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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]

Objectives: Cardiac rehabilitation (CR) provides evidence-based secondary prevention for people with heart disease (HD) (clients). Despite HD being the leading cause of mortality and morbidity, CR is under-utilised in Australia. This research investigated healthcare systems required to improve access to CR in rural and remote areas of North Queensland (NQ). Methods: A qualitatively dominant case study series to review management systems for CR in rural and remote areas of NQ was undertaken. Data collection was via semi-structured interviews in four tertiary hospitals and four rural or remote communities. An audit of discharge planning and CR referral, plus a review of community-based health services, was completed. An iterative and co-design process including consultation with healthcare staff and community members culminated in a systems-based model for improving access to CR in rural and remote areas. Results: Poorly organised CR systems, poor client/staff understanding of discharge planning and low referral rates for secondary prevention, resulted in the majority of clients not accessing secondary prevention, despite resources being available. Revised health systems and management processes were recommended for the proposed Heart: Road to health model, and given common chronic diseases risk factors it was recommended to be broadened into Chronic disease: Road to health. Conclusion: A Chronic disease: Road to health model could provide effective and efficient secondary prevention for people with chronic diseases in rural and remote areas. It is proposed that this approach could reduce gaps and duplication in current healthcare services and provide flexible, client-centred, holistic, culturally responsive services, and improve client outcomes. What is known about the topic? Cardiac rehabilitation is known to improve health outcomes and reduce hospitalisations, but referrals and attendance are low (30%). What does this paper add? A revised systems-based model for improved access to secondary prevention for people with heart and related chronic diseases in rural and remote areas of North Queensland is proposed: Chronic disease: Road to health. What are the implications for practitioners? A functional system from hospitalisation to local healthcare services has been designed to improve access to secondary prevention. Staff require support and education to improve skills, better manage care and improve job satisfaction. [ABSTRACT FROM AUTHOR]

This paper investigates alcohol consumption within cultures of football fandom through the innovative combination of theories of the carnivalesque and Bourdieu's concepts of habitus, field, and capital. Focus groups (n = 79) were conducted with football supporters in England and Scotland. Semi-structured interviews (n = 15) were also conducted with key organizational stakeholders. Research explored the importance and role of alcohol consumption for supporters when watching or attending matches.. Participants confirmed the cultural significance, perceived normalcy and historical links between football and alcohol consumption. Supporters highlighted the importance of the sociability, friendship, and social capital aspects of alcohol consumption. Participants believed football supporters are perceived differently in comparison with supporters of other sports, arguing that legislation surrounding alcohol consumption at other sports allowed supporters to enhance the carnivalesque by drinking alcohol, whereas football fans were more restricted. Participants agreed the habitus of excessive drinking and violence associated with football supporters led to a bad reputation, however, this view was outdated. Participants also recognized a growing drug culture in football. The findings draw attention to the alcohol-sport relationship and the contested relations, and diverging interests and influences, within the social field of football. [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]

Background: Medicines are often suboptimally managed for heart failure patients across the transition from hospital to home, potentially leading to poor patient outcomes. The Improving the Safety and Continuity Of Medicines management at Transitions of care programme included: understanding the problems faced by patients and healthcare professionals; developing and co‐designing the Medicines at Transitions of care Intervention (MaTI); a cluster randomized controlled trial testing the effectiveness of a complex behavioural MaTI aimed at improving medicines management at the interface between hospitals discharge and community care for patients with heart failure; and a process evaluation. The MaTI included a patient‐held My Medicines Toolkit; enhanced communication between the hospital and the patient's community pharmacist and increased engagement of the community pharmacist postdischarge. This paper reports on the patients' experiences of the MaTI and its implementation from the process evaluation. Design: Twenty one‐to‐one semi‐structured patient interviews from six intervention sites were conducted between November 2018 and January 2020. Data were analysed using the Framework method, involving patients as co‐analysts. Interview data were triangulated with routine trial data, the Consolidated Framework for Implementation Research and a logic model. Results: Within the hospital setting patients engaged with the toolkit according to whether staff raised awareness of the My Medicines Toolkit's importance and the time and place of its introduction. Patients' engagement with community pharmacy depended on their awareness of the community pharmacist's role, support sources and perceptions of involvement in medicines management. The toolkit's impact on patients' medicines management at home included reassurance during gaps in care, increased knowledge of medicines, enhanced ability to monitor health and seek support and supporting sharing medicines management between formal and informal care networks. Conclusion: Many patients perceived that the MaTI offered them support in their medicines management when transitioning from hospital into the community. Importantly, it can be incorporated into and built upon patients' lived experiences of heart failure. Key to its successful implementation is the quality of engagement of healthcare professionals in introducing the intervention. Patient or Public Contribution: Patients were involved in the study design, as qualitative data co‐analysts and as co‐authors. [ABSTRACT FROM AUTHOR]

