐setting and planning strategies within diabetes self‐management education, concerns about how well goal‐setting currently fits within diabetes self‐management education and follow‐up care were evident. Additionally, many educators experienced the delivery of goal‐setting and action‐planning strategies as challenging and would value additional training opportunities. What's new?: This study is the first to explore diabetes self‐management education (DSME) providers' perspectives on the implementation of goal‐setting and action‐planning components within a DSME programme.Educators in such programmes are encouraged to embrace these behaviour change strategies to promote patient‐centred DSME; however, the present study shows that, although educators see value in goal‐setting, many experience its delivery as challenging and would value additional training.Many educators questioned how well goal‐setting currently fits within the Dose Adjustment for Normal Eating (DAFNE) DSME programme and are concerned about a lack of follow‐up after DSME.Issues highlighted in this study should be addressed in DSME research, and could be targeted within DSME providers' training. [ABSTRACT FROM AUTHOR]

Video interaction guidance, based on the Marte Meo method, is used in child protection services (CPSs) and offered to parents to improve interactions with their children. However, the factors that promote and limit the use of video guidance in CPS are unclear. The present study explored the perceptions of 8 Norwegian Marte Meo therapists who utilize this method in the CPS. The therapists were asked questions about the method's strengths, weaknesses, opportunities, and threats, to clarify factors that may be important for the use of Marte Meo in the CPS context. Therapists reported a predominance of strengths associated with the method; for example, that Marte Meo provides a set of conditions that makes it possible for parents to see themselves as significant persons in interactions with their children and raise their parenting competency to a reflective level. The results also suggested that there is a need to develop the method to make it applicable to different age groups, problem areas, and contexts. A central agency could establish procedures for identifying such challenges, to ensure continuous quality improvement and to improve Marte Meo through research and innovation. [ABSTRACT FROM AUTHOR]

Background: Care of older adults in the community is becoming increasingly complex. However, nursing staff often has insufficient knowledge and skills to adequately address the needs of frail older adults. There is therefore a need for nurses with advanced qualifications. To meet this need, advanced geriatric nursing has been introduced in Norway. Aims and Objectives: This study aimed to describe the experiences of nurses with their new role as advanced geriatric nurses in care of older adults and to determine what strategies the nurses considered important in the development of their new role. Design: This study applied a descriptive, exploratory design. Methods: In‐depth interviews were conducted with 21 nurses who had undergone an educational programme to become advanced geriatric nurses in Norway in 2016. Content analysis was used to analyse the data. Findings: The participants described a complex and extensive nursing role, which they related to a new understanding of the patients, relatives and the system in which they worked. This new gaze had developed based on a combination of their new knowledge, their skills, experiences and professional interests. The opportunities to use their role depended on their workplace conditions. They related to contextual challenges at their workplace in different ways to optimise the use of their new gaze. Conclusions: Common for all participants was a broader and deeper understanding of the patient's health and life situation, which guided participants' actions. The key issue in developing the new role was developing effective strategies to foster role integration. Implications for Practice: Advanced geriatric nurses should collaborate with their managers to create a role that takes advantage of their knowledge and skills, as well as collaborate with colleagues to enhance understanding of utilisation of their role. [ABSTRACT FROM AUTHOR]

Context Good preparation for surgical procedures has been linked to better performance and enhanced learning in the operating theatre. Mental imagery is increasingly used to enhance performance in competitive sport and there has been recent interest in applying this in surgery. Objectives This study aims to identify the mental imagery components of preoperative preparation in orthopaedic trauma surgery and to locate these practices in existing socio-material theory in order to produce a model useful for surgical skills training. Methods Semi-structured interviews were conducted with nine orthopaedic surgeons. Participants were identified by personal recommendation as regularly performing complex trauma operations to a high standard, and by affiliation to an international instruction course in trauma surgery. Interviews were audio-recorded and transcripts were independently analysed using thematic analysis. Results Analysis revealed that surgeons interact intensively with multiple colleagues and materials during their preparatory activities. Such interactions stimulate mental imagery in order to build strategy and rehearse procedures, which, in turn, stimulate preparatory interactions. Participants identified the discussion of a preoperative 'plan' as a key engagement tool for training junior surgeons and as a form of currency by which a trainee may increase his or her participation in a procedure. Conclusions Preoperative preparation can be thought of as a socio-material ontology requiring a surgeon to negotiate imaginal, verbal and physical interactions with people, materials and his or her own mental imagery. Actor-network theory is useful for making sense of these interactions and for allowing surgeons to interrogate their own preparative processes. We recommend supervisors to use a form of preoperative plan as a teaching tool and to encourage trainees to develop their own preparatory skills. The ability of a trainee to demonstrate sound preparation is an indicator of readiness to perform a procedure. [ABSTRACT FROM AUTHOR]

