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Aim s : The objective of this study was to examine the relationship between caregiving burden and pre‐death grief, with a specific focus on adult‐child caregivers in mainland China. Additionally, the study explored whether coping strategies played a mediating role in this correlation. Methods: A convenience sample of 320 adult‐child caregivers of older parents with dementia from Kunming, mainland China, was recruited for the study. Data were collected using the Chinese version of the Marwit‐Meuser Caregiver Grief Inventory‐Short Form, the Burden Scale for Family Caregivers, and the Ways of Coping Checklist‐Revised. Results: Results using linear regression and multiple mediation analysis with Hayes' process model indicated that caregiving burden was positively related to pre‐death grief and that active coping mediated the relationship between them. In the female group, active coping partially mediated the association between caregiving burden and pre‐death grief, but in the male group, this mediating effect did not exist. Conclusion: The study found evidence supporting the link between caregiving burden and pre‐death grief among adult‐child caregivers of older parents with dementia in mainland China. Furthermore, the caregiving burden prevented the use of active coping, and this decrease in coping increased the perception of pre‐death grief. These associations only existed in the female group. Implications: This paper presented the importance of active coping skills in the dementia caregiving process. Impact: The findings of this study emphasize the necessity for health practitioners to provide targeted interventions regarding pre‐death grief among dementia caregivers and strengthen caregivers' active coping strategies to reduce their pre‐death grief. Community‐based and personal care support services should be promoted to alleviate their caregiving burden. Reporting Method: We have adhered to the transparent reporting of evaluations with quantitative design statements and the corresponding checklist was followed. Patient or Public Contribution: 'No patient or public involvement'. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known about the subject?: Loneliness is common among young and middle‐aged stroke survivors. It not only hinders the recovery of their neurological and physical functions but also increases the risk of stroke recurrence, disability, and even death.Improving the mental health of young and middle‐aged stroke survivors is of utmost importance. However, previous research has not yet investigated the impact of interpersonal sensitivity and resilience on the relationship between stigma and feelings of loneliness. What the paper adds to existing knowledge?: This study confirms that stigma has a positive impact on loneliness among young and middle‐aged stroke survivors.Interpersonal sensitivity partially mediates the relationship between stigma and loneliness, and resilience plays a moderating role in the mediating mechanism. What are the implications for practice?: Mental health nurses can formulate nursing interventions to reduce loneliness of young and middle‐aged stroke survivors with the goals of improving stigma, reducing interpersonal sensitivity and cultivating resilience. Introduction: Previous studies have not explored the impact of interpersonal sensitivity and resilience on the relationship between stigma and loneliness. However, improving the resilience of young and middle‐aged stroke survivors and increasing their social participation is of great significance for reducing patients' loneliness of patients and promoting their physical and mental rehabilitation. Aims: To investigate the influence of stigma, interpersonal sensitivity and resilience on loneliness among young and middle‐aged stroke survivors. Methods: A cross‐sectional design was used to collect data. A total of 330 participants completed measures of stigma, resilience, interpersonal sensitivity and loneliness. The descriptive statistical approach, Pearson's correlation analysis and Hayes' PROCESS Macro Model 4 and 7 in regression analysis were used to analyse the available data. Results: The results revealed that young and middle‐aged stroke survivors' stigma, resilience, interpersonal sensitivity and loneliness were significantly correlated between every two variables, with coefficients ranging between −0.157 and 0.682. Interpersonal sensitivity played a partial mediating role in stigma and loneliness, accounting for 63.27% of the total effect; This process was moderated by resilience. Discussion: Stigma positively predicts participants' loneliness. As a mediating mechanism with moderating, interpersonal sensitivity and resilience further explain how stigma affects loneliness. Implications for Practice: Understanding this mechanism is of guiding significance to reduce loneliness of young and middle‐aged stroke patients and promote their physical and mental rehabilitation. [ABSTRACT FROM AUTHOR]

Purpose: Building on social exchange and leader-member exchange theories, this paper aims to propose a model of the impact of coronavirus-induced anxiety on health-care professionals' burnout and turnover intention through the mediation role of servant leadership. Design/methodology/approach: This model was examined by adopting partial least square-based structural equation modeling using data collected from 271 health professionals (doctors, nurses, midwives and analysts) from Turkey. Findings: The findings of the research illustrate that coronavirus-induced anxiety is positively associated with burnout and turnover intention. Furthermore, servant leadership mediates the relationship between coronavirus-induced anxiety, burnout and turnover intention. Yet, according to factor loadings, the mediating role of servant leadership is not strong (β : 0.035 and 0.053, respectively). Research limitations/implications: First, this study targeted the health-care professionals from Turkey. Therefore, this population may not be able to provide general information on the topic. Thus, this study suggests that the subject be addressed in other populations as well. Second, the data were self-reported by the participants. Although common method bias and social desirability bias were not an issue in this study, it should be known that the results are based on the subjective judgments of the participants. Third, this study was limited to investigating the mediating role of servant leadership only. Practical implications: This study gives much beneficial information to both administrators and organizations by mirroring highly stressed workers' inside throughout statistically results. Hence, it is assumed that the findings will help leaders to cope with several difficult situations, especially in crisis moments. As the chaotic circumstances occurred, achieving organizational goals became more and more difficult. To do this, some leaders play critical roles for members like servant leaders by contributing uniquely spiritual dimensions. Social implications: Struggling with the COVID-19 pandemic has aggravated the health-care professionals' existing mental health and has loaded more agitation on them. According to Mozes (2021), suicide cases among nurses have doubled the number of women in the general population. Thus, leaders should do something to lower those ratios. This study points out that servant leaders could break down those unwanted issues by decreasing burnout and turnover intention rates of health workers. Barbuto and Wheeler (2006) highlighted this situation by creating a dimension called "The Natural Desire to Serve Others." Originality/value: To the best of the authors' knowledge, to date, this study is the first to examine the mediating role of servant leadership in the effect of coronavirus-induced anxiety on burnout and turnover intention. Furthermore, this research reveals that servant leadership may play a role in avoiding burnout and turnover intention in the health sector. [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]