Aim: Being front‐line healthcare professionals is associated with possible severe information anxiety during the COVID‐19 pandemic. Investigating signs of information anxiety is the first and key step of its targeted medical intervention. This study aims to explore the signs of front‐line healthcare professionals' information anxiety during the COVID‐19 pandemic. Design: This study is qualitative research. Grounded theory was used to classify information anxiety signs of front‐line healthcare professionals. Methods: Twenty‐four front‐line healthcare professionals from a general hospital with over 5000 beds in Wuhan were recruited to participate in semi‐structured interviews. According to the frequency and frequency variation of signs appearing in interviews, the trends of signs during the virus encounter, lockdown, flattening and second wave were compared. Based on the interviews, those signs that were conceptually related to each other were extracted to construct a conceptual model. Results: Psychological signs (emotion, worry, doubt, caution, hope), physical signs (insomnia, inattention, memory loss, appetite decreased) and behavioural signs (panic buying of goods, be at a loss, pay attention to relevant information, change habits) could be generalized from 13 subcategories of information anxiety signs. Psychological signs were the most in every period of the pandemic. Furthermore, psychological signs decreased significantly during lockdown, while behavioural and physical signs increased. Finally, severe psychological and behavioural signs were associated with physical signs. [ABSTRACT FROM AUTHOR]

Hispanic women who experience intimate partner violence (IPV) face unique disparities. They have poorer health outcomes and are less likely to seek help than their non-Hispanic counterparts. When women remain in relationships where IPV occurs and refuse to disclose or seek treatment, they may resort to self-silencing, which can also worsen health outcomes. The purpose of this study was to develop a theory that explains how self-silencing evolves among Hispanic women who experience IPV. Participants were recruited from two research studies focused on Hispanic women's health, and from snowball sampling, which involved referrals by previously registered participants. Data were collected via Zoom® and included individual interviews. A total of 25 women participated in this study. Analysis followed constructive grounded theory levels of analysis described by Charmaz and constant comparative methods described by Glaser and Strauss. A grounded theory entitled Bearing (Aguantando) With Intimate Partner Violence emerged from the data. The theory explains the main strategy Hispanic women use to deal with violence while remaining in a relationship where IPV occurs. The theory is constructed of four categories with subcategories. The results of this study provide an initial framework to understand the self-silencing process among Hispanic women who experience IPV. In addition, this study identifies different levels of interventions that can be useful for researchers and healthcare providers to promote Hispanic women's ability to become empowered, use their voices, and seek help. [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]

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]

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]

