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Objectives: Few evidence-based psychosocial programs exist within craniofacial care. This study (a) assessed feasibility and acceptability of the Promoting Resilience in Stress Management-Parent (PRISM-P) intervention among caregivers of children with craniofacial conditions and (b) described barriers and facilitators of caregiver resilience to inform program adaptation. Design: In this single-arm cohort study, participants completed a baseline demographic questionnaire, the PRISM-P program, and an exit interview. Participants: Eligible individuals were English-speaking legal guardians of a child <12-years-old with a craniofacial condition. Intervention: PRISM-P included 4 modules (stress-management, goal-setting, cognitive-restructuring, meaning-making) delivered in 2 one-on-one phone or videoconference sessions 1–2 weeks apart. Main Outcome Measures: Feasibility was defined as >70% program completion among enrolled participants; acceptability was defined as >70% willingness to recommend PRISM-P. Intervention feedback and caregiver-perceived barriers and facilitators of resilience were summarized qualitatively. Results: Twenty caregivers were approached and 12 (60%) enrolled. The majority were mothers (67%) of a child <1-year-old diagnosed with a cleft lip and/or palate (83%) or craniofacial microsomia (17%). Of these, 8 (67%) completed PRISM-P and 7 (58%) completed interviews; 4 (33%) were lost-to-follow-up before PRISM-P and 1 (8%) before the interview. Feedback was highly positive, with 100% willing to recommend PRISM-P. Perceived barriers to resilience included uncertainty about their child's health; facilitators included social support, parental identity, knowledge, and control. Conclusions: PRISM-P was acceptable among caregivers of children with craniofacial conditions but not feasible based on program completion rates. Barriers and facilitators of resilience support the appropriateness of PRISM-P for this population and inform adaptation. [ABSTRACT FROM AUTHOR]

Objective: The Integrative Health and Wellness Clinic (IHWC), established in 2019 at the San Francisco VA Health Care System, is an interdisciplinary clinic consisting of a medical provider, dietician, physical therapist, and psychologist trained in complementary and integrative health (CIH) following the VA Whole Health model of care. Veterans with complex chronic conditions seeking CIH and nonpharmacologic approaches are referred to the IHWC. This study evaluated the clinic's acceptability and feasibility among veteran patients and its preliminary impact on health and wellbeing, health-related goals, and use of CIH approaches. Methods: Mixed methods were used to assess patient-reported outcomes and experiences with the IHWC. Participants completed surveys administered at baseline and 6-months and a subset completed a qualitative interview. Pre- and post-scores were compared using t-tests and chi-square tests. Results: Thirty-five veterans completed baseline and 6-month follow up surveys. Of these, 13% were women; 24% < 50 years of age, and 44% identified as racial/ethnic minorities. Compared to baseline, at 6 months, there were significant (P <.05) improvements in overall health, physical health, perceived stress, and perceived helpfulness of clinicians in assisting with goal attainment; there was a trend toward improved mental health (P =.057). Interviews (n = 25) indicated satisfaction with the interdisciplinary clinical model, support of IHWC providers in goal attainment, and positive impact on physical and mental health. Areas for improvement included logistics related to scheduling of multiple IHWC providers and referrals to other CIH services. Conclusion: Results revealed significant improvement in important clinical domains and satisfaction with interprofessional IHWC clinic providers, but also opportunities to improve clinic processes and care coordination. An interdisciplinary clinic focused on CIH and Whole Health is a feasible and acceptable model of care for veterans with complex chronic health conditions in the VA healthcare system. [ABSTRACT FROM AUTHOR]

In this article, we describe the exploration of the content and quality of annual goals included in the Individualized Education Programs (IEPs) of students with disabilities in one rural U.S. school district. We utilized content analysis to understand the district's service delivery model comprehensively. Findings revealed disparities between inclusive placements and special education service delivery, suggesting that, despite high rates of inclusive placements noted on IEPs, most services occurred outside general education classrooms, especially for students with intellectual and developmental disabilities (IDD). We evaluated the quality and rigor of 546 annual goals using a rubric adapted from Kurth et al. Only 37.7% of goals were rated as rigorous, highlighting a need for clearer, more specific, and applicable goals. Notably, communication goals for students with IDD were largely absent, raising concerns about support for meaningful participation in general education settings. In addition, special factors related to communication and assistive technology were not consistently addressed in IEPs. We discuss implications for improving educational experiences for students who qualify for special education services under IDD in rural schools and highlight the value of further research and actions in this area. [ABSTRACT FROM AUTHOR]

The use of telehealth, specifically virtual visits, has increased and adoption continues. Providers need effective training for how to communicate with patients to develop a connection during virtual visits. This article describes the implementation and evaluation of a course called Mastering Presence in Virtual Visits. Results show that although providers perceive lack of time, technology issues, and lacking experiential knowledge as barriers to enacting course behaviors, the course was feasible and acceptable. Following the course, providers rated key course behaviors as helpful for practice, and 80.7% of providers were likely to recommend the course to a colleague. The course shifted provider perceptions of the purpose, patient experience, and procedures in virtual visits. Prior to the course, providers perceived virtual visits as fundamentally different than in-person visits. However, after the course, they recognized the importance of connection in virtual visits and how to foster that connection. Providers continue to require support in conducting high-quality virtual visits. Online, asynchronous courses, developed in partnership with providers, are feasible and effective for encouraging behavior change. Key findings: When asked on a needs assessment in 2020, communication strategies to connect with patients in virtual visits were a top provider need. Partnering with providers to create online, communication training content is effective for increasing the acceptability of courses about virtual visits. Asynchronous, online courses can meet provider needs for communication strategies to connect with patients in virtual visits. [ABSTRACT FROM AUTHOR]