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]

Background: Despite the significant emphasis on self‐determination in special education and the crucial role of mobile learning, there is a notable absence of path modelling studies that explore the effect of self‐determination on the usage of mobile learning by students with special needs. Objectives: This study sought to investigate the intentions of mobile learning usage among students with special needs by proposing a model rooted in the technology acceptance model, complemented by extraneous constructs from self‐determination theory (competence, autonomy and relatedness). Methods: The data of the study was obtained online from 1298 special needs university students with eight different types of disabilities. Data were analysed with descriptive statistics, confirmatory factor analysis, structural equation modelling and bootstrapping. Results and Conclusions: The proposed model explained 78.4% of ease of use, 85.2% of usefulness, and 76.5% of intention. 11 of the 12 hypotheses tested within the scope of the model were supported. All hypotheses examining the impacts of self‐determination theory constructs on ease of use, usefulness, and intention were validated (8 hypotheses), with the exception of the autonomy → intention relationship. Substantial empirical evidence has been acquired to support the role of the self‐determination theory in exploring the intention toward mobile learning among university students with special needs. Concurrently, a robust theoretical framework has been introduced to the field of special education to elucidate the acceptance and utilization of technology by university students with special needs. Lay Description: What is already known about this topic: Numerous studies have demonstrated the significance of mobile tools and mobile learning in the realm of special education.Self‐determination holds immense importance in fostering independence and social engagement by empowering individuals with special needs to gain confidence, assume control and accountability for their own choices and actions.Self‐determination theory underscores the importance of providing individuals with support for three fundamental psychological needs—autonomy, competence, and relatedness—to foster healthy development. What this paper adds: To the best of the authors' knowledge, this study stands as a unique contribution within its field due to its distinctive characteristics. The model, supported by exceptionally successful outcomes and its ability to elucidate technology acceptance constructs at remarkably high levels, offers a robust theoretical framework for enabling students with special needs to engage effectively with mobile learning in both special and inclusive educational settings.Investigating how self‐determination theory enhances the explanatory power of the technology acceptance model in special education.Illuminating the significance of basic psychological needs in the adoption of mobile learning, employing advanced statistical methods with a substantial participant base, and delivering valuable insights to advance the utilization of mobile learning in special education. Implications for practice and/or policy: Special education settings should encourage students to take initiative, make choices, and exercise autonomy, and curriculum design should include opportunities for students to make choices.Making students part of the design processes and emphasizing usability through the prioritization of customizable, user‐friendly designs should be an inherent aspect of educational technology.Educators and support staff must have training and professional development opportunities to effectively use mobile learning tools and create inclusive learning environments. [ABSTRACT FROM AUTHOR]

Purpose: The importance of effective public messages has been widely recognized during the coronavirus disease 2019 (COVID-19) pandemic. In particular, the role of news items and interpersonal conversations for the acceptance of public health measures has been highlighted. The authors propose a conceptual model based on the existing literature on how to measure the degree of persuasion of news narratives in the context of the COVID-19 pandemic. Design/methodology/approach: The authors adopted a whole population approach, where the unit of analysis was the population of the media news about the COVID-19 pandemic. The authors selected a sample to develop and test their conceptual model. The sample size was n = 248. The questionnaire was distributed online using a non-probability convenience sampling plan. The authors used a pre-post pseudo-experimental design. Respondents answered questions about their attitude toward the COVID-19 pandemic. After watching a narrative news report on the same subject, they then answered questions designed to measure changes in their attitude. A structural equation model, the Sobel test and a paired samples t-test were used to test hypotheses. Findings: The results showed that there is a significant relationship between narrative with transportation and empathy. There was also a positive and significant relationship between transportation and empathy with attitude and interpersonal talk. The relationship between transportation and self-referencing was also supported. Further, transportation and attitude mediated the relationships between narrative and interpersonal talk, self-referencing as well as empathy. A paired samples t-test revealed that attitudes were changed or reinforced before and after watching the narrative news report. Originality/value: This paper contributes to the body of knowledge by identifying the outcomes of narrative persuasion during public health crises such as the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Online medical consultation (OMC) is generating considerable interest among researchers and practitioners due to the mandatory quarantine measures implemented during the COVID-19 pandemic in China. However, the acceptance rate of OMC has declined over time. This paper aims to empirically investigate OMC acceptance using a proposed research model by integrating the technology acceptance model (TAM) with trust and its antecedent variables. A quantitative self-administered cross-sectional survey was conducted to collect data from 260 healthcare consumers. A partial least squares structural equation modeling method was used to examine the data. Results revealed that healthcare consumers' behavioral intention was influenced by attitudes, while perceived usefulness and trust significantly influenced behavioral intention through attitude as a mediator. In addition, perceived risk, perceived privacy protection, network externalities, cognitive reputation, and interactivity directly influenced trust. Overall, the research model explained 50% of the variance in attitude and 71% of the variance in behavioral intention. The study's findings should provide useful insights into making effective design, development, and implementation decisions for OMC services. [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]

Purpose: The reduction of the violence and child abuse requires the cooperation of national and international health-related organizations. The purpose of this paper is to investigate the role of NGOs in health and peace development through administrating supportive programs for child abuse and violence victims. Design/methodology/approach: The present research was a mixed method research, and the type of research was a descriptive-analytic study. To collect data, library and field methods were used. The research sample included 137 staff members of the NGOs supporting children in Tehran. Data analysis was performed using SPSS software. Findings: According to authorities and members of the NGOs supporting children, networking and affective factors played a significant role in the development of health and peace (P<0.01). This was feasible by controlling the factors affecting violence and child abuse. Practical implications: Given the fact that NGOs are contributing to the development and establishment of peace through effective participation and networking, trying to support the victims of child abuse and violence, the need for more attention from governments is recommended in order to support these organizations, especially legislative and financial support is needed to expand the activities of such organizations. Originality/value: This paper is original in its method, topic and findings. The first is mixed method research, which has studied the role of networking of NGOs for peace development through implementing support programs for victims of child abuse and violence. [ABSTRACT FROM AUTHOR]

