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Introduction: Although Jordan has made significant progress toward expanding the utilization of facility‐based intrapartum care, prior research highlights that poor service quality is still persistent. This study aimed to identify quality gaps between women's expectations and perceptions of the actual intrapartum care received, while exploring the contributing factors. Methods: Utilizing a pre–post design, quality gaps in intrapartum care were assessed among 959 women pre‐ and postchildbirth at a prominent tertiary hospital in northern Jordan. Data were gathered using the SERVQUAL scale, measuring service quality across reliability, responsiveness, tangibles, assurance, and empathy dimensions. Results: The overall mean gap score between women's expectations and perceptions of the quality of intrapartum care was −0.60 (±0.56). The lowest and highest mean gap scores were found to be related to tangibles and assurance dimensions, −0.24 (±0.39) and −0.88 (±0.35), respectively. Significant negative quality gaps were identified in the dimensions of assurance, empathy, and responsiveness, as well as overall service quality (p < 0.001). The MLR analyses highlighted education (β = 0.61), mode of birth (β = −0.60), admission timing (β = −0.41), continuity of midwifery care (β = −0.43), physician's gender (β = −0.62), active labour duration (β = 0.37), and pain management (β = −0.33) to be the key determinants of the overall quality gap in intrapartum care. Conclusion: Our findings underscore the importance of fostering a labour environment that prioritizes enhancing caregivers' empathetic, reassuring, and responsive skills to minimize service quality gaps and enhance the overall childbirth experience for women in Jordan. Patient or Public Contribution: This paper is a collaborative effort involving women with lived experiences of childbirth, midwives, and obstetrics and gynaecologist physicians. The original idea, conceptualization, data generation, and coproduction, including manuscript editing, were shaped by the valuable contributions of stakeholders with unique perspectives on intrapartum care in Jordan. [ABSTRACT FROM AUTHOR]

Aims: To elicit experiences of patients, family caregivers, and healthcare professionals in intermediate care units (IMCUs) in an academic medical centre in Baltimore, MD related to the challenges and intricacies of multimorbidity management to inform development of a multimorbidity symptom management toolkit. Design: Experience‐based co‐design. Methods: Between July and October 2021, patients aged 55 years and older with multimorbidity admitted to IMCUs at an academic medical centre in Baltimore, Maryland, USA were recruited and interviewed in person. Interdisciplinary healthcare professionals working in the IMCU were interviewed virtually. Participants were asked questions about their role in recognizing and treating symptoms, factors affecting the quality of life, symptom burden and trajectory over time, and strategies that have and have not worked for managing symptoms. An inductive thematic analysis approach was used for analysis. Results: Twenty‐three interviews were conducted: 9 patients, 2 family caregivers, and 12 healthcare professionals. Patients' mean age was 67.5 (±6.5) years, over half (n = 5) were Black or Hispanic, and the average number of comorbidities was 3.67. Five major themes that affect symptom management emerged: (1) the patient–provider relationship; (2) open and honest communication; (3) accessibility of resources during hospitalization and at discharge; (4) caregiver support, training, and education; and (5) care coordination and follow‐up care. Conclusion: Patients, caregivers, and healthcare professionals often have similar goals but different priorities for multimorbidity management. It is imperative to identify shared priorities and target holistic interventions that consider patient and caregiver experiences to improve outcomes. Implications for the Profession and/or Patient Care and Impact: This paper addresses the paucity of research related to the shared experience of disease trajectory and symptom management for people living with multimorbidity. We found that patients, caregivers, and healthcare professionals often have similar goals but different care and communication priorities. Understanding differing priorities will help better design interventions to support symptom management so people with multimorbidity can have the best possible quality of life. Reporting Method: We have adhered to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines in our reporting. Patient or Public Contribution: This study has been designed and implemented with patient and public involvement throughout the process, including community advisory board engagement in the project proposal phase and interview guide development, and member checking in the data collection and analysis phases. The method we chose, experience‐based co‐design, emphasizes the importance of engaging members of a community to act as experts in their own life challenges. In the coming phases of the study, the public will be involved in developing and testing a new intervention, informed by these qualitative interviews and co‐design events, to support symptom management for people with multimorbidity. [ABSTRACT FROM AUTHOR]