Objective: To explore healthcare professionals' experiences of the development and delivery of Early Supported Discharge for people after stroke, including experiences of the COVID-19 pandemic. Design: Qualitative descriptive study using one-to-one semi-structured interviews. Data were analysed using reflexive thematic analysis. Setting: Nine Early Supported Discharge service sites in Ireland. Participants: Purposive sampling identified 16 healthcare professionals. Results: Five key themes were identified (1) Un-coordinated development of services, (2) Staff shortages limit the potential of Early Supported Discharge, (3) Limited utilisation of telerehabilitation post COVID-19 pandemic, (4) Families need information and support, and (5) Early Supported Discharge involves collaboration with people after stroke and their families. Conclusions: Findings highlight how Early Supported Discharge services adapted during the COVID-19 pandemic and how gaps in the service impacts on service delivery. Practice implications include the need to address staff recruitment and retention issues to prevent service shortages and ensure consistent access to psychology services. Early Supported Discharge services should continue to work closely with families and address their information and support needs. Future research on how telerehabilitation can optimally be deployed and the impact of therapy assistants in Early Supported Discharge is needed. [ABSTRACT FROM AUTHOR]

Mortality salience refers to a state of conscious awareness of death and the inevitable conclusion of life, associated with psychological terror. The COVID-19 pandemic generated increased awareness of illness and death, and effectuated changes in death cognitions and people's experiences around psychological or sociocognitive domains of media and life goals. To understand these changes, this study administered the Multidimensional Mortality Awareness Measure (Levasseur et al., 2015) to 103 emerging adults in India, post which 6 participants proceeded for a semi-structured interview exploring pandemic experiences, news consumption and goal prioritization, to examine specific areas in relation to death cognition. The thematic analysis demonstrates psychological effects, and discusses developments in health and death-related psychological processes. Focus on career goals and health maintenance, cautious news consumption and disadvantageous impacts on mental health are seen, significant in navigating healthcare measures for emerging adults, as we move forward into this 'new normal'. [ABSTRACT FROM AUTHOR]

Team collaboration is an essential component of augmentative and alternative communication (AAC) services that directly impacts outcomes for students in special schools. Given the central role of the Special Education Teacher (SET) in the AAC team, there is a need to explore and understand SETs' perceptions to support effective team collaboration. This study explored the perceptions of SETs on team working and collaboration in AAC service delivery in Ireland during a period of significant systemic change. A qualitative interview approach was utilised to explore the perceptions of five SETs working with students who use AAC in special education settings in Ireland. The dataset was analysed through the process of reflexive thematic analysis and identified four themes. Participants valued team collaboration but perceived it as inconsistent or non-existent in current practice. The impact of recent service changes on collaboration was highlighted, with all participants recognising a need for enhanced collaboration. Facilitators to collaboration identified included child centredness, shared goals, role clarity, sharing of knowledge and resources, and effective working relationships. [ABSTRACT FROM AUTHOR]

Young adults (YAs), defined as individuals between the ages of 18 and 39 years, experience unique challenges when diagnosed with advanced cancer. Using the social constructivist grounded theory approach, we aimed to develop a theoretical understanding of how YAs live day to day with their diagnosis. A sample of 25 YAs (aged 22–39 years) with advanced cancer from across Canada participated in semi-structured interviews. Findings illustrate that the YAs described day-to-day life as an oscillating experience swinging between two opposing disease outcomes: (1) hoping for a cure and (2) facing the possibility of premature death. Oscillating between these potential outcomes was characterized as living in a liminal space wherein participants were unsure how to live from one day to the next. The participants oscillated at various rates, with different factors influencing the rate of oscillation, including inconsistent and poor messaging from their oncologists or treatment team, progression or regression of their cancer, and changes in their physical functioning and mental health. These findings provide a theoretical framework for designing interventions to help YAs adapt to their circumstance. [ABSTRACT FROM AUTHOR]

The production of data and numbers has become the key mechanism of both knowing and governing global public policy. And yet, processes of quantification are inherently paradoxical: from expectations of technocratic rationality and political usability of producing 'global' numbers that count for 'local' politics and needs to practical limitation of measurement and the necessity to work with 'good enough' data. This begs a question – how do these competing epistemic, political and value orders manifest themselves through the work that experts do? In this article, we explore the problem by focussing on reflexivity as a way for experts (primarily those working in key International Organisations) to make sense of and tame the tensions inherent in their work. Through rich qualitative exploration of over 80 semi-structured interviews with experts working in the areas of poverty, education and statistical capacity development, we contribute to debates in the social studies of quantification by arguing that reflexivity is not just a mental process that experts engage in but rather an important resource allowing them to make sense of the contradictions inherent in their work and to mobilise political and ethical considerations in the technocratic process of producing numbers. We identify three types of reflexivity: (1) epistemic reflexivity – regarding the quality of data and its epistemic status as reflecting the reality; (2) care-ful reflexivity – regarding values embedded in data and the duty of care to the populations affected by the measurement and (3) instrumental reflexivity – regarding political rationality and necessary trade-off required to realise political goals. Overall, the article argues that reflexivity becomes an increasingly central expert practice, allowing the transformation of the process of quantification into one of qualification enabling them to attach political attributes and values to data and measurement. [ABSTRACT FROM AUTHOR]

Purpose: This pre-pilot randomized controlled trial (RCT) assessed a mindfulness-based intervention (MBI, "REMIND1.0") during the COVID-19 pandemic. Methods: Twenty mental health service users were allocated to either 8 weekly mixed-mode MBI (n = 10) or treatment-as-usual (TAU) (n = 10). Results: There were significant interactions between group and time (baseline T0, post-intervention T1, and 1-month follow-up T2) across all quantitative outcomes (personal recovery, trait mindfulness, self-compassion, resilience, moods, quality of life, and general health). The main themes that emerged from qualitative interviews at T1 are previous experience with MBIs, features of current MBI, and benefits of personal recovery and at T2 are recollection of MBI content, maintaining regular practice after MBI, and retained benefits of personal recovery. Conclusions: The current MBI is acceptable, feasible, and potentially effective in facilitating personal recovery. [ABSTRACT FROM AUTHOR]