U.S. organizations seek to provide interns with positive socialization experiences such that their internships may lead to job offer acceptances. This study presents a process model examining how developmental relationships shape interns' experiences and outcomes. Utilizing a sample of 6,802 recent graduates from across 200 U.S. colleges and universities who completed an internship, the study found that supervisor support indirectly influences an intern's decision to accept a job offer through learning and intern satisfaction. Findings further show that interns benefit from developmental relationships such as mentors since mentor status buffered the decrements in learning when supervisor support was low. This study contributes to the growing internship literature that draws upon early socialization and newcomer adaptation by examining the critical role developmental relationships play in the experiences of interns. [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]

Purpose: Using the PRECEDE model, the purpose of this paper is to determine the predictors of mothers' performance in daily consumption of fruit and vegetables (FV) in rural preschoolers. Design/methodology/approach: This study was carried out on 350 mothers of preschool children who had health records in the rural health-care centers of Iran. To collect data, a researcher-made questionnaire based on the PRECEDE model was used. The data were analyzed using the SPSS 19 software. Findings: The results showed that 11.42 percent of the mothers observed the FV intake for their children recommended by WHO. The independent t-test showed a significant difference between the mean scores of predisposing, enabling and reinforcing factors. Originality/value: This study showed that the rate of FV intake by preschool children in rural areas was much lower than the recommended WHO rate. To promote behavior, attention to the predisposing, enabling and reinforcing factors seems to be necessary. [ABSTRACT FROM AUTHOR]

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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]

Objective: This study aims to examine the impact of nurses' nursing information competence on their creative self-efficacy and innovation behavior, and to investigate its role as a mediating factor between these two elements. Methods: A survey was conducted from July to September 2023 involving 1,200 nurses from two tertiary-level oncology specialty hospitals in Beijing, selected through convenience sampling. Instruments used included the Creative Self-Efficacy Scale, Nursing Information Competence Assessment Scale, and Nurses' Innovative Behavior Scale. Data analysis was conducted using SPSS 25.0 and R 4.1.2; AMOS26 was used to construct structural equation models and Bootstrap method was used to test the mediating hypotheses. Results: Out of the distributed questionnaires, 1,166 were valid, yielding an effective response rate of 97.16%. Pearson correlation analysis revealed significant correlations between innovation self-efficacy, nursing information competence, and nurses' innovative behaviors (P < 0.001). The Bootstrap method indicated that nursing information competence serves as a mediating factor in the relationship between creative self-efficacy and innovative behaviors, contributing to 24.5% of the observed effect. Additionally, regression analysis suggested that nursing information competence moderates the relationship between creative self-efficacy and innovation behavior. Conclusion: The findings suggest that nursing information competence not only mediates but also moderates the relationship between creative self-efficacy and innovative behavior. Enhancing nurses' information competence could therefore foster creative self-efficacy, leading to an increase in innovative behavior and, subsequently, improvements in the quality of oncology nursing care. [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]

Purpose Health Sector Evolution Plan (HSEP) is known as the biggest and most comprehensive reform in Iran's health system. One of the goals of HSEP is to reduce inequity in the healthcare financing. The purpose of this paper is to demonstrate HSEP agenda setting from the perspective of equity in healthcare financing (EHCF) using the multiple streams model.Design/methodology/approach This qualitative study was conducted by 26 documents review and analysis, and 30 semi-structured interview with Iranian key informants in the field of HSEP that were selected based on purposeful and snowball sampling method. Data were collected using a researcher-made checklist based on the goals. All audio-taped interviews were transcribed and analyzed thematically. Data management and analysis were performed using the framework analysis in MAXQDA software.Findings The framework analysis identified 12 complementary sub-themes totally. Problem stream included four sub-themes (high share of Out Of Pocket, high index of catastrophic health expenditures, low EHCF index, and inappropriate economic state and sanctions). Focus on EHCF in general policies of the Iran World Health Organization's report in 2000, the Targeted Subsidies Law and emphasis on equalizing healthcare financing in the Fourth and Fifth Development Plan were considered as policy stream sub-themes. Finally, political stream showed four sub-themes including strong support from the Minister of Health for HSEP, mass media, the pressure of WHO and people's request to reduce health costs.Research limitations/implications The limitations of the present study included paying attention to one package (evolution in the treatment sector) of three health packages to assess EHCF, as well as the lack of similar national and international evidence in implementation framework.Practical implications The results of this study can be used to analyze other health sector reforms around the word and can help the formulation and implementation of most practical reforms, especially in field of health system financing.Social implications This study gives a holistic view about health system policy setting that can be used for understanding policy-making streams to population.Originality/value This is the first study that has examined HSEP (the biggest health sector reform in Iran) from the perspective of agenda setting. In addition, using the popular and well-known Kingdon's model to explain HSEP agenda setting is one of the strengths of this study. Furthermore, taking advantage of a wide range of related views by including highly informed people increased the strength of the results of the study. In addition, the short interval between the interview and reviewing the results on reforms reduced the recall bias of the participants in the study. [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]

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]

This paper describes the process a wound care team used to develop a protocol to standardise the care of skin tears in an orthopaedic specialty hospital. The aims of the project were to: 1) find a classification tool to implement standardisation and 2) develop and implement a treatment algorithm and guidelines according to current evidence. A protocol and algorithm were developed to deal with skin tears in a standardised format. Knowledge increased 36% after an educational intervention targeting skin tear aetiology and implementation of the newly developed protocol. [ABSTRACT FROM AUTHOR]