Background: Evidence‐based practice involves the synthesis of multiple forms of evidence to inform clinical decision‐making and treatment evaluation. Practice‐ and patient‐based evidence are two forms of evidence that are under‐represented in the stuttering literature. The collection of such knowledge is essential to support the design and delivery of effective stuttering interventions for adults. Aims: To build stakeholder consensus on the core components of intervention for adults who stutter, and to establish a guiding framework for the design and development of evidence‐based interventions for adults who stutter. Methods & Procedures: Adults who stutter and speech and language therapists (SLTs) with experience in providing stuttering intervention participated in the three‐round e‐Delphi Survey focused on: (1) identifying key stuttering intervention components, including principles, practices, and structural and contextual elements; and (2) obtaining group consensus on stuttering intervention components. Statements were categorized using the International Classification of Functioning, Disability and Health (ICF) model adapted to the study of stuttering. Outcomes & Results: A total of 48 individuals agreed to participate: 48/48 (100%) completed the Round 1 questionnaire, 40/48 (83%) responded to Round 2 and 36/40 (90%) participated in Round 3. Following content analysis of Round 1, 101 statements were developed, and consensus was achieved on 89 statements perceived as representing the core components of stuttering intervention for adults. Categorization of these statements reflected the key stuttering intervention components relating to personal reactions to stuttering, limitations in life participation and environmental factors. Conclusions & Implications: Consensus on the core components of stuttering intervention was reached through engagement with key stakeholders. The evidence‐based framework presented highlights the range of key intervention components a clinician should consider when designing interventions for adults who stutter. What this paper adds: What is already known on the subject: Evidence‐based practice endorses the synthesis of multiple knowledge forms including research, practice and patient evidence to support clinical decision‐making and treatment evaluation. The stuttering literature is characterized by an over‐representation of efficacy evidence, with significantly less practice and patient evidence to guide clinical practice. What this paper adds to existing knowledge: This study adds valuable practice‐ and patient‐based evidence for effective stuttering intervention components for adults who stutter. These relate to personal reactions to stuttering, limitations in life participation and environmental factors. What are the potential or actual clinical implications of this work?: This research presents a stakeholder‐informed framework for stuttering intervention to guide SLTs working with adults who stutter in designing evidence‐based interventions. The framework supports the adoption of a person‐centred approach to intervention to ensure each client's unique needs, preferences, values and desired outcomes are explored and integrated into therapy. [ABSTRACT FROM AUTHOR]

Aims: To explore the feasibility and effects of the programme based on information‐motivation‐behavioural skills (IMB) model (IMB programme) on adherence to inhalation therapy and other health outcomes in chronic obstructive pulmonary disease (COPD) patients. Background: Poor adherence to inhalation therapy is common among COPD patients. The IMB model is supported by previous studies as useful in promoting adherence to health behaviours. Methods: This pilot randomized controlled trial randomized 35 COPD patients to receive either the IMB‐based programme or usual care. The 4‐week IMB programme consisted of a face‐to‐face and two telephone sessions to empower patients with skills and knowledge on using inhalation therapy and support their goal attainment for treatment compliance. Outcome evaluation including adherence to inhalation therapy, inhalation techniques, disease impact, and quality of life was conducted at baseline and at 6 weeks after randomization. Feasibility of the IMB programme was evaluated by a satisfaction survey and implementation experience. Results: Thirty patients completed the study, with an attrition rate of 14.3%. The intervention group (n = 15) had significant improvements in inhalation adherence, inhalation techniques, and quality of life than the control group over the evaluation period. Patient satisfaction survey results and observations on programme implementation suggested the feasibility of the IMB programme. Conclusion: A IMB model is a feasible and potentially effective intervention for improving COPD patients' adherence to inhalation therapy. SUMMARY STATEMENT: What is already known about this topic? Information‐motivation‐behavioural skills (IMB) models have produced positive effects on adherence behaviour in patients with acquired immune deficiency syndrome, coronary heart disease, and diabetes. What this paper adds? No study has evaluated the effects of the IMB model on an intervention for adherence behaviour in patients with chronic obstructive pulmonary disease (COPD).The pilot randomized controlled trial (RCT) showed that the IMB model used in the intervention was effective in improving COPD patients' adherence to inhalation regimen and techniques.The pilot study found that the IMB intervention programme was feasible for implementation in outpatient settings and was highly accepted by COPD patients. The implications of this paper: This programme may be effective in improving COPD patients' adherence to inhalation regimen and inhalation techniques.The programme is feasible and acceptable.There is need to conduct an adequately powered multisite RCT to provide stringent outcome evaluation of the IMB intervention programme. [Correction added on 28 January 2020: 'The implications of this paper' section has been amended.] [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe individuals' with type 2 diabetes mellitus sense‐making of blood glucose data and other influences impacting self‐management behaviour. Background: Type 2 diabetes mellitus prevalence is increasing globally. Adherence to effective diabetes self‐management regimens is an ongoing healthcare challenge. Examining individuals' sense‐making processes can advance staff knowledge of and improve diabetes self‐management behaviour. Design: A qualitative exploratory design examining how individuals make sense of blood glucose data and symptoms, and the influence on self‐management decisions. Methods: Sixteen one‐on‐one interviews with adults diagnosed with type 2 diabetes mellitus using a semi‐structured interview guide were conducted from March–May 2018. An inductive–deductive thematic analysis of data using the Sensemaking Framework for Chronic Disease Self‐Management was used. The consolidated criteria for reporting qualitative research (COREQ) checklist were used in completing this paper. Results: Three main themes described participants' type 2 diabetes mellitus sense‐making and influences on self‐management decisions: classifying blood glucose data, building mental models and making self‐management decisions. Participants classified glucose levels based on prior personal experiences. Participants learned about diabetes from classes, personal experience, health information technology and their social network. Seven participants expressed a need for periodic refreshing of diabetes knowledge. Conclusion: Individuals use self‐monitored glucose values and/or HbA1C values to evaluate glucose control. When using glucose values, they analyse the context in which the value was obtained through the lens of personal parameters and expectations. Understanding how individuals make sense of glycaemic data and influences on diabetes self‐management behaviour with periodic reassessment of this understanding can guide the healthcare team in optimising collaborative individualised care plans. Relevance to clinical practice: Nurses must assess sense‐making processes in self‐management decisions. Periodic "refresher" diabetes education may be needed for individuals with type 2 diabetes mellitus. [ABSTRACT FROM AUTHOR]

