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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]

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]