Addressing the challenging behavior of students requires evidence-based interventions that can be implemented in school settings; however, there is a relative lack of literature investigating effective strategies for high school students in secondary settings. Behavior contracts have been used to address challenging behavior in elementary and middle settings but less so in high school settings. Furthermore, the extent to which they have involved student input at the high school level has been unclear despite research indicating that collaborative intervention development processes may be associated with several additional benefits beyond effectiveness. Despite these empirical shortcomings, behavior contracts may be well suited to address individual high school students' challenging behavior given their flexibility, collaborative nature, and use of goal setting and clearly stated contingencies (i.e., rules) to promote behavior change. Thus, the purpose of this study was to evaluate the acceptability and effectiveness of a structured interview-informed behavior contract intervention to address the disruptive behavior of high school students. Specifically, we used a multiple baseline design across three students and found that the interview-informed behavior contracts were effective in increasing their academically engaged behavior (Tau =.62) and decreasing disruptive and passive off-task behavior. Limitations and future directions are discussed. [ABSTRACT FROM AUTHOR]

This study investigated the disclosure goals, disclosure-facilitating resources, and overall disclosure trajectory of 16 women who participated in the 2016 #notokay antisexual violence campaign. Findings indicate that most participants' disclosure goals were approach focused. Factors that facilitated disclosure were social media affordances and psychological, professional, and financial resources. Participants' overall disclosure trajectory was upward, but not linear, and disclosure outcomes included self-growth and awareness of the intersectional nature of violence. The findings suggest that the disclosure processes model can be strengthened by considering goal-relevant resources as a structural or environmental factor that influences the choice of approach versus avoidance goals, and consequently, beneficial or harmful disclosure outcomes. Further, by investigating how participants' #notokay disclosure was situated in their other online and offline disclosure episodes, this study provides a contextualized perspective of online hashtagged disclosures of sexual violence. [ABSTRACT FROM AUTHOR]

Background: Family members can support advance care planning conversations. However, how family involvement in advance care planning operates to achieve goal-concordant care remains unclear. Aim: To explore how family involvement impacts the process of advance care planning for advanced cancer patients and their family members to achieve goal-concordant care in Japan. Design: Qualitative study incorporating semi-structured in-depth interviews with thematic analysis informed by Family Systems Theory. Setting/participants: Medical oncology departments at two tertiary hospitals in Japan. A purposive sample of 13 advanced cancer patients, 10 family members and 9 healthcare professionals who cared for them. Results: Twenty-five interviews were conducted, comprising 7 dyads of patients and their family members and 18 individual interviews. Four themes were identified: characteristics of patients and family members and their views on illness and advance care planning; family context and communication; interactions with healthcare professionals and societal and cultural influences; and family members' acceptance, preparation and confidence. Family involvement was observed as being variable at an individual level and also across generations. Family members provided patients with the instrumental and emotional support that facilitated the advance care planning process. Family involvement enabled family members to better prepare for realising patients' wishes. It increased family members' confidence in surrogate decision-making. Conclusions: Two mechanisms of how family involvement may enable goal-concordant care were identified: family members' support provision and their preparation for realising patients' wishes. Healthcare professionals should assess family's readiness to engage in advance care planning, and the time required to prepare them for the process. [ABSTRACT FROM AUTHOR]

Objective: To explore rehabilitees' and professionals' experiences of goal-setting in a context of (un)certainty with a progressive neurodegenerative disease and how they navigate this (un)certainty in Parkinson's disease rehabilitation. Design: A long-term multi-sited ethnographic fieldwork (2019−2020) following 20 rehabilitees and their goals over time and settings. Observation at 30 goal-setting meetings. Participants: Rehabilitees and professionals in Danish Parkinson's disease rehabilitation. Two randomly chosen groups of rehabilitees attending a Parkinson's disease course at a rehabilitation centre participated. Methods: Semi-structured interviews and participant observation. Results: Living with Parkinson's disease holds a certainty that the condition will progress yet an uncertainty regarding the pace and severity, as indicated by the notion (un)certainty. The (un)certainty challenges goal-setting. Reflecting on goal-setting, rehabilitees brought forth existential, economical, and societal considerations. Some expressed an ambivalent view, questioning the value of goal-setting with a progressive condition, yet finding own rehabilitation goals relevant. Others expressed a pragmatic view, attuning goals to fit the situation. Professionals found that the visible and invisible symptoms and the uncertain pace of Parkinson's made goal-setting challenging. They had to strike a balance between mentioning symptoms to come, yet not rendering the future too bleak. Conclusions: Rehabilitees and professionals found that setting goals in a condition that progresses is no easy task. They made use of strategies such as observation, repetition, future-proofing strategies, and attuning goals to navigate the (un)certainty. In goal-setting, to maintain functioning with progressive Parkinson's disease was a viable goal. Participants found they just do the best they can to navigate (un)certainty. [ABSTRACT FROM AUTHOR]

Background: Given the deleterious effects of physical inactivity in persons with chronic obstructive pulmonary disease (COPD) and/or heart failure (HF), interventions that promote long-term daily physical activity are needed. Mindful Steps, designed to promote walking behaviors in COPD and HF, is a multicomponent intervention that integrates mind-body content with other self-regulatory components. The aim of the current qualitative study was to characterize participants' experiences with Mindful Steps and understand the perceived influence of the intervention on walking and health. Method: In the context of a pilot randomized controlled feasibility trial comparing the year-long Mindful Steps program to usual care among individuals with COPD and HF, semi-structured qualitative interviews were administered at 6- and 12-months. Interviews were audio recorded and transcribed. The constant comparative method was used to code transcripts, identify categories, and develop interrelated themes. Results: Nineteen participants (63% female; M age = 70.2 years, SD = 6.95) who were randomized to the intervention group completed the 6-month interview and 17 completed the 12-month interview. The pedometer with feedback, live group classes, and mind-body videos were described as the most helpful intervention components. Participants learned several strategies that helped their walking (e.g., breathing regulation and awareness, body awareness, mind-body techniques, pacing), described walking as enjoyable, and identified internal reasons for walking (e.g., to feel good). They also reported several physical and mental health benefits of the intervention. Some participants reported limited influence of the intervention on walking or health. Many participants continued to use the strategies they learned in the first half of the intervention at 12-months. Conclusions: The mind-body content of Mindful Steps appeared to positively influence walking behaviors. Participants' experiences with the intervention helped to identify areas for future intervention refinement. Future quantitative work is needed to corroborate these qualitative findings and assess the efficacy of the intervention on long-term physical activity engagement. Trial Registration: This trial is registered in Clinical Trials.gov, ID number NCT01551953. [ABSTRACT FROM AUTHOR]