The purpose of this study was to investigate the effects of the concrete-representational-abstract–integrated (CRA-I) sequence on students with learning disabilities' performance when learning fraction and decimal concepts. Three elementary-level students in Grades 4 and 6 participated in a single-case multiple probe across behaviors study. The intervention involved explicit use of fraction blocks, coins, base ten blocks, number lines, pictures, and abstract symbols to teach unit fractions, fraction and decimal equivalence, addition of fractions with unlike denominators, and writing fractions as decimals. The researchers demonstrated a functional relation between CRA-I and three different behaviors related to fraction concepts: decreased error in estimating fraction magnitude, addition of unlike fractions, and writing fractions as decimals. The findings show promise in the use of CRA-I for teaching fraction concepts to students with learning disabilities. [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 COVID-19 pandemic, on a global scale, has prompted multifaceted challenges, including a notable psychological toll on the general population. This study uses mixed-method approach for a nuanced exploration of these experiences. Using a phenomenological strategy, qualitative responses from 999 participants were analyzed regarding their pandemic-induced anxiety and the influence of quarantine measures on their lives. Quantitative measures, including the revised Impact of Event Scale (IES-R), patient health questionnaire-9 (PHQ-9), the seven-item generalized anxiety disorder assessment (GAD-7), and Insomnia Severity Index (ISI), were used to quantify trauma, depression, anxiety, and insomnia attributed to COVID-19. Partial least squares structural equation modeling (PLS-SEM) was utilized for quantitative data analysis. The anxiety-related responses were mainly clustered into four themes: life threats, support shortage, economic consequences, and disruptions to family and social life. Subthemes that addressed the perceived effects encapsulated disruptions to academic and professional lives, familial and social relationships, psychopathological stress, and movement limitations. The findings from quantitative analysis revealed the significant associations between COVID-19-related trauma and symptoms of anxiety, depression, and insomnia, as indicated by coefficients exceeding 0.10 (all z-values > 1.96; p-values < 0.05). In conclusion, the findings underscore COVID-19's role in escalating anxiety, influenced by various factors, and its disruptive effects on daily life due to quarantine measures. The strong associations between the pandemic and the symptoms of depression, anxiety, and insomnia underscore the urgency of comprehensive psychological and public health interventions to alleviate these impacts. [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]

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]

This interpretive research study explores U.S. adults' lived experiences during the beginning months of the COVID-19 global pandemic. Participants (N= 44), recruited from a convenience sample of U.S. adults, engaged in in-depth semi-structured interviews or focus groups. Through an iterative analysis of participants' experiences and the theoretical model of communal coping (TMCC), the authors identified three convergent stressors (i.e., isolation, uncertainty, conflict) and several coping strategies related to participants' stressor appraisal (i.e., individual or joint) and action orientation (i.e., individual or joint). Based on these findings, this study offers the novel theoretical concept of Discursive coping and proposes a model for how this perspective might be integrated with current theorizing about individual and communal coping. Implications for communal coping and discursive theory are discussed as well as practical recommendations for public health messaging. [ABSTRACT FROM AUTHOR]

Objective: Indigenous Australians are nearly three times more likely to have diabetes than non‐Indigenous Australians. The prevalence of diabetes‐related vision impairment for Indigenous Australians is 5.5% compared to 1.5% for non‐Indigenous Australians, and treatment rates are lower for Indigenous Australians. Despite this situation, there is limited evidence on effective service delivery models for diabetic retinopathy care and treatment. This study seeks to identify best‐practice features of diabetic retinopathy care that could be used to inform current and future service delivery models for Indigenous Australians with diabetic retinopathy. Setting: All states, territories and geographic remoteness categories in Australia. Participants: Eight ophthalmologists engaged in providing eye healthcare to Indigenous Australians. Design: Semi‐structured interviews were conducted. The Framework Approach was used to conduct a thematic analysis of the interviews to facilitate identification of key themes and issues that emerged from these discussions. Results: Seven best‐practice features for service delivery of diabetic retinopathy treatment for Indigenous Australians were identified. These were: cultural safety, affordability and accessibility, partnerships with key stakeholders, timeliness, integration with primary care, clarity of guidelines, and clinician attitude and motivation. Conclusion: The findings from this study identified seven best‐practice features for diabetic retinopathy treatment. These have the potential to inform and influence how care is delivered to Indigenous Australians. Although further research is warranted to capture other service provider inputs and Indigenous end‐user perspectives, these features in the meantime can begin to inform the decisions of the Indigenous eyecare sector on policy reforms and best‐practice diabetic retinopathy treatment approaches. [ABSTRACT FROM AUTHOR]