Purpose According to the great importance of community health as well as the ever-increasing development of health technologies, the importance of designing an interactive model of factors affecting health technology assessment (HTA) can be highlighted. The purpose of designing and implementing the framework of health information system assessment is to ensure that the required accurate data which are necessary to measure the main health indicators are available. The purpose of this paper is to design an interactive model of factors affecting HTA.Design/methodology/approach This is a cross-sectional, descriptive-analytic study conducted in the Iran Ministry of Health and Medical Education in the second half of 2017. A sample of 60 experts and professionals working in the field of health technologies are selected using purposive and snowball sampling methods. Two researcher-made questionnaires are used to collect the required data. The collected data are analyzed using decision-making trial and evaluation laboratory (DEMATEL) and MATLAB R2013a.Findings The results showed that “Legal dimension,” “safety,” “Effectiveness” and “Social dimension” were the affecting factors and net causes, and “Current application,” “Knowledge of technology,” “Ethical dimension,” “Costs” and “Organizational dimension” were the affected factors and net effects in the interactive model. Furthermore, “Legal dimension” with the coordinates C: [1.88, 1.27] and “Ethical dimension” with the coordinates C: [1.75, −75] were known as the most affecting and most affected factors in the interactive model, respectively.Originality/value The DEMATEL model is an appropriate tool for managers and policy makers to structure and prioritize factors influencing the HTA. Policy makers and decision makers can use this model for identifying relationships among factors and prioritize them. Because health policy makers and managers have a major role in formulating the regulations and guidelines related to the HTA, they should pay more attention to the legal considerations in their decisions and use the management tools to move the available resources toward implementing and enforcing rules and guidelines related to the HTA. [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]

Introduction: Mental health is a serious concern among novice school nurses in Japan. Numerous novice school nurses with various health problems experience high stress levels, affecting their mental health. They may be experiencing reality shock, a known risk factor for burnout and turnover, or its factor, the "reality gap." Objective: This study aimed to examine the hypothetical model by which the reality gap affects the mental health of novice school nurses. Methods: This cross-sectional study conducted a self-administered questionnaire survey, and responses were obtained from 102 novice school nurses. A path model was created based on a hypothetical model. Results: After several revisions on the hypothesis model, a modified path model was generated (CFI =.98, TLI =.93, RMSEA =.06). The path model showed that reality gaps negatively affected work engagement, work engagement positively affected intention to stay, and intention to stay positively affected mental health. Reality gap was also directly negatively associated with mental health. Having various support networks reduced the effects of reality gaps on mental health. Additionally, social support in the workplace boosted work engagement. Conclusion: Unique from other studies, this study contributed to understanding the effects of reality gaps on mental health. School managers and administrators should establish a support system that enables school nurses to receive various supports from within and outside the school. In addition, novice school nurses should take advantage of networks and support inside and outside school to reduce reality gaps and grow as professionals. [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]

Prenatal depression affects approximately 10% to 15% of women. Guidelines recommend supporting women to make informed treatment decisions; however, minimal evidence exists regarding this decision-making process. This study aimed to develop a constructivist grounded theory of prenatal antidepressant treatment decision-making. Semi-structured interviews were conducted with purposively sampled women from the community or specialty clinics (N = 31). Iterative data collection and analysis, theoretical sampling, and member checking supported model sufficiency. In the Creating Comfort in Choice theory that we developed, participants were highly conscious of societal stigma toward mental illness and prenatal medication use, so fear, anxiety, and guilt dominated decision-making. Participants navigated dynamically among three clusters of decision-making activities: seeking information, making sense of information, and self-soothing. "Seeking information" included internal and external processes. In "making sense of information," participants appraised available evidence. In "self-soothing," participants engaged in coping strategies to try to alleviate painful emotions. The Creating Comfort in Choice theory can support patient-oriented decision-making regarding prenatal mental healthcare. [ABSTRACT FROM AUTHOR]

This study adds to a small body of Canadian literature investigating the ways that newcomer women experience, and are impacted by, intimate partner violence (IPV). The study involved qualitative interviews with 15 newcomer women who migrated to Saskatchewan, Canada, from 12 different countries. These findings provide insight into participants' complex lived experiences and illustrate how women's status as newcomers intersected with their experiences of IPV. As well as abuse related to language ability and immigration status, participants in our study described their experiences of physical; sexual; emotional; psychological; economic; and legal abuse; as well as coercive control; isolation; surveillance, stalking, and harassment while in the relationship and after separation; challenges with shared parenting; and the imposition of patriarchal values. Perpetrators of IPV maintained control by intentionally isolating survivors, and participants were also isolated due to their status as a newcomer and their limited English-language ability and social connections. [ABSTRACT FROM AUTHOR]

The Flourishing through Leisure Model (FTL) is a recently developed practice model in the field. Using a convenience sample of 210, this cross-sectional study aimed to test the model's validity. Participants were recruited from seven different sites that provided therapeutic recreation services (both clinical and community settings). A 110-question online survey was used to collect data on the theoretical constructs of the FTL, including overall well-being, leisure, and other well-being domains (i.e., psychological, cognitive, social, physical, and spiritual well-being), as well as the ecological impact on well-being. The results of this study suggested that overall well-being is significantly correlated with all other well-being domains. Additionally, the regression model with the following predictors--psychological/ emotional, environmental factors, leisure participation, social, and leisure experiences--successfully explained 71.3% of the variance in predicting overall well-being. The findings of this study supported the FTL as a sound model to guide recreational therapists in practice. [ABSTRACT FROM AUTHOR]