BACKGROUND Exposure to community violence compromises teacher effectiveness, student learning, and socioemotional well-being. This study examined the challenges, strategies, and support needs of teachers in urban schools affected by high levels of community violence. METHODS Twenty teachers from 3 urban middle schools with predominantly low-income African American students completed open-ended interviews. Selected schools were in geographic areas with high violent crime levels. RESULTS Consistent with an ecological risk and resilience framework, findings revealed that teachers experienced challenges and adopted coping strategies at the individual, family, school, and community levels. Teachers employed a number of strategies associated with resilience, such as prayer and seeking support from family and colleagues, but also engaged in some avoidant strategies, such as emotional withdrawal and avoiding difficult students. CONCLUSIONS Findings suggest interventions to improve school safety and reduce the negative impact of violence-related stressors. Teacher training in behavior management, effective school leadership, improved school security, peer mediation, expanded mental health services, and parent involvement may promote resilience among both teachers and their students. [ABSTRACT FROM AUTHOR]

Medical Education 2012: 46: 390-398 Context Consultants in charge of postgraduate medical education (PGME) in hospital departments ('lead consultants') are responsible for the implementation of educational change. Although difficulties in innovating in medical education are described in the literature, little is known about how lead consultants approach educational change. Objectives This study was conducted to explore lead consultants' approaches to educational change in specialty training and factors influencing these approaches. Methods From an interpretative constructivist perspective, we conducted a qualitative exploratory study using semi-structured interviews with a purposive sample of 16 lead consultants in the Netherlands between August 2010 and February 2011. The study design was based on the research questions and notions from corporate business and social psychology about the roles of change managers. Interview transcripts were analysed thematically using template analysis. Results The lead consultants described change processes with different stages, including cause, development of content, and the execution and evaluation of change, and used individual change strategies consisting of elements such as ideas, intentions and behaviour. Communication is necessary to the forming of a strategy and the implementation of change, but the nature of communication is influenced by the strategy in use. Lead consultants differed in their degree of awareness of the strategies they used. Factors influencing approaches to change were: knowledge, ideas and beliefs about change; level of reflection; task interpretation; personal style, and department culture. Conclusions Most lead consultants showed limited awareness of their own approaches to change. This can lead them to adopt a rigid approach, whereas the ability to adapt strategies to circumstances is considered important to effective change management. Interventions and research should be aimed at enhancing the awareness of lead consultants of approaches to change in PGME. [ABSTRACT FROM AUTHOR]

This article describes an action research project carried out in North West England that aimed to assist Children's Services Departments and Care Trusts in developing their strategies for supporting care leavers into employment and training. The study found a range of models and approaches that can be utilised to develop local and regional partnerships offering employment and training opportunities designed to meet the needs of care leavers. Relevant questions about the extent to which such opportunities should be ring-fenced or targeted on particular fields of employment are identified. © 2010 The Author(s). Children & Society © 2010 National Children's Bureau. [ABSTRACT FROM AUTHOR]

The purpose of this study was to understand the processes and interactions that African American tobacco control organizations use to engage African American communities in tobacco control efforts. The study used grounded theory methods to interpret participant's perspectives on tobacco control. The study sample consisted of African American tobacco control program directors from African American tobacco control organizations throughout the United States. Data collection involved 1 interview per participant using a semistructured interview at a location selected by the participant. Each interview lasted approximately 30-90 min. The results showed that organizations used specific strategies to involve African Americans in tobacco control. The tobacco control organizations built community capacity using 3 processes: developing relationships and partnerships, raising awareness, and creating collective power. Contextual, cultural processes, and historical references used by African American tobacco control organizations provide insight into how to engage African American communities in tobacco control efforts and achieve tobacco-related health parity. Public health professionals and nurses should be aware of these and other strategies that may increase the involvement of African American communities in tobacco control. [ABSTRACT FROM AUTHOR]