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In times of shrinking resources and fragmented societies, partnership is a value-driven social structure that should be theorized in order to be considered for implementation, effectively and sustainably. Recognizing the scarce theoretical perspectives on partnership, this article addresses the lack of an integrated universal model. It delineates the theoretical field through extensive literature review, reaffirming the critical gap in knowledge. Original qualitative research utilized an international case-study of a social partnership, and a historic investigation since its inception three decades ago. A Grounded Theory Methodology guided the systemic analysis of the empirical data, culminating in a proposed universal partnership model. The study finds mutuality to be the heart of a partnership and a differentiating criterion from other social structures. Three pillars that are grounded in mutuality sustain a partnership, and include a common ground, connection, and commitment. Further research is needed to test the proposed model on other diverse partnerships. [ABSTRACT FROM AUTHOR]

Treatment burden contributes to suboptimal adherence and lower health-related quality of life among people diagnosed with chronic conditions, but little is known about how the psychological process of emotional dysregulation influences treatment burden. To explore this relationship, we conducted a descriptive, cross-sectional study comprised of 149 men and women diagnosed with one or more Centers for Medicare and Medicaid Systems defined chronic conditions recruited from a single primary care setting. Multivariate analyses demonstrated emotional dysregulation as an independent factor contributing to total (p <.001), medication (p =.007), and dietary (p <.001) treatment burden, with model effect sizes ranging from large (.43) to moderate (.21), controlling for other known antecedent factors of treatment burden. Emotional dysregulation was not a factor contributing to exercise related treatment burden. Our findings indicated emotional dysregulation as an important factor contributing to higher levels of total, medication, and dietary treatment burden associated with daily self-management regimens. [ABSTRACT FROM AUTHOR]

Objective. This study expects to investigate and verify the intervention effect of the university's innovative teaching management model on college students' resilience by implementing the university's innovative teaching management model for college students with low psychological resilience. Method. The scientific scale is used to investigate the current level of college students' psychological resilience, and the development characteristics of college students' psychological resilience are obtained through statistical analysis. Based on the theoretical analysis of the application of psychological resilience intervention, combined with the theory of one-to-one tutoring and operational techniques, the university's innovative teaching management mode scheme is designed. The design adopts a quasi-experimental pre-experimental test to investigate and explore the intervention effect system of the university's innovative teaching management mode on college students' psychological resilience. In the intervention, each unit of activity is carried out in strict accordance with the established plan, and records and reflections are made at the end. One-to-one and face-to-face qualitative interviews were conducted with the subjects, and qualitative data were collected for qualitative analysis. Results/Discussion. Compared with the control group that did not receive the intervention, the psychological resilience of the subjects in the experimental group was significantly improved after receiving the intervention of the university's innovative teaching management model. The university's innovative teaching management model has a good intervention effect on the resilience of college students. The university's innovative teaching management model scheme compiled in this study integrates a variety of psychotherapy methods and combines one-to-one psychological counseling frameworks and techniques. It is an effective and easy-to-implement intervention scheme for college students' psychological resilience intervention. [ABSTRACT FROM AUTHOR]

Dating violence is a public health problem affecting people worldwide. This study evaluated the occurrence of different types of adolescent dating violence using a mixed analysis of each data source. The present study addresses the following research questions: does the occurrence of the types of violence analyzed in the quantitative phase match with the narratives obtained in the qualitative phase? and does the additional information obtained in the qualitative phase improve the understanding of the analyzed phenomenon? In the quantitative phase, 410 participants (aged 13 to 19 years) answered a questionnaire based on the Modified Conflict Tactics Scale, while in the qualitative phase, 26 participated in two focus groups. Data were collected from May to June 2019. Written informed consent was obtained from the parents or legal guardians of those who had agreed to participate. The present research was approved by the Human Research Ethics Committee of the Pontifical Catholic University of Ecuador. The results were divided on: prevalence of dating violence based on age groups and gender, management and resolution of dating conflicts, victimization and perpetration of intimate partner violence, factors favoring intimate partner violence and acceptance of abuse. The results were analyzed via triangulation and indicated thatadolescents were involved in the perpetration and victimization of psychological as well as mild and severe physical violence. An analysis of the contributing factors revealed a strong tendency toward the acceptance of the traditional gender model. Challenging these models is crucial to deconstruct hierarchical models, develop conflict resolution skills, and promptly identify abusive behaviors that affect emotional development. The combination of different methodological approaches improved the understanding of the phenomenon studied. [ABSTRACT FROM AUTHOR]