Aims: To explore how emerging adult‐aged women self‐manage their sexual and reproductive health and to generate a grounded theory of these self‐management processes. Design: Grounded theory methods using a constructivist approach. Methods: Between September 2019 and September 2020, 18‑ to 25‐years‐old women (n = 13) were recruited from a 4‐year university, a 2‐year community college, and neighbourhoods surrounding the institutions of higher education. Individual interviews were transcribed verbatim and qualitatively analysed using a constant comparative method and inductive coding. Results: The theory purports that core processes of sexual and reproductive health self‐management used by the women in this study included both passive and (re)active processes. These processes expanded upon and/or maintained the women's accessible sexual and reproductive health knowledge, behaviour and beliefs, defined as the sexual and reproductive health repertoire. The processes appeared to be cyclical and were often initiated by a catalysing event or catalyst and resulted in conversations with confidantes, or trusted individuals. A catalyst was either resolved or normalized by expanding or maintaining the sexual and reproductive health repertoire. Conclusion: The resulting theory, EMeRGE Theory, offers insight into the complex and cyclical processes emerging adult‐aged women use to simultaneously develop and adapt their foundational sexual and reproductive health knowledge, behaviours and beliefs. Implications for the Profession and/or Patient Care: This explication of emerging adult‐aged women's sexual and reproductive health self‐management processes can be used by nurses and nurse researchers to better address this population's unique health needs. Impact: The EMeRGE Theory provides valuable guidance for future exploratory and intervention research aimed at improving the health and well‐being of emerging adult‐aged women. Reporting Method: The authors adhered to the Consolidated Criteria for Reporting Qualitative studies (COREQ) in preparation of this publication. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background: Despite progress made over the past twenty years, child mortality remains high, with 5.3 million children under five years having died in 2018 globally. Pneumonia, diarrhoea, and malaria remain among the commonest causes of under-five mortality; contributing 15%, 8%, and 5% of global mortality respectively. Recent evidence shows that integrated community case management (iCCM) of pneumonia, diarrhoea, and malaria can reduce under-five mortality. However, despite growing evidence of the effectiveness of iCCM, there are implementation challenges, especially stock out of iCCM commodities and inadequate supportive supervision of community health workers (CHWs). This study aimed to address these two key challenges to successful iCCM implementation by using mobile health (mHealth) technology.Methods: This cluster randomised controlled trial compared health centre catchment areas (clusters) where CHWs and their supervisors implemented mHealth-enhanced iCCM supportive supervision and supply chain management vs clusters implementing iCCM as per current Zambian guidelines. CHWs in intervention clusters used community DHIS2 platform on mobile phones to report on a weekly basis children with iCCM conditions and make requisitions for iCCM commodities. Their supervisors received electronic reports on disease caseloads and monthly automated supervision reminders. The supervisors on receipt of requisitions, organized the medical supplies and notified CHWs for collection. Intention-to-treat analysis on the primary outcome, the percentage of children aged 2-59 months receiving appropriate treatment for malaria, pneumonia, or diarrhoea from an iCCM trained CHW, was performed using a generalized linear model. Prevalence ratios and 95% confidence intervals comparing the prevalence of appropriate treatment in the intervention and control groups were calculated using log binomial regression with an exchangeable correlation matrix, adjusted for clustering by health facility.Results: In the intervention clusters, 61.3% (98/160) of expected monthly supervision visits took place vs 52.0% (78/150) in the controls. A total of 3690 children 2-59 months old presented with malaria, diarrhoea, or pneumonia. In the intervention group, 65.9% (1,252/1,899) of children received appropriate care for iCCM conditions, compared to 63.3% (1,134/1,791) in the control group. The mHealth intervention was associated with 18.0% improvement in supportive supervision and 21.0% increase in appropriate treatment for pneumonia; these changes were not statistically significant. There was a 2-3-fold increase in the proportion of CHWs receiving supplies ordered: prevalence ratios ranged from 2.82 (confidence interval (CI) = 1.50, 5.30) to 3.01 (95% CI = 1.29, 7.00) depending on the particular commodity.Conclusion: This study was unable to determine whether using mHealth technology would strengthen supervision and supply chain management of iCCM commodities for community-level workers. There was no statistically significant effect of mHealth enhanced iCCM on appropriate diagnosis and treatment for children with malaria, pneumonia, and diarrhoea in rural Zambia. Longer term longitudinal studies are required to determine the impact of mHealth enhanced iCCM on health outputs and outcomes.Trial Registration: ClinicalTrials.gov, NCT02866097. [ABSTRACT FROM AUTHOR]

Background: Increasing compliance with isolation precautions is important in reducing hospital-acquired infections and their consequences. It is not possible to achieve and maintain nurse compliance through supervision, control, pressure, or training. Therefore, nurses must personally demand compliance with isolation precautions. This study aimed to determine the relationship between compliance with isolation precautions and the moral sensitivity levels of nurses who have just started working. Methods: This study employed a descriptive and cross-sectional research design. The study population consisted of 456 new nurses recruited during the pandemic. All of the new nurses who volunteered to participate in the study and completed the questionnaires completely were included in the study and 398 nurses constituted the sample of the study. Data were collected from 398 out of 456 novice nurses who agreed to participate in the study. The population coverage rate was 87.28%. Participants were selected using convenience sampling method. The data collection tools included an Introductory Information Form, The Isolation Compliance Precautions Scale (TIPCS), and the Moral Sensitivity Questionnaire (MSQ). Descriptive statistics, correlation analyses, and regression models were used to analyze data. Findings: The mean score of the MSQ was high (mean ± SD = 90.49 ± 25.94; median (P25-P75) = 84 (range, 74–97), and the score for TIPCS was high (mean ± SD = 79.29 ± 7.68; median (P25-P75) = 82 (range, 76–85)). No correlation was found between MSQ and TIPCS (p > 0.05). According to the regression analysis, although the MSQ did not correlate with TIPCS, compliance with isolation measures was found to increase as the conflict subscale of moral sensitivity increased (β= -0.36, CI= -0.55 to -0.16; p < 0.001). Choosing the profession willingly had a positive correlation with compliance with isolation measures (β = 5.3, CI = 2.4 to 8.3; p < 0.001). In addition, starting the profession at an early age had a positive correlation with compliance with isolation measures (β= -0.49, CI= -0.8 to -0.17; p = 0.002). Conclusion: The conflict sub-dimension of moral sensitivity is an important factor in nurses' compliance with isolation measures, and conducting necessary training and other studies to improve nurses' moral sensitivity may increase their compliance with isolation measures. [ABSTRACT FROM AUTHOR]