Background: African American men have poorer health outcomes compared to their white counterparts despite medical advancements and early detection of diseases. The purpose of this study was to determine to what extent the constructs of the multi theory model (MTM) explain the intention for initiation and sustenance of the consumption of fruits and vegetables among African American adult men in Mississippi. Methods: Using a cross-sectional design a valid and reliable paper survey was administered during November and December of 2019. The target population for the study consisted of African American adult men (18 or older) that had not consumed recommended levels of fruits and vegetables within 24 hours of taking the questionnaire. A convenience quota sample of African American men from select barbershops in Jackson, Mississippi, were asked to complete the 40-item questionnaire on preventive health screening behavior (n = 134). Results: The mean total number of fruits and vegetables consumed by participants within 24 hours of the taking the survey was 1.63 (SD =1.47). The mean intention to initiate consuming 5 or more cups of fruits and vegetables per day score was 2.13 (SD=1.17) as measured on a 5-point scale (0-4). Behavioral confidence (β = 0.495, P < 0.0001), and changes in physical environment (β = 0.230, P < 0.0001) accounted for 40.8% of the variance in predicting the intention to initiate behavioral change regarding the daily consumption of fruits and vegetables. Practice for change (β = 0.462, P< 0.001) and emotional transformation (β = 0.215, P< 0.0001) accounted for 37.5% of the variance in the intention to sustain fruits and vegetables consumption behavior. Conclusion: Based on data found in the study, MTM appears to predict the intention to initiate and sustain fruit and vegetable intake of African American men. Further research studies of suitable interventions to target African American men are needed. [ABSTRACT FROM AUTHOR]

Aims: To explore professionals' (i.e. nurses and nursing assistants) motivation for Patient Education according to their emotional skills. Design: A cross‐sectional study using a convenience sample of professionals completing self‐reported questionnaires assessing their general emotional skills and their Patient‐Education‐related sense of competence, autonomy and relatedness, according to the theory of basic psychological needs. Methods: Professionals from 27 French hospitals working in various departments completed paper and web‐based questionnaires between January 2015 ‐ May 2017. Mediation analyses were performed controlling for the already known variables associated with motivation for patient education. Results: Usable questionnaires (N = 185) were analysed. Professionals' emotional skills were associated with their motivation for Therapeutic Patient Education both directly and indirectly (i.e. partial mediation) via a higher sense of competence in Patient Education. Among the covariates, professionals who had received a high‐level training in Patient Education, those with a high recognition of their work in patient education and nurses (compared with nursing assistants) were the most motivated. Conclusion: Professionals' emotional skills are the mainstay of their motivation for Patient Education. Training should aim to develop these skills so that professionals can manage their own emotions better (e.g. frustration when faced with non‐motivated patients) and those of patients (e.g. discouragement) and thus effectively support patient self‐management. Impact: The study addressed nurses' and nursing assistants' motivation for patient education. Their emotional skills were directly and indirectly – via a higher sense of patient‐education‐related competence – associated with higher motivation. Training for professionals should therefore develop their emotional skills. [ABSTRACT FROM AUTHOR]