Background: Rates of participation in HIV care, medication uptake, and viral suppression are improving among persons living with HIV (PLWH) in the United States. Yet, disparities among African American/Black and Latino PLWH are persistent, signaling the need for new conceptual approaches. To address gaps in services and research (e.g., insufficient attention to structural/systemic factors, inadequate harm reduction services and autonomy support) and improve behavioral interventions, we integrated critical race theory, harm reduction, and self-determination theory into a new conceptual model, then used the model to develop a set of six intervention components which were tested in a larger study. The present qualitative study explores participants' perspectives on the study's acceptability, feasibility, and impact, and the conceptual model's contribution to these experiences. Methods: Participants in the larger study were African American/Black and Latino PLWH poorly engaged in HIV care and with non-suppressed HIV viral load in New York City (N = 512). We randomly selected N = 46 for in-depth semi-structured interviews on their experiences with and perspectives on the study. Interviews were audio-recorded and professionally transcribed verbatim, and data were analyzed using directed qualitative content analysis. Results: On average, participants were 49 years old (SD = 9) and had lived with HIV for 19 years (SD = 7). Most were male (78%) and African American/Black (76%). All had taken HIV medication previously. Challenging life contexts were the norm, including poverty, poor quality/unstable housing, trauma histories exacerbated by current trauma, health comorbidities, and substance use. Participants found the study highly acceptable. We organized results into four themes focused on participants' experiences of: 1) being understood as a whole person and in their structural/systemic context; 2) trustworthiness and trust; 3) opportunities for self-reflection; and 4) support of personal autonomy. The salience of nonjudgment was prominent in each theme. Themes reflected grounding in the conceptual model. Participants reported these characteristics were lacking in HIV care settings. Conclusions: The new conceptual model emphasizes the salience of systemic/structural and social factors that drive health behavior and the resultant interventions foster trust, self-reflection, engagement, and behavior change. The model has potential to enhance intervention acceptability, feasibility, and effectiveness with African American/Black and Latino PLWH. [ABSTRACT FROM AUTHOR]

The purpose of this study was to validate an original and innovative survey focused on both teens' personal beliefs and how they perceived their peers' beliefs regarding relationship abuse with four research questions: What are the measured constructs in this survey? Is the hypothesized factor structure of the five types of relationship abuse confirmed? Does the validity of constructs vary among racial/ethnic groups and genders? Are there differences between teens' own beliefs on relationship abuse and their perceptions of peers' beliefs? To address these questions, two confirmatory factor analysis (CFA) models were examined with 591 high school students' responses. The first CFA model was created based on the exploratory factor analysis results and the second CFA model was created based on the theoretically hypothesized model of five types of relationship abuse. The results indicate that the 5-factor, 11-item model based on the theoretical hypothesis is the best fit to the data. The multiple group model analysis demonstrated that the identified CFA measurement model was invariant across different gender and racial/ethnic groups. The validated instrument of Teen Beliefs on Relationship Abuse Measure is a reliable and valid way to measure both teens' personal beliefs and their perceptions of peers' beliefs on five types of relationship abuse including emotional, physical, sexual, stalking, and digital abuses. With the validated model, t-test results indicate that teens' own beliefs are significantly more positive than their perceptions of their peers' beliefs for all the five factors. The measure is useful for researchers, educators, and parents to measure and understand teen perceptions of themselves and their peers on different types of relationship abuses to better support them develop healthy, respectful, and nonviolent relationships. [ABSTRACT FROM AUTHOR]