The Interpersonal Exchange Model of Sexual Satisfaction proposes that sexual satisfaction can be explained by the balance of sexual rewards or costs exchange. The Interpersonal Exchange Model of Sexual Satisfaction Questionnaire (IEMSSQ) was developed from this model. The IEMSSQ includes the Reward/Costs Checklist (RCC). The RCC assesses different sexual exchanges that are categorized into sexual rewards and/or costs. Analyses and comparisons of sexual rewards and costs in the Hispanic cisgender population based on gender (man or woman) and sexual orientation (heterosexual and homosexual) with this measure have not been conducted. The main goal was to analyze and rank the sexual rewards, costs, and both, indicated by a sample of 1996 Hispanic partnered participants (heterosexual men, gay men, heterosexual women, and lesbians). The predominant sexual exchanges that were reported involved emotional aspects, both as rewards and costs. When participants indicated that the exchange was both a reward and a cost, they were referring to aspects specifically related to the sexual relationship itself. Heterosexual men and women had greater rewards and higher costs, respectively. Gay men obtained a greater number of items reported as rewards and costs. The results provide further insight into sexual satisfaction related to gender and sexual orientation. [ABSTRACT FROM AUTHOR]

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]

Aims and Objectives: This study aimed to investigate the role of the family in supporting diabetes self‐management and explore the possible mechanisms between family and diabetes self‐management among rural patients in China. Background: The prevalence of Type 2 diabetes mellitus (T2DM) is growing rapidly in rural areas of China, where healthcare resources remain relatively poor and family members play an important role in chronic disease self‐management. Design: This was a multicentre cross‐sectional study. Methods: A total of 276 adults with T2DM were recruited from nine county hospitals in China. Diabetes self‐management, family support, family function, and family self‐efficacy were evaluated using the mature scales. A theoretical model was built based on the social learning family model and previous studies and then verified using a structural equation model. The STROBE statement was used to standardise the study procedure. Results: Family support and general family factors, including family function and self‐efficacy, were positively correlated with diabetes self‐management. Family support fully mediates the relationship between family function and diabetes self‐management and partially mediates the relationship between family self‐efficacy and diabetes self‐management. The model explained 41% of the variability in diabetes self‐management and had a good model fit. Conclusion: General family factors can explain nearly half of the change in diabetes self‐management in rural areas of China, while family support is a mediator between general family factors and diabetes self‐management. Family self‐efficacy, a potential intervention point of family based diabetes self‐management education, can be improved by building special lessons for family members. Relevance to Clinical Practice: This study emphasises the role of family in diabetes self‐management and proposes suggestions for diabetes self‐management intervention among patients with T2DM in rural areas of China. Patient or Public Contribution: Patients and their family members completed the questionnaire which was used for data collection. [ABSTRACT FROM AUTHOR]

We tested an assessment model, by which teacher self-efficacy, perceived school climate, and psychological wellbeing at work, might predict teaching enjoyment. We invited a convenience sample of 355 teachers of English as a foreign language (EFL) to respond to four online questionnaires. We used confirmatory factor analysis (CFA) to check the scales' construct validity and structural equation modeling (SEM) to test associations among the variables. Our results showed that teacher self-efficacy, perceived school-climate, and psychological wellbeing were direct predictors of foreign language teaching-enjoyment (FLTE). Teacher self-efficacy affected FLTE indirectly, as induced by psychological well-being. School climate also indirectly influenced FLTE, as mediated by teacher self-efficacy and psychological wellbeing, with school climate a direct predictor of teacher self-efficacy and psychological wellbeing. Teacher self-efficacy directly affected psychological wellbeing. We discuss implications of these findings for teacher-education programs. [ABSTRACT FROM AUTHOR]

Purpose: The digitalization has changed the volunteer paradigm, making young volunteers use technology in their volunteering activities. The current study sets out to identify and model the antecedents that determine intention to engage in digital health volunteering among Algerian physicians to give insights promoting the development of digital volunteering in different countries of the world. Design/methodology/approach: To this end, the authors used a survey design to extend the technology acceptance model (TAM) with two construct (self-efficacy and perceived risk of COVID-19 infection). A convenience sample of 163 physicians; working in the private and public sectors in six provinces of Algeria was selected. The data were analyzed through a multiple linear regression. Findings: The findings show that the perceived usefulness, ease of use, attitudes toward digital volunteering, level of self-efficacy and perceived risk of COVID-19 infection have a significant positive effect on physicians' intentions to engage in digital volunteering work in the context of health crises. Practical implications: This study reveals that engaging in digital volunteering can be promoted during health crises as an effective strategy to provide support and assist public health institutions and emergency management. Originality/value: To the best of the authors' knowledge, this is the first study from Africa that explores digital volunteer work, and the first study that extends the TAM to investigate digital volunteer intention among physicians. [ABSTRACT FROM AUTHOR]

The sense of guilt in informal caregivers has been associated with lower levels of overall life-satisfaction, an increase in feelings of overwork, stress, and health problems, including anxiety and depression. Even though women who care for dependent relatives have higher levels of feelings of guilt than male caregivers, little research has been done on the dynamics of guilt from a gender perspective. This study examines the dynamics of this moral emotion in women caregivers' psychosocial health. This study is based on semi-structured interviews with nineteen Spanish women who are informal caregivers looking after dependent family members. The interviews were subsequently transcribed and subjected to thematic analysis. Three themes emerged from qualitative analysis: first, doing more for the people being cared for than for oneself; secondly, being demanding on oneself; and thirdly, controlling one's own desires. The results show dynamics of self-control that seem to function as mechanisms for the women caregivers to avoid feelings of guilt, but at the price of taking on greater caring responsibilities, denying their own desires, and endangering their psychosocial health. We consider that intervention to help women reduce anticipatory guilt is essential, as these feelings put women caregivers' psychosocial health at risk. [ABSTRACT FROM AUTHOR]

