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

Background: Considerable evidence suggests that students' achievement emotions are important contributors to their learning and success online. It is, therefore, essential to understand and support students' emotional experiences to enhance online education, especially under the COVID‐19 context. However, to date, very few studies have investigated how students' achievement emotions might be affected by teaching and learning factors in online learning environments. Objectives: Based on Pekrun's (2006) control‐value theory of achievement emotions, this study examined the influence of students' perceived online teaching quality and appraisals of control and value on their achievement emotions in an online second language (L2) learning context instigated by the COVID‐19. Methods: Data were collected using an online survey of 1503 undergraduates from ten universities across different regions of China. Confirmatory factor analyses (CFA) were performed to test the validity of the instruments and structural equation modelling were conducted to examine the relations between L2 teaching and learning variables. Results and Conclusions: Results revealed that perceived teacher internet and communication technology competence had positive effects on enjoyment, but negative effects on anxiety and boredom, and these effects were fully mediated by perceived control and/or value. Perceived chaotic teaching structure (CTS) had reverse effects for the three emotions. Perceived CTS effects on enjoyment and anxiety were fully and partially mediated by perceived control, respectively. Takeaways: Online teaching quality is critical for students' appraisals and emotions towards L2 learning. Teachers should strive to improve online teaching quality and design interventions targeting students' perceived control and value to temper their affective experiences associated with the crisis‐prompted online teaching practices. Lay Description: What is already known about this topic: Teachers' internet and communication technology (ICT) competence and pedagogical design can enhance students' e‐learning efficacy, motivation and interests.Students' perceived control and value can influence their achievement emotions in online learning.Teacher's ICT competence and pedagogical design can impact students' emotions in online learning. What this paper adds: Perceived teacher ICT competence and chaotic teaching structures can have differential impact on students' perceived control and value for e‐learning.Perceived control and intrinsic value differently mediated the effects of the two teaching factors on students' emotions for e‐learning.Perceived teacher ICT competence and chaotic teaching structures can have both direct and indirect effects on students' e‐learning emotions via perceived control and value. Implications for practice and/or policy: Teacher training and development programs should prepare teachers for varying teaching formats including unplanned online teaching due to a forced switch to remote teaching.Teachers should acquaint themselves with using various online platforms and software to communicate the goals, expectations, structures and requirements of their language lessons to students' in a clear manner.Online language teaching interventions aiming to increase or decrease a specific emotion could directly target specific combinations of teaching characteristics and appraisals. [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]

Background: People with early-stage dementia could benefit greatly from on-going spiritual support. However, health care professionals working in dementia care often do not have a clear idea of what such support might entail. There is a lack of tools that can help professionals provide such support. The Diamond conversation model used in palliative care could provide such a support. Aims: To develop the Diamond model for early-stage dementia so that professionals can provide better spiritual support. Methods: Participatory research was conducted. Reflective interviews with chaplains, case managers and health psychologists identified frequently occurring existential and spiritual issues of clients and family members. A core participatory group consisting of chaplains, a psychologist and a researcher further analysed these issues thematically and co-developed the Diamond model for early stage dementia over three co-creation sessions. Researchers with Diamond model expertise provided feedback to the core participatory group in between these sessions based on the session output. Findings: Central existential and spiritual issues were found to be: self-confidence and –worth, adaptability and capacity, security and loss, burden and enrichment of memory and faith and meaning. The five polarities of the Diamond model were found helpful to understand tensions surrounding these issues. Specific tensions were identified between maintaining a self and being valued, finding direction in what to do and a way to bear changes in ability, a strong need for attachment and letting go of past ways to relate to one another, the renewed intensity of long term memories and decline of the short term ones and surrendering to one's life situation and wanting certainty and meaning. Conclusions: The newly developed Diamond model for people with early-stage dementia offers a valuable framework to help professionals provide conversational support. More research needs to be done to further test and develop the model in practice. [ABSTRACT FROM AUTHOR]

With the rising popularity of SNS games, virtual goods are expected to generate revenue for game providers. However, previous findings may be at odds with changes in this new virtual environment, while some social platforms lack understanding of what motivates users to purchase virtual goods in SNS games either. Considering the social nature of SNS games, this study adopted the self-presentation theory to explore these factors. A conceptual model was proposed and subsequently empirically tested with 302 samples collected from the questionnaire survey. The results show that the desire for online self-presentation is significantly influenced by SNS games involvement, online self-presentation norms, interactivity, and perceived usability. The results also indicate that the effect of the desire for online self-presentation on intention to purchase virtual goods is significant. In addition, the moderated role of perceived usability on the relationship between interactivity and the desire for online self-presentation is established as well. Our findings contribute to the literature on SNS games as well as self-presentation. It also lends insights into how SNS providers can tap this source of revenue. [ABSTRACT FROM AUTHOR]