Stigma remains a pervasive barrier to Ending the HIV Epidemic (EHE) in New York City (NYC). As part of an EHE implementation science planning process, we mapped multi-level HIV-related stigma-reduction activities, assessed their evidence base, and characterized barriers and facilitators. We interviewed and surveyed a convenience sample of 27 HIV prevention and/or treatment services organizations in NYC, March-August, 2020, using an embedded mixed-methods design. The greatest facilitators of stigma reduction included integration of health services, hiring staff who represent the community, and trainings. Intersecting stigmas were primarily addressed through the integration of HIV with mental health and substance use services. Barriers were multilevel, with organizational structure and capacity most challenging. A strong base of stigma-reduction activities was utilized by organizations, but intersectional frameworks and formal evaluation of activities' impact on stigma were lacking. Effectiveness-implementation hybrid research designs are needed to evaluate and increase the uptake of effective stigma-reduction approaches in NYC. [ABSTRACT FROM AUTHOR]

Background: Moving to a residential aged care facility involves living far from family and a familiar environment, and leaving behind the social support system of relatives, friends, and society. The pressure to find and develop new and meaningful connections in a residential aged care facility can be significant for older adults. Objective: To provide a theoretical explanation of how older adults seek and maintain connections in a residential aged care facility. Methods: A grounded theory study was conducted. A total of 17 residents were recruited from two Nepalese residential aged care facilities using theoretical sampling. Face to face in‐depth, semi‐structured interviews and observation within interviews were conducted. Data analysis included the process of open, axial, selective coding, and constant comparative analysis as per Corbin and Strauss' variant of grounded theory. Results: This study identified that the process of seeking connections in a residential aged care facility was forward‐moving, and involved "identifying sources," "developing connections," and "appraising responses." By seeking connections, residents built new connections. Similarly, the study found that maintaining connections was a continuous process of "sustaining connections with co‐residents," "preserving connections with nurses/caregivers," and "continuing connections with inner‐self and higher being/s." Maintaining connections led residents to balance shifting connections. Furthermore, it was found that the process of seeking and maintaining connections was conditional on facility arrangement i.e. the way residents were placed, rules, regulations, co‐residents' language, gender, religious affiliation, attitudes, the attitudes and practices of nurses/caregivers, decreasing physical abilities of residents, increasing illness of residents, illness or death of co‐residents, and retirement or resignation of nurses/caregivers. Conclusion: The current study provides unique insights into the process of seeking and maintaining connections in a residential aged care facility. Facility arrangement, rules, regulations, and caregiving practices should resonate with residents' socio‐cultural expectations and spiritual belief system to support their process of seeking and maintaining connections. Implications for practice: The findings can be beneficial for managers, nurses, caregivers, and spiritual advisors in developing interventions that promote the development of meaningful connections in a residential aged care facility. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to investigate the causal effects of automatic negative thought on craving mediating by cognitive emotional regulation. Method: This study had a descriptive and correlational design. The study population consisted of methadone maintained clients of the Iranian National Center for Addiction Studies, Tehran City (n=78) and Mehr-Aein clinic in Rey city (n=42) who referred to treatment centers during February to April 2019. Data were collected through convenient sampling using craving questionnaires including Francken's Obsessive-compulsive Drug Use Scale and Visual Analog Scale. Other study questionnaires were Cognitive Emotional Regulation Questionnaire and Automatic Negative Thought Scale. For data analysis, we used multivariate linear regression using the structural equation modeling and path analysis using STATA software. Results: Findings revealed that there are significant correlations between automatic negative thoughts, cognitive emotional regulation and craving (P<0.001). Also, the results of hierarchical regression analysis indicate that cognitive emotional regulation can mediate the relationship between automatic negative thoughts and craving (P< 0.001). Conclusion: According to the results of this study, it can be concluded that clients who have higher levels of automatic negative thoughts and higher negative strategies of cognitive emotional regulation, experience a higher level of craving. Thus, identifying the level of negative thoughts and cognitive emotion regulation strategies of methadone-treated clients can predict the severity of craving and their leave or retention of the treatment. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe the current situation and analyse influencing factors of resource utilisation in maintenance haemodialysis patients. Background: The self‐management level of patients undergoing maintenance haemodialysis in China is low. The applicability of the Chronic Illness Resources Survey in Chinese maintenance haemodialysis patients has been validated, and this survey can be used to assess the utilisation of self‐management support resources among haemodialysis patients. Determining the influencing factors of resource utilisation can help improve the self‐management behaviour of haemodialysis patients and control the progression of the disease. Design: A descriptive study design was chosen. Methods: A convenience sample of 314 patients undergoing haemodialysis was recruited from dialysis centres in three hospitals in western Xinjiang from June 2018–April 2019. SPSS19.0 software was used to describe the current situation of resource utilisation. Moreover, t test, analysis of variance and multivariate linear regression were applied to explore the influencing factors of patients' resource utilisation. Standards for observational studies STROBE Statement checklist‐v4 were chosen on reporting the study process. Results: The average score of the total resource utilisation was 2.95 ± 0.51. The average item score of seven dimensions from high to low was 3.46 for medical staff, 3.32 for personal, 3.22 for family and friends, 3.16 for work‐related, 3.12 for media policy, 2.55 for neighbourhood/community and 2.23 for organisation. Multiple linear regression showed that there have six main factors, which explained 65.4% of the variance of haemodialysis patients' resource utilisation. Conclusions: The personal, family and friends, work and media and policy subscales were rated the highest, with support from neighbourhood/community and organisation rated the lowest. In general, participants perceived moderate levels of support. Government and healthcare team should pay more attention on haemodialysis patients who had low level of education, poor economic conditions and poor mental condition. Relevance to clinical practice: ESRD has caused a burden on healthcare expenditure and has become a critical public health problem worldwide. Self‐management is particularly important for dialysis patients which have attracted extensive interest. In the future research, we can use this questionnaire to evaluate the related resources of disease management of dialysis patients, encourage patients to make full use of the resources around them and focus on those patients with low education and monthly income level and bad mental state. [ABSTRACT FROM AUTHOR]