This online randomised controlled study evaluates benefits associated with structured topic-focussed narrative writing tasks versus unstructured narrative writing tasks, monitoring to what extent tasks impact well-being, psychopathology and satisfaction. Participants were randomised to structured topic-focussed or unstructured narrative writing conditions. Structured condition consisted of Conflict Analysis (CA), a self-guided narrative-based therapeutic assessment. Unstructured conditions consisted of narrative disclosure tasks about traumatic experiences. Both conditions consisted of ten 20-minute tasks completed within one week. One hundred and three participants completed baseline measures. Eighty-two participants completed two-week follow-up measures. Repeated measure ANOVA and t-tests were used to evaluate differences over time. Follow-up data suggest that CA participants had significantly improved outcomes when compared to narrative disclosure participants. Evidence supports continued structured narrative writing research. [ABSTRACT FROM AUTHOR]

The purpose of this study was to develop a model describing the process of how older adults with age-related macular degeneration develop physical activity self-efficacy. The primary aim of this research was to determine how adults with age-related macular degeneration living in a southeastern metropolitan area develop physical activity self-efficacy. Sixteen older adults with age-related macular degeneration participated in face-to-face interviews and observations of their regular physical activity. Grounded theory approach was used to identify emerging themes and a model describing the development of physical activity self-efficacy in this cohort. Five themes related to the development of physical activity self-efficacy emerged: 1) physical activity engagement, 2) self-management behaviors, 3) physical activity determinants, 4) strategies, and 5) self-perceived benefits. These themes were analyzed to produce a preliminary model describing the development of physical activity self-efficacy in older adults with age-related macular degeneration. Findings provide a preliminary model, which practitioners can use to facilitate self-efficacy and participation in physical activity in older adults with age-related macular degeneration. [ABSTRACT FROM AUTHOR]

Dublin Anti-Bullying Self-Efficacy Scales aim to measure the effectiveness of school anti-bullying programs in promoting five steps that victims and bystanders take against online and offline bullying behaviors. These steps are anti-bullying self-efficacy beliefs to recognize bullying behaviors, comprehend emergency, take responsibility, know what to do, and intervene. However, when an anti-bullying program is very effective for the majority of participants who give high scores, a considerable number of participants who give low scores are very likely to be detected as outliers. This raises two measurement issues. First, high scores create highly negatively skewed data and lead to measuring a unidimensional rather than multidimensional construct. This could be one reason why recent research has been unclear about the extent to which the scales measure a unidimensional, multidimensional, or bifactor construct. Second, should outliers be removed or be considered as participants for whom the program was ineffective? If the scales had measurement invariance across the group of outliers and non-outliers or low and high self-efficacy, it could be concluded that the anti-bullying program was ineffective for some participants. The current research aims to address these issues by testing both measurement invariance as well as unidimensional and bifactor models of anti-bullying self-efficacy. Results of Pure Exploratory Bifactor (PEBI) Analyses and Item Response Theory (IRT) with Two-Parameter-Logistic (2PL) Models of data from a convenience sample of 14-year-old students in Ireland (N = 1,222) indicated sufficient psychometric properties of both unidimensional and multidimensional scales for victim offline, victim online, bystander offline, and bystander online. Further research can use these scales for measuring the bifactor model of anti-bullying self-efficacy as well as the cut-off score for distinguishing between low and high anti-bullying self-efficacy. [ABSTRACT FROM AUTHOR]

Introduction: Illness perception and self-efficacy in patients with coronary artery disease (CAD) may affect medication adherence, which is one of the most important challenges in disease management in this group of patients. Objective: The present study aimed to investigate the factors influencing medication adherence in CAD patients, especially the effect of illness perception and self-efficacy. Methods: This study was cross-sectional and conducted from April to September 2021. A total of 259 patients with confirmed CAD were selected by convenience sampling method based on inclusion criteria. Illness perception, self-efficacy, and medication adherence were investigated using Brief IPQ, SCSES, and MARS_10 questionnaires, respectively. The data were analyzed using the STATA software (version 14) and the regression path analysis method. Results: Patients had moderate illness perception and high self-efficacy, and 61.8 of them adhered to their medication regimen. Greater illness perception, better self-efficacy, and higher education had a positive effect on medication adherence, and increasing age had a negative effect on it. The final path model shows a good fit of the data in the model (χ2: 0.37, df: 274, χ2/df: 0.36, CFI: 1, IFI: 0.95, TLI: 1.07, and RMSEA: 0.00). Conclusion: The results of the present study suggest that patients' illness perception can play an important role in predicting self-efficacy in disease management and the level of medication adherence in patients with CAD. To improve self-efficacy and medication adherence, future intervention studies should focus on the patient's illness perceptions and their improvement. [ABSTRACT FROM AUTHOR]

Aim: We tested key hypotheses derived from the Cultural Determinants of Trauma Recovery Theory (CDTR) with an American sample. Design: A cross‐sectional study using anonymous online surveys. Methods: This study was conducted with 225 American survivors of gender‐based violence (GBV) between August to November 2019. Demographics, distress (depression: PHQ8; PTSD: PCL‐5), mental health service utilization (counselling and medication), sense of coherence (SOC), internal barriers to help‐seeking (shame, frozen and problem management subscales: BHS‐TR Internal) and the GBV healing (GBV‐Heal) were used. Structural equation modelling (SEM) was conducted to test the hypotheses. Results: The final SEM model showed that the relationship between distress and mental health service utilization was not mediated by internal help‐seeking barriers; the relationship between distress and trauma healing was partially mediated by internal help‐seeking barriers; the relationship between internal help‐seeking barriers and trauma healing was partially mediated by SOC; mental health service utilization was not significantly associated with trauma healing. Overall, the relationship between distress and trauma healing was partially mediated by internal help‐seeking barriers and SOC. Conclusions: This study confirmed some hypothetical pathways between distress and trauma healing. Further research with larger and international samples should be necessary to test the overall CDTR and compare groups. Impact: This study can help us focus on psychological interventions that enhance meaning and mitigate internal help‐seeking barriers to promote holistic trauma recovery. Public and public contribution: The sample was gathered from a clinical population registry that alerts patients of potential research opportunities. [ABSTRACT FROM AUTHOR]