Purpose: Financial knowledge often does not translate into financial well-being. This study looks at how knowledge might be converted to well-being for people living in low-income environments, based on a theory called Financial PSS. Methods: The study tests the validity of the two scales that make up Financial PSS: Perceived Financial Barriers and Financial Hope. Then it examines how these measures along with an intervention measure called TIP are associated with financial capability. Results: Results validated the Perceived Financial Barrier Scale and Financial Hope Scale. Next, the study found that the Perceived Financial Barriers Scale and the Financial Hope Scale are associated with financial capability, as is the TIP score. Conclusions: The study concludes that Financial PSS as a newly applied practice-based theory should be further tested. Workforce providers could integrate financial education and empowerment-based F-PSS process models and see a positive impact on their placement and retention outcomes. [ABSTRACT FROM AUTHOR]

This pilot study examined (a) the perceived barriers to creating high-quality social and emotional learning (SEL) IEP goals for autistic students without intellectual disabilities, and (b) the impact of using a data-driven SEL IEP goal builder—a key component of the Ivymount Social Cognition Instructional Package (IvySCIP)—on the quality of SEL IEP goals. Based on data from 40 instructor/student dyads, we found the following: First, based on phone interviews, instructors identified a number of significant barriers to the creation of SEL IEP goals for this population, including lack of ability to reliably assess students' SEL strengths and needs, lack of a goal builder/goal bank, and lack of comprehensive, data-driven support for generating SEL goals and tracking progress toward goal mastery. Interviewees agreed that IvySCIP effectively addressed these barriers. Second, based on a comparison of pre-intervention SEL IEP goals and those created using the IvySCIP goal builder, the quality of instructors' IEP goals appeared to improve after introduction of the goal builder, with post-intervention goals significantly more likely to include settings, givens, specific/demonstrable behavior being targeted, and measurement criteria to ensure meaningful progress monitoring. Post-intervention goals also drew more equitably from a range of SEL domains. [ABSTRACT FROM AUTHOR]

This qualitative study explored perspectives of college students with learning disabilities (LD) regarding their self-determination and parental influences on student self-determination during students' transition from high school to postsecondary education. Data were collected from in-depth interviews with 12 college students with LD. Qualitative analyses were conducted to examine students' participation in secondary transition, self-determination behaviors, and parental influences on students' self-determination. The findings identified five important self-determination behaviors (i.e., postsecondary education goal setting and attainment, self-advocacy, being autonomous, self-awareness, and decision-making) students demonstrated in secondary transition. Four themes pertain to parental influences on student self-determination, including encouraging students to be advocates, fostering students' academic competency, showing moral support and high expectations, and providing opportunities for students to make decisions. Recommendations for engaging parents to promote student self-determination are provided. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: While it is well established that unmet healthrelated social needs (HRSN) adversely affect health outcomes, there has been limited evaluation in adult primary care of patients' perceptions of how these needs impact their health and the role of the primary care provider (PCP). The objective of this study is to identify patients' perceptions of HRSN and how PCPs could help address them. Secondary objectives include exploring the impact of goal setting and a 1-time cash transfer (CT). Methods: This qualitative study used semi-structured baseline and follow-up interviews with patients in internal medicine clinics. Adult primary care patients were included if they screened positive as having 1 of 3 HRSN: financial resource strain, transportation needs, or food insecurity. All participants completed an initial interview about their HRSN and health, and were asked to set a 6-month health goal. At enrollment, participants were randomized to receive a $500 CT or a $50 participation reward. At 6-months, patients were interviewed again to investigate progress toward meeting their health goals, [when applicable] how the CT helped, and their beliefs about the role of PCPs in addressing HRSN. Results: We completed 30 initial and 25 follow-up interviews. Participants identified their HRSN, however most did not readily connect identified needs to health. Although participants were receptive to HRSN screening, they did not feel it was their PCP's responsibility to address these needs. Verbal goal-setting appeared to be a useful tool, and while the CTs were appreciated, patients often found them inadequate to address HRSN. Conclusions: Given the importance of identifying the social conditions that shape patients' health, providers, and health systems have an opportunity to re-evaluate their role in helping patients address these barriers. Future studies could examine the effect of more frequent disbursement of CTs over time. [ABSTRACT FROM AUTHOR]

Introduction: University students are at a high risk for mental health difficulties. Occupational performance coaching is an action-oriented and strengths-based approach that can help clients set and accomplish personally valued goals. We carried out a pilot project to evaluate a tele-rehabilitation occupational performance coaching service for university students within an occupational therapy fieldwork placement. Method: A pretest post-test design was used. Severity of symptoms of depression, anxiety and stress and goal achievement were measured before and after the intervention and semi-structured interviews were carried out with student clients and student therapists. Development of student therapist competencies were noted. Results: Thirty-five student clients enrolled in occupational performance coaching and participated in 1–6 sessions. They identified academic, health, social and vocational goals. Through occupational performance coaching, clients made important progress on their goals. Following occupational performance coaching, clients demonstrated statistically significant improvement in anxiety and depression. The occupational therapy students attained competencies comparable in number and level to those achieved in more traditional placements. Conclusion: Occupational performance coaching is a potentially valuable addition to student mental health services. Such a service can be provided by supervised fieldwork students. [ABSTRACT FROM AUTHOR]