Introduction: Medical tourism is developing more rapidly, particularly in developing countries, as a tool to enhance economic growth and achieve a competitive position. The present study aims to investigate and identify contributory factors to the competitiveness of Iran’s medical tourism using importance-performance analysis. Methods: This is an applied study with a descriptive nature conducted using field studies and surveys. A conceptual model was adopted and contributory factors were extracted from previous studies. A questionnaire was designed based on extracted factors and opinions of experts who are specialists in the field of medical tourism. The statistical population consisted of tourism experts, health experts, physicians, and medical staff working in hospitals with international units. Data analysis was performed using SPSS. Results: The results showed that “medical services” were more important than the two components “special factors of tourism” and “characteristics of medical tourism destinations”. It was also revealed that the current situation of “medical tourism destination characteristics” is unfavorable compared to the other two components. Conclusion: This study provided an insight into the importance and quality of performance of the factors affecting the competitiveness of medical tourism, which can be beneficial for managers and planners in Iran and other medical tourism destinations. [ABSTRACT FROM AUTHOR]

In this study, the constructive communication process of anti-vaccination advocates is explored to provide insight into the challenges of communicating with an engaged, educated public that is distrustful of mainstream medical and governmental organizations. Using the circuit of culture as a theoretical and methodological model, this article examines how anti-vaccination advocates use social media to construct and reinforce a belief system that counters dominate understandings of health. Findings show that, through online communication, anti-vaccination advocates create shared cultural constructs embracing the identity of health information crusader, critic, and expert. This community consumes, produces, and distributes information that reframes mainstream health information and reinforces shared values. The purposes of this study are to better understand the culture of anti-vaccination advocates, identify communication barriers, and offer practical implications for health care professionals. [ABSTRACT FROM AUTHOR]