Introduction: The associations between affiliate stigma, caregiving burden, psychological distress, and quality of life (QoL) among family caregivers of people living with dementia (PwD) have been demonstrated in the literature. However, there is a dearth of literature regarding how these factors could form a psychological mechanism. The present study proposed a theoretical model to portray the relationships between these factors. Methods: Utilizing convenience sampling and cross-sectional study design, 275 family caregivers (145 females [52.7%]; mean age = 52.71 years) were recruited from a general hospital from October 2013 to September 2014. Each participant completed the following instruments in a quiet room in the general hospital without disturbance: Caregiver Burden Inventory, World Health Organization QoL Questionnaire-Brief, Affiliate Stigma Scale, and Beck Anxiety Inventory alongside the Taiwan Depression Questionnaire (assessing psychological distress). Structural equation modeling was used to examine the proposed theoretical model. Results: Affiliate stigma (standardized coefficient [β] = -0.338; P = 0.011) and psychological distress (β = -0.538; P < 0.001) were negatively associated with QoL, caregiving burden was positively associated with psychological distress (β = 0.818; P < 0.001), and affiliate stigma was positively associated with caregiving burden (β = 0.793; P < 0.001). Moreover, a significant mediated effect was observed between affiliate stigma and QoL via sequential mediators of caregiving burden and psychological distress (unstandardized coefficient = -1.17 and 95% confidence interval = -1.88, -0.46). Conclusion: Affiliate stigma, caregiving burden, and psychological distress are key factors contributing to low QoL among family caregivers of PwD. Health-care providers should design programs to help reduce affiliate stigma, caregiving burden, and psychological distress for family caregivers of PwD to facilitate their QoL. [ABSTRACT FROM AUTHOR]

Aim: First, to identify which aspects of missed care accurately define the integration of care and context of care dimensions of the Fundamentals of Care Framework. Second, to test the Framework for validity and reliability and lastly, to explore how leadership influences care integration. Design: A non‐experimental research design using self‐audit data collected information about variations in nursing care as exemplars for dimensions of the Framework. Methods: A multi‐variate approach using path analysis was used to apply the consensus scores of 3079 Australian residential care nurses and carers to define the dimensions of the Framework. Results/Findings In the Australian residential care setting, the factors that define both the contexts of care and the integration of care dimensions constructs are now empirically established. The most direct predictor for the integration of care dimension arises from both the leadership and resource allocation variables, while the remaining context of care factors have indirect but significant effects. The integration of psychosocial care in the residential care sector is not influenced by any of the Framework's context‐based factors. Conclusion: The component variables of the Framework show both good reliability and convergent validity. These findings confirm a predictive relationship exists between the elements of the context of care and the different types of nursing activities that form the integration of the care dimension, including organizational leadership. [ABSTRACT FROM AUTHOR]

This study aimed to identify the social representations of sports for Brazilian athletes with disabilities and to understand the extent to which sports can contribute to their empowerment. A total of 153 Brazilian athletes of various sports and with different types of disabilities took part in the study (122 men and 31 women; M = 31.91 years, SD = 9.46). The research was performed by an online survey by means of the free word association technique. All analyses were carried out using the Iramuteq computer program. The results indicated that the social representations of sports are related to individual and collective gains derived from practicing sports and that the representations are distinct according to the discipline practiced by the athlete. These results are discussed in light of the advantages of valuing the collective experience of athletes with disabilities as a group rather than as cases of individual overcoming. Social implications and possible future directions for research are presented. [ABSTRACT FROM AUTHOR]

Prevention capacity of local health organisations is associated with the performance and outcomes in public health. In Colombia, where cardiovascular disease is the leading cause of morbidity and mortality, there is limited knowledge about the capacity of local health departments to prevent this condition. Efforts are needed to address problems, potential solutions and expected outcomes regarding cardiovascular disease. In this study, a conceptual model for cardiovascular disease prevention capacity in Colombian local health departments was developed, a questionnaire based on this model was validated, the overall cardiovascular disease prevention capacity in a subsample of these organisations was measured, and the association between cardiovascular disease prevention capacity and political, population, and organisational factors was examined. Once the acceptable performance of the questionnaire was verified, variability in cardiovascular prevention capacity was found among a subsample of local health departments. Furthermore, this study provides primary evidence regarding the association between the size of local health departments and overall cardiovascular disease prevention capacity in Colombia. Future studies should focus on measuring this capacity on a larger scale and developing, implementing, and evaluating interventions aimed at strengthening cardiovascular prevention capacity in Colombian local jurisdictions. [ABSTRACT FROM AUTHOR]

The study aims to (1) investigate current levels of patient acceptance of mHealth in Germany; (2) determine the influencing factors of patients' intention to use, and (3) test the influence of prescription and reimbursement status on patient acceptance. Online survey with 1349 participants, of which 1051 were complete and included for statistical analysis, from a broad cross-section of the German population, addressing both users of mobile health (mHealth) applications and people without prior experience. SEM modeling based on a combination of two theoretical frameworks: the extended Unified Theory of Acceptance and Use of Technology and Health Protective Behavior Theories were used to assess acceptance. Users of mHealth in Germany are mostly patients between the ages of 30 – 50 with mental health or endocrine conditions. General willingness to use mHealth apps / DiGAs (mHealth apps fully reimbursed by social health insurance) is high at 76%, especially if they are governmentally certified, however only 27% of respondents were willing to pay out of pocket. With the exception of a spike in performance expectancy and data security, DiGAs lack a clear differentiation from mHealth apps. Perceived self-efficacy and performance expectancy are significant predictors of willingness to use digital health interventions; with age, attitude, and e-literacy being key demographic predictors. A key takeaway for regulators, providers of mHealth apps/ DiGAs, and other stakeholders involved in mHealth adoption is the importance of addressing negative beliefs early on, targeted communication around effortless usage of mHealth services across age groups and demographics, and focus on highlighting expected benefits of mHealth app/ DiGA usage. [ABSTRACT FROM AUTHOR]

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