One core component of the Paediatric Autism Communication Therapy–Generalised involves supporting parents to change their interaction and communication style with their child. This behaviour change has been found to affect child outcomes. Implementation science methodologies offer a range of opportunities to investigate how interventions are delivered in practice; however, few autism intervention studies have used such designs to explore the behaviour change of parents. We interviewed 27 parents and explored their use of intervention strategies after the Paediatric Autism Communication Therapy–Generalised trial. We employed the Theoretical Domains Framework and Consolidated Framework for Implementation Research to systematically explore a range of barriers and facilitators experienced by the parents associated with parents' characteristics, their context and features of the intervention. Our analysis revealed barriers and facilitators across three themes: Motivating Factors, which was further subdivided into Compatibility and Buy-In and Alignment of Goals and Outcomes; Opportunity and Support; Parent Characteristics. Almost all parents reported continued use of the Paediatric Autism Communication Therapy–Generalised strategies. Facilitators (e.g. parental confidence in using the strategies) and barriers (e.g. child's behaviour) were identified. Consideration of these factors can inform identification of implementation strategies to test in future studies of Paediatric Autism Communication Therapy–Generalised and other parent-mediated early autism interventions. Many early autism interventions teach parents therapeutic strategies to help them adjust their communication style with their children. Research has shown that this behaviour change in parents leads to improvements in child communication. It is, therefore, important to learn what factors support or hinder parents in their use of therapeutic strategies learned in such interventions. This study set out to interview parents who had participated in a research trial of the Paediatric Autism Communication Therapy–Generalised intervention. We interviewed 27 caregivers and explored their use of the strategies up to 2 years after the end of the research trial. Qualitative frameworks were used to inform interview questions and data analysis. These frameworks focused on a range of contextual factors, including parents' characteristics, their context and features of the intervention. Parents reported barriers and facilitators to using Paediatric Autism Communication Therapy–Generalised strategies across three themes: Motivating Factors; Opportunity and Support; Parent Characteristics. One of these themes, Motivating Factors, was further divided into the subthemes Compatibility and Buy-In and Alignment of Goals and Outcomes. Almost all parents reported continued use of the Paediatric Autism Communication Therapy–Generalised strategies. Facilitators included parental confidence in using the strategies and barriers included child's behaviour. Consideration of these factors can inform ways to better support parents in future autism interventions. [ABSTRACT FROM AUTHOR]

Work ability, or the perception of one's ability to work presently and in the future, may impact quality of life (QOL) among young adult (YA) cancer survivors. Through a convergent mixed methods design, we explored work ability, work-related goals, and QOL among YA hematologic cancer survivors within five years of diagnosis. We described associations at the individual- and microsystem (work)- levels; and compared factors across low and high work ability groups. Participants (N = 40) completed a survey and interview via digital platforms. Qualitative analysis revealed self-assessed declines in work ability led to questioning work-related goals and influenced QOL. Integrated analysis led to the development of four profiles, growing our understanding of work's influence on QOL for YA cancer survivors, and identifying components YAs considered when contemplating work-related goals after a cancer diagnosis. Larger studies are needed to elucidate these profiles and identify modifiable factors to inform targeted interventions to improve QOL. [ABSTRACT FROM AUTHOR]

Children with autism spectrum disorder (ASD) often experience skill deficits that can negatively affect long-term outcomes. Interventions based on applied behavior analysis (ABA) yield improvements in targeted skills. However, families often have difficulty accessing ABA services. The purpose of this study was to evaluate the efficacy of a caregiver coaching program delivered via telehealth. Thirty children with ASD and their caregivers (e.g., parents, grandparents) participated in all phases of the study. The program consisted of therapists providing coaching in English or Spanish to caregivers of children with ASD via synchronous video call telehealth visits, typically provided one to two times per week. Caregivers received coaching in interventions (e.g., functional communication training, discrete trial teaching, total task chaining, and naturalistic teaching) to address individualized goals. We collected data on caregiver treatment fidelity and child outcomes (i.e., Vineland-3, observation, and analysis of time series data). Caregivers implemented intervention procedures with 95% accuracy on average. The single-case effect sizes calculated based on the time series baseline and intervention data yielded medium, large, or very large improvements for 85% of goals addressed. Results indicated that the children improved on appropriate engagement (measured via observation), but there was no statistically significant improvement for the remaining pre-post measures. These results, along with the results of previous studies, provide preliminary support for the use of telehealth to provide ABA services. However, there is a need for additional research evaluating the efficacy of these types of programs. [ABSTRACT FROM AUTHOR]

Children in care have consistently lower educational attainment than peers who live with their birth families. However, metrics often define 'education' narrowly, focusing on traditional in-school achievements with which this population typically struggles. In this study, interviews with current and former children in care (n = 7, ages: 11–59) revealed that they perceive education in a much broader way, occurring across their life experiences and encompassing both life and social skills. Regardless of their performance in school, participants storied themselves as achievers in the context of this broader concept of 'education' and described positive outcomes such as independence, agency, development of authentic identities and capacity to strive for and achieve goals. These reflections have implications for the provision of social support services and the evaluation of outcomes for children who are taken into the care of the state. For example, it may be valuable to redefine 'education' to include a wider range of activities and to therefore encompass a variety of potential interventions to support development and success. Additionally, there seems to be scope for working more closely with children in care when making decisions, centring their lived experiences and drawing on their insights so as to achieve a better balance of support for both formal and informal educational opportunities. [ABSTRACT FROM AUTHOR]

The paper reflects on researchers' adultness in the context of two central motifs that accompany interview research with children, "ascertaining children's perspectives" and "meeting research objectives (the researcher's objectives)". Sequential re-analysis of conflictual interview sequences reveals "ad hoc practices" in which researchers (re)produce adultness and generational orders. Reflection on such practices in connection with 'turning points' in adult actions may assist in fine-tuning the appositeness in the approach to interviews with children and helping researchers advance their individual research skills. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis is highly individualized in terms of its flare ups and periods of remission. Each patient's unique experience requires a high level of personalization in terms of treatment making it necessary to understand what their goals for living are. This study explores patient perceptions on how the burden of RA shapes patients' goals for living and their preferences for symptom and side-effect management within the United States. Fifteen patients diagnosed with RA with varying lengths of diagnosis were interviewed. A thematic analysis was conducted to construct a conceptual framework. Emerging themes identified disease burdens as: (1) inability to perform essential needs, (2) negative feelings about disease, and (3) its influence on relationships. These burdens shaped desired goals for living which guided the symptom and side-effect priorities the patient wanted managed. Practitioners should consider patient goals and preferences in conjunction with disease progression when engaging in treatment decisions. [ABSTRACT FROM AUTHOR]