Purpose: In this paper, we present an exploratory, qualitative strand of a multiphase program evaluation of the Canadian-based SNAP® Youth Justice (SNAP YJ) model for males involved with the youth criminal justice system. SNAP YJ's therapeutic approach is founded on the evidence-based SNAP (Stop Now And Plan) model which focuses on strategies to enhance emotion regulation, self-control, and problem-solving for latency-aged children and their families. Integrating best practices from the literature, the SNAP YJ intervention uses technology (digital modules) to convey the manualized strategies and program sessions, engaging youth in an interactive manner. This systemic, cognitive behavioral intervention is designed to reduce further contact with the law and/or gang affiliation. The objectives of this study are to understand youth experiences of programing, enrich and contextualize preliminary outcome findings, and further develop programing through the inclusion of the youth perspective and feedback. Methods: A thematic analysis of 15 interviews with program participants from diverse backgrounds was conducted. Results: The results revealed a continuum of learning related to self-understanding and awareness of feelings; thinking and consequences; and prosocial skills and behavior. Discussion: Refinements to the program to target increased program effectiveness as a result of youth experiences are discussed. [ABSTRACT FROM AUTHOR]

A standard approach to analysis of case-cohort data involves fitting log-linear models. In this paper, we describe how standard statistical software can be used to fit a broad class of general relative rate models to case-cohort data and derive confidence intervals. We focus on a case-cohort design in which a roster has been assembled and events ascertained but additional information needs to be collected on explanatory variables. The additional information is ascertained just for persons who experience the event of interest and for a sample of the cohort members enumerated at study entry. One appeal of such a case-cohort design is that this sample of the cohort may be used to support analyses of several outcomes. The ability to fit general relative rate models to case-cohort data may allow an investigator to reduce model misspecification in exposure-response analyses, fit models in which some factors have effects that are additive and others multiplicative, and facilitate estimation of relative excess risk due to interaction. We address model fitting for simple random sampling study designs as well as stratified designs. Data on lung cancer among radon-exposed men (Colorado Plateau uranium miners, 1950–1990) are used to illustrate these methods. [ABSTRACT FROM AUTHOR]

This paper examines the ways in which older people's residential and nursing homes can constitute heteronormative environments – social spaces in which the same-sex attractions and desires of residents are disregarded in the provision of everyday care. The aim of this discussion is to examine the synergies and differences between older lesbian, gay and bisexual (LGB) adults' expectations for future care home provision and the expectations of care staff and managers in providing residential services to older people with diverse sexual backgrounds. We present qualitative evidence from research into the provision of care environments in Wales. In this paper, we present findings from two cohorts: first, from five focus groups with care and nursing staff and managers; and second, from 29 semi-structured interviews with older LGB adults (50–76 years) residing in urban and rural locations across Wales. We argue that residential care environments can constitute heterosexualised spaces in which LGB identities are neglected in comparison to the needs and preferences of other residents. To this extent, we discuss how care staff and managers can be more attentive and responsive to the sexual biographies of all residents and argue against the separation of care and sexual orientation in practice. [ABSTRACT FROM PUBLISHER]

Consumer-directed care (CDC) is increasingly widespread among aged care service options in Organisation for Economic Co-operation and Development (OECD) countries. However, the evidence base regarding the programmatic and contextual factors that affect the outcome of CDC interventions is surprisingly small. This paper reports on a self-directed care approach for older Australians with complex care needs. A multimethods longitudinal comparative cohort study was employed comprising 4 survey tools and 56 semi-structured interviews. Participation rates were around 20%. A total of 185 (98 in the intervention and 87 in the control group) older people and carers were recruited at baseline. Eleven months later, 109 participants (59 in the intervention and 50 in the control group) completed the repeat measure. Attrition rates were around 40%. Data collection occurred between July 2010 and April 2012. The data suggest that intervention group participants were likely to be more satisfied with the way they were treated (P = 0.013), their care options (P = 0.014), the 'say' they had in their care (P < 0.001), the information they received regarding their care (P = 0.012), what they were achieving in life (P = 0.031), that the services changed their view on what could be achieved in life (P = 0.020) and with their standard of living (P = 0.008). The evaluation suggests that while only a very small segment of older people is interested in a voucher or cash option, a substantially larger group would like to have greater say over and more direct access to their care, without, however, assuming administrative and financial responsibilities. The paper concludes that a stepped capacity-building approach to CDC may improve the acceptability of CDC to older people and generate synergies that improve older people's care outcomes. [ABSTRACT FROM AUTHOR]