Parents' experiences of family health conversations after having a child in need of neonatal intensive care Background: When a newborn child requires neonatal intensive care, it is often the beginning of a journey of stress and worry for the parents. Such situations could cause difficulties in problem-solving and communication within the family and result in decreased family functioning. Studies have shown that nurse-led interventions in the form of Family Health Conversations promote family's well-being and functioning and strengthen their relationships. However, this model has not previous been used and evaluated with families who have a child in need of neonatal intensive care. Aim: To describe parents' experiences of participating in Family Health Conversations after having a child in need of neonatal intensive care. Method: Family interviews were conducted with 12 families from three neonatal intensive care units in southern Sweden, six months after a Family Health Conversations intervention. Data were analysed using qualitative content analysis. Findings: The parents experienced the Family Health Conversations as an opportunity to co-create a comprehensive picture of what had happened after their child was born. Parents shared their experiences of the Family Health Conversations in terms of feeling validated and strengthened as individuals, as a couple, and as a family. They found the conversations to be supportive to their well-being and to processing experiences and becoming equipped for the future. The parents reported that it was valuable to talk with conversational leaders who had knowledge in neonatal care and who thereby understood what the parents were talking about. This provided a different type of support compared with other conversational contacts. Conclusion: These results highlight the importance of having an early onset of family conversations in order to help the parents to cope with their challenges and improve their well-being. [ABSTRACT FROM AUTHOR]

BACKGROUND: Evidence continues to build on the value of Individual Placement and Support (IPS), enabling those with long-term mental health conditions to find mainstream employment. Many of these individuals would like to work; however, unemployment for this population remains high. IPS research thus far has targeted the effectiveness of the model, with less emphasis on how individuals perceive and experience IPS and the return to work. OBJECTIVE: This study explores the barriers, enablers, meaning and personal experience of being supported to find work through IPS, for individuals with long-term mental health conditions. Findings based on lived experiences of nine participants from two Scottish centres running IPS, should be useful to enhance and develop services. METHODS: This study involves qualitative data collection, using semi-structured interviews and Interpretative Phenomenological Analysis (IPA). RESULTS: Transcript analysis revealed three master themes: 1) "Working is good for me": positive aspects to working; 2) "Rome wasn't built in a day": time-unlimited supported journey and 3) "My inner critic": negative aspects to working. Participants praised IPS for the on-going practical and emotional support in overcoming self-identified occupational barriers. CONCLUSION: Paid employment was greatly associated with financial freedom, social inclusion, increased self-esteem and alleviation of depressive symptoms. Participants described the person-centred, time-unlimited approach taken by the employment specialists (ESs) or occupational therapists (OTs), as the main enabler to maintaining paid employment. Barriers, such as anxiety and work-related stress were identified, however, participants felt supported to overcome some of these negative symptoms. [ABSTRACT FROM AUTHOR]

Background: Developing a chronic disease, like heart failure in older adults disrupts the foundations of the family and imposes a heavy burden on family members. The aim of this study was to determine the effect of the Family-Centered Empowerment Model (FCEM) on the care burden of family caregivers of older adults with heart failure. Methods: It was a quasi-experimental study with a controlled before and after design, which was conducted on 80 primary caregivers of older adults with heart failure referring to health centers affiliated with Kashan University of Medical Sciences, Kashan, Iran. The subjects were nonrandomly assigned to either the control (n=40) or intervention (n=40) groups. The program was implemented based on the concepts of the model (perceived threat, self-efficacy, self-esteem, and evaluation) in eight 2-hour sessions, twice a week for four consecutive weeks. Both groups answered the Zarit Burden Interview (ZBI) in the beginning, in the end, and one month after the study. The data were analyzed by Chi-square, t-test, and the repeated measures ANOVA using SPSS v. 16 software. Results: There was no significant difference between the two groups regarding the pretest mean score of care burden (P>0.05). However, the groups' mean score of care burden was significantly different immediately after the intervention (P<0.05) and one month after the study (P<0.05). The repeated measures ANOVA illustrated a significant difference between the mean scores of care burden in the three measurement time points (P<0.0001). Conclusion: Implementation of the FCEM model reduces the burden of care in caregivers of older adults with heart failure. It is suggested that this model be used in training programs for older adults with heart failure and their caregivers. [ABSTRACT FROM AUTHOR]