Autistic people are over-represented at gender clinics, but there is limited research to guide clinical practice with this group. We investigated the perspectives of clinicians working with autistic patients who experience gender dysphoria. We asked clinicians about the relationship between autism and gender dysphoria, and whether they work differently with this patient group. We recruited clinicians from young person and adult gender clinics and autism services (n = 16). We analysed the interview transcripts using interpretative phenomenological analysis (IPA). The first overarching theme was clinician understanding of the intertwined experiences of patients, with four subthemes: (a) coming to an individualised understanding of autism, gender dysphoria, and mental health; (b) different ways of thinking about gender; (c) social differences as barriers and facilitators to gender comfort; (d) the challenge of sensory sensitivities and puberty. The second overarching theme was mismatch of patient and clinician communication styles and goals, with three subthemes: (a) different communication of gender needs; (b) changing clinical sessions to overcome barriers; (c) tension between clinician and patient aims and thinking styles. We conclude that autism adaptations should be made in gender settings, by increasing clinician understanding of how autism and gender dysphoria can intersect, as well as by making adjustments to clinic processes. Autistic people are more likely to have a gender identity which does not match their sex assigned at birth. Some people experience distress about their sex and gender not matching, which is called gender dysphoria. Such individuals may wish to attend a gender clinic to access healthcare support for gender dysphoria. Currently, there is limited evidence to help clinicians best support autistic people who need healthcare for gender dysphoria. We wanted to find out what healthcare clinicians think about working with autistic patients with gender dysphoria. We interviewed 16 clinicians who work in healthcare services with adults and young people who are autistic and experience gender dysphoria. We recorded the interviews and carefully analysed the content to find key themes. We found that clinicians worked with patients to try and better understand their experiences of gender dysphoria. Clinicians identified features of autism that they believed were related to gender identity and dysphoria including different thinking styles, social differences, and sensory sensitivities. Clinicians noticed that autistic people spoke about their gender in different ways to non-autistic people. Clinicians tried to adapt their practice to better meet the needs of their autistic patients. These adaptations tended to focus on differences in the assessment process, for example, offering longer or shorter appointments and changing their communication style. We conclude that clinicians were offering an individualised approach to autistic patients experiencing gender dysphoria. However, these clinicians were particularly interested in working with autistic people, and so may not be representative of the wider clinician population. Clinicians working in this area should receive training on autism adaptations and the intersection of autism and gender dysphoria. [ABSTRACT FROM AUTHOR]

Medical clowns (MCs) are trained professionals who aim to change the hospital environment through humor. Previous studies focused on their positive impact and began identifying their various skills in specific situations. When placed in pediatrics, MCs face various challenges, including approaching frustrated adolescents who are unwilling to cooperate with their care, dealing with their anxious parents, and communicating in a team in the presence of other health professionals. Research that systematically describes MCs' skills and therapeutic goals in meeting these challenges is limited. This article describes a qualitative, immersion/crystallization study, triangulating between 26 video-recorded simulations and 12 in-depth-semi-structured interviews with MCs. Through an iterative consensus-building process we identified 40 different skills, not limited to humor and entertainment. Four main therapeutic goals emerged: building a relationship, dealing with emotions, enhancing a sense of control, caring, and encouragement, and motivating treatment adherence. Mapping MCs' skills and goals enhances the understanding of MCs' role and actions to illustrate their unique caring practices. This clarification may help other healthcare professionals to recognize their practices and the benefits in involving them in care. Furthermore, other health professionals may apply some of the identified skills when faced with these challenges themselves. [ABSTRACT FROM AUTHOR]

Objective: Most chronic disease self-management interventions emphasise the integral role of self-efficacy in achieving behaviour change. We explored the applicability of this model in a low-income setting, from the perspective of both patients and clinicians. Methods: Interviews with multimorbid patients and their health providers at two rural community health centres in Victoria, Australia. We used a phenomenological methodology, exploring themes of confidence to manage health, outcome expectations and goals. Results: Many assumptions in which the self-efficacy model is grounded did not apply to this population. Past experiences and resource constraints, especially poverty and healthcare access, influenced confidence, expectations and the ability to achieve desired outcomes. Discussion: The focus of traditional self-management support on individual behaviour change disadvantages rural low-income patients, who face barriers related to life experience and resource constraints. For this group, self-management support needs to return to its roots, moving away from a narrow conception of behaviour change and reinstating the role of 'support' into 'self-management support' interventions. Health providers working in rural low-income settings should recognise the limits inherent in self-efficacy focussed interventions and think broadly about engaging with their clients in whatever way supports them to find a life with meaning and purpose. [ABSTRACT FROM AUTHOR]

Objectives: To help better control chronic conditions we need to address root causes of poor health like unhealthy behaviors, mental health, and social needs. However, addressing these needs in primary care is difficult. One solution may be connecting patients with a navigator for support creating a personal care goal. Methods: As part of an RCT to evaluate a feasible approach to care planning, 24 clinicians from 12 practices in the Virginia Ambulatory Care Outcomes Research Network (ACORN) and 87 intervention patients with uncontrolled chronic conditions participated in a care planning intervention. We had a structured process to guide patients, train navigators, and adapt the navigation process to meet the needs of each practice. Results: Only 1 practice had bandwidth for staff to serve as a patient navigator, even for extra pay. For the other 11 practices, a research team member needed to provide navigation services. On average, patients wanted 25 weeks of support to complete care plans. The average time patients needed to speak with navigators on the phone was 7 min and 3 s. In exit interviews, patients consistently shared how motivational it was to have a caring person check in on them, offer help, and hold them accountable. Conclusion: Patient navigation to address care plans should be feasible. The time commitment is minimal. It does not require intensive training, and primary care is already doing much of this work. Yet, given the burden and competing demands in primary care, this help cannot be offered without additional resources. [ABSTRACT FROM AUTHOR]