Aim: To explore the interplay between the work of nurse managers and the support they receive and provide. Background: Support is the cornerstone of management practices and is pivotal in employees feeling committed to an organisation. Support for nurse managers is integral to effective health sector management; its characteristics merit more attention. Methods: The experiences of 15 nurse managers in rural health institutions in South Australia were explored using structured interviews, observation and document review. Results: Effective decision making requires adequate support, which influences the perceptions and performance of nurse managers, creating an environment in which they feel appreciated and valued. An ideal support system is proposed, the “sandwich support model,” to promote effective functioning and desirable patient outcomes via support “from above” and “from below.” Implications for Nursing Management: The need to support nurse managers effectively is crucial to how they function. The sandwich support model can improve management practices, more effectively assisting nurse managers. Organisations should revisit and strengthen support processes for nurse managers to maximize efficiencies. Conclusion: This paper contributes to understanding the importance of supporting nurse managers, identifying the processes used and the type of support offered. It highlights challenges and issues affecting support practices within the health sector. [ABSTRACT FROM AUTHOR]

Technology acceptance has been studied extensively within the IS discipline. Few, if any, have studied end users’ acceptance of newly implemented technologies within organisational contexts before end users start using the technology. Thus, by integrating variables from multiple relevant literature, this research attempts to answer this research question: will the introduction of a richer model for technology acceptance in a mandatory adoption environment, specifically in the pre-implementation phase, allow us to capture and account for the complexities of organisational technology implementations? The research model was tested in an organisational setting where a new content management system was being implemented. A total of 148 employees participated in this survey and partial least squares method was used to analyse the data to test the model. Implementation climate, valence, attitude, and perceived ease of use positively influence goal commitment to technology acceptance in a mandatory environment, and the model has displayed relatively large explanatory and predictive power. Theoretical and practical implications are discussed in the paper. [ABSTRACT FROM PUBLISHER]

Aims: To examine the presence of symptom clusters and synergistic effects of symptom clusters on quality of life in rheumatoid arthritis patients. Background: Rheumatoid arthritis patients frequently experience multiple concurrent symptoms of pain, fatigue, and depression. Design A nonexperimental, cross‐sectional correlation design. Methods: The study participants were 179 rheumatoid arthritis patients. Data were collected between August and December 2016. A hypothetical model was developed based on the Theory of Unpleasant Symptoms Model: physiological antecedents included disease activity and obesity; symptoms of pain, fatigue, and depression were hypothesized as being clustered, and quality of life was taken as the outcome variable. Results: Disease activity had significant direct effects on pain, fatigue, and depression and indirect effects on fatigue and depression, whereas obesity had a significant direct effect on fatigue alone. Three symptom clusters, namely, pain fatigue, fatigue depression, and pain‐fatigue depression were identified and found to have significant synergistic effects on quality of life. Conclusions: Our findings support the importance of managing clusters of symptoms simultaneously, that is, collective symptom management. Inter‐cluster dynamics between symptoms should be considered when nurses develop symptom management strategies or self‐management programs to improve the quality of life of rheumatoid arthritis patients. SUMMARY STATEMENTS: What is known about this topic? A symptom cluster is a stable group of different symptoms that co‐occur in association with a specific disease.Rheumatoid arthritis patients frequently experience multiple concurrent symptoms of pain, fatigue, and depression. What this paper adds? The most common and distressing rheumatoid arthritis symptoms of pain, fatigue, and depression were found to co‐occur and to be interrelated, which are the two major criteria of symptom clusters.Three symptom clusters, namely, pain fatigue, fatigue depression, and pain‐fatigue depression, were identified and found to have significant synergistic effects on quality of life. The implications of this paper: Our findings support the importance of managing clusters of symptoms simultaneously, that is, collective symptom management.The complicated intercluster dynamics demonstrated between symptoms in the present study should be considered when nurses develop effective symptom management strategies or self‐management intervention programs to improve the quality of life of rheumatoid arthritis patients. [ABSTRACT FROM AUTHOR]