Chronic cardiovascular and pulmonary diseases are prevalent in the US home health population. Heart failure and chronic obstructive pulmonary disease are both chronic and terminal, but they are not always perceived as serious illnesses with imminent death. Therefore, they provide a context for advance care planning that is distinct from the diagnostic contexts of cancer, end-stage renal disease, or dementia. Advance care planning is defined as a process that supports adults at any age or stage of health in understanding and sharing their goals, values, and preferences about future medical care, including the designation of a surrogate decision-maker. This study tests the hypothesis that US home health agencies with higher percentages of patients with chronic cardiovascular and pulmonary conditions have less robust advance care planning protocols. The Spearman correlation coefficient was r = 0.22 (S = 74684, P =.025, 1-tailed), which was statistically significant and an unexpected finding. The greater percentage of patients with chronic cardiac and pulmonary diagnoses in an agency, the more robust the advance care planning protocol was. This supports our previous findings and existing literature indicating that agencies may be using exacerbation events marked by acute care use as opportunities to initiate or repeat advance care planning. [ABSTRACT FROM AUTHOR]

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Introduction: Reablement services support people to regain skills and increase their independence. This aim resonates with occupational therapy philosophy. This article presents results of a study of the role of occupational therapists in reablement services that involve two organisations. Method: Theories on the role of occupational therapists in reablement were identified using a realist synthesis approach and were tested and expanded using a qualitative case study design. Each of the three case studies consisted of one reablement service in England. Methods of the study included observations and interviews with occupational therapists, interviews with managers in both organisations and focus groups and interviews with reablement support workers. Findings: Findings conclude that occupational therapists' education and experience underpin their ability to undertake assessments and person-centred goal setting. They utilise a range of intervention techniques selecting from their toolbox of interventions to support people. Occupational therapists have a role in training reablement support workers to work in an enabling way. Regular communication and co-location support levels of trust and shared purpose between members of the reablement team. Conclusion: The conceptual framework developed from the study can be used by organisations when commissioning and developing reablement services to consider the different contextual layers of reablement. [ABSTRACT FROM AUTHOR]

Background: Experts consider goal-concordant care an important healthcare outcome for individuals with serious illness. Despite their relationship to the patient and knowledge about the patient's wishes and values, little is known about bereaved family caregivers' perceptions of how end-of-life care aligns with patient goals and preferences. Aim: To understand caregivers' perceptions about patients' care experiences, the extent to which care was perceived as goal-concordant, and the factors that contextualized the end-of-life care experience. Design: Qualitative interview study employing a semi-structured interview guide based on the National Health and Aging Trends Survey end-of-life planning module. Template analysis was used to identify themes. Setting/participants: Nineteen recently bereaved family caregivers of people with serious illness in two academic medical centers in the Northeastern United States. Results: Most caregivers reported goal-concordant care, though many also recalled experiences of goal discordance. Three themes characterized care perceptions and related to perceived quality: communication, relationships and humanistic care, and care transitions. Within communication, caregivers described the importance of clear communication, inadequate prognostic communication, and information gaps that undermined caregiver confidence in decision making. Patient-clinician relationships enriched care and were considered higher-quality when felt to be humanistic. Finally, care transitions impacted goal discordance when marked by logistical barriers, a need to establish relationships with new providers, inadequate information transfer, and poor care coordination. Conclusions: Bereaved caregivers commonly rated care as goal-concordant while also identifying areas of disappointing and low-quality care. Communication, relationships and humanistic care, and care transitions are modifiable quality improvement targets for patients with advanced cancer. [ABSTRACT FROM AUTHOR]

This qualitative study aimed to investigate the influences on 32 rural Iranian high school students' adoption of achievement goals. To this end, the high school students took part in individual semi-structured interviews. The outcomes indicated the high school students' goal orientation adoption was impacted by a host of significant individuals in four contexts: (1) school (e.g. teachers, classmates), (2) family (e.g. parents, relatives), (3) rural community (e.g. neighbors and rural university graduates) and (4) media (e.g. counselors on TV). Likewise, various factors (i.e. social, psychological, economic, educational, rural, biological and religious) also appeared to influence their achievement goal adoption. Results may have implications for various stakeholders such as educational authorities, policy makers, researchers and significant others (e.g. teachers, counselors, parents, among many others). [ABSTRACT FROM AUTHOR]

Introduction: Occupational therapists have an integral role in the treatment of people with functional neurological disorder, yet there is evidence of variable implementation of occupational therapy in community settings. This study explored the barriers and enablers to delivering community-based occupational therapy to people with functional neurological disorder in the United Kingdom. Methods: Community-based neurological occupational therapists (n = 10) with experience in functional neurological disorder were invited to complete semi-structured qualitative interviews. The interview schedule and analysis were based on the Theoretical Domains Framework, a behavioural science tool for investigating barriers and enablers to clinical practice. Data were analysed using a combined content and framework analysis approach. Findings: Important barriers to treatment included limited published information to guide practice, lack of professional role clarity and restricted multidisciplinary team working. Enablers included occupational therapists' dual training in physical and mental health and focus on activity engagement. Service provision, quality and access varied across geographical locations. Conclusion: Occupational therapists are uniquely placed to help people with functional neurological disorder; however, findings suggest that existing community service structures in many regions in the United Kingdom are inadequate and limit the quality of treatment that can be provided. Additional resources are required to support occupational therapy service provision in community settings. [ABSTRACT FROM AUTHOR]

Ethnic–racial socialization (ERS) is the collection of practices by which individuals learn about norms, values, and customs regarding ethnicity and race (Hughes et al., 2006). In contrast to research with families of color, few studies have examined ERS among White families (Umaña-Taylor & Hill, 2020). In this study, we used the Consensual Qualitative Research procedure (Hill et al., 2005) to analyze the ERS goals expressed by 35 White parents of White children during semi-structured interviews. We identified 11 domains (privilege awareness, take action, racism, value diversity, egalitarianism, children lead the way, informed, embracing the difficulty of being anti-racist, empathy, protection, and racial–ethnic identity) that generally map onto Hughes et al.'s (2006) existing ERS framework. Our results suggest that some White parents have ERS goals that move beyond kindness and diversity to delve into issues of equity and justice in order to support children in their own anti-racist journies. [ABSTRACT FROM AUTHOR]

Introduction: This paper provides a report of social validity and its usefulness in understanding study effects. Social validity data were drawn from a larger single-case study designed to investigate the effectiveness of the Matrix Approach in the practice of early intervention visual impairment professionals. Methods: Qualitative measures were used to assess social validity. According to Wolf (1978), validation of a study should encompass the significance of goals, appropriateness of procedures, and importance of outcomes. Therefore, data sources were created to provide evidence of social validity in these areas including pre- and post-intervention interviews of parents and professionals. Results: Three themes emerged from the social validity data. These are organized under the topics introduced by Wolf (1978) and identified as measures of quality by Horner et al. (2005). The themes are (a) Goals: role of the parent as learner and the professional as expert before using the Matrix Approach, (b) Procedures: helpfulness of coaching and the structure of the Matrix Approach, and (c) Outcomes: personal and professional growth as a result of using the Matrix Approach. Discussion: Evaluation of social validity in single-case research is an important component in a study's design and in interpreting the study's outcomes. Wolf's framework proved valuable in promoting a robust evaluation of study effectiveness, especially when incorporated into the study design. Intentionally planning to measure social validity held the researchers accountable to the practical needs of the participants. In fact, there is value in gathering social validity data at various points in a study. Further, hearing the perspective of stakeholders can provide valuable insights as researchers seek to understand the complexities of change evident in the outcomes of a study. Implications for Practitioners: Collaborative planning is an essential component of early intervention. The Matrix Approach shows promise as a mechanism to foster such collaboration. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the experience of clients and clinicians in working with a tool to help set goals that are personally meaningful to rehabilitation clients. Design: We have applied the tool in the outpatient rehabilitation setting. Clients' and clinicians' experiences in working with the tool were evaluated in individual, semi-structured interviews and focus group interviews, respectively. Thematic analysis was used to analyze the data. Setting: A university medical center and a rehabilitation center. Subjects: Clients with a first-time stroke (n = 8) or multiple sclerosis (n = 10), and clinicians (n = 38). Intervention: The tool to help set meaningful goals consisted of a session (i) to explore the client's fundamental beliefs, goals and attitudes and (ii) to identify a meaningful overall rehabilitation goal. The results of that session were used by the multidisciplinary rehabilitation team (iii) to help the client to set specific rehabilitation goals that served to achieve the meaningful overall rehabilitation goal. Results: Both clients and clinicians reported that the tool helped to set a meaningful overall rehabilitation goal and specific goals that became meaningful as they served to achieve the overall goal. This contributed to clients' intrinsic rehabilitation motivation. In some clients, the meaningfulness of the rehabilitation goals facilitated the process of behavior change. Both clients and clinicians made suggestions on how the tool could be further improved. Conclusion: In the opinion of both clients and clinicians, the tool does indeed result in goal setting that is personally meaningful. Further development, implementation and evaluation of the tool is warranted. [ABSTRACT FROM AUTHOR]

Introduction. The success of family-based community programs for childhood obesity may be increased by promoting social-cognitive factors that influence motivation and participant engagement. Incentivizing behavior can potentially enhance engagement and encourage behavior change. This research investigated motivators to engagement with a multicomponent incentive-based strategy to improve attendance and health-related behavior change in a family community-based weight management program for overweight and obese children. Method. Qualitative analysis combining; demographic data (n = 512), survey of parents (n = 273), and stakeholder (n = 10) and family interviews (n = 24). Participants were selected from program providers and families participating in an Australian community weight management program during a randomized controlled trial (n = 512 children). Maximum variation sampling (demographics and group characteristics) and inductive thematic analysis were used. Results/Conclusion. Four factors influencing engagement were (1) personal value, (2) achievement, (3) support, and (4) overwhelm. These themes corroborated with social-cognitive factors, fostered by a combination of behavior change components in the program that increased participant accountability and intrinsic motivation. Focusing on autonomous goal planning with parental involvement, tracking of goals, and reviewing of goals may complement existing strategies in child-focused treatment programs. Low-value noncash incentives linked to goal setting for encouraging healthy eating and physical activity were well accepted and may enhance family engagement and attendance. [ABSTRACT FROM AUTHOR]

Purpose: The UMass Chan Medical School/New England AIDS Education and Training Center Community-Based HIV and Viral Hepatitis Fellowship was launched in 2014 to train physicians and nurse practitioners to become experts in outpatient management of HIV, hepatitis B and C, and latent tuberculosis. The purpose of this study was to identify areas of strength and improvement and understand fellows' perceptions of the program and its impact on their current positions and career trajectories. Methods: Qualitative study utilizing a semi-structured interview guide with (11) fellowship graduates (8 MDs; 3 NPs). 45 to 60 min interviews were conducted in April and May 2021, recorded and transcribed. Transcripts were analyzed for representative themes and general patterns in the data. Results: Results indicate high satisfaction with the fellowship, which left a positive and indelible impact on their careers and patient care. Fellows highlighted the program's commitment to health equity, its role in transforming them into leaders and advocates for HIV in primary care, and their ability to balance their work and training demands with their personal lives and needs. The fellowship motivated them to become more involved in public health initiatives, serve marginalized communities and reduce their health disparities. They expressed confidence in their ability to independently manage outpatient HIV, viral hepatitis B and C, and latent tuberculosis, and found areas of overlap with their work in primary care. Conclusion: As the care of people with HIV becomes more commonplace in primary care clinics, it is imperative that primary care providers receive the necessary training and education to meet this need. Our study of 11 former fellows shows that the Community-Based HIV and Viral Hepatitis Fellowship offers such training, spreads it to other institutions, and can be a model for other programs nationwide. [ABSTRACT FROM AUTHOR]

Background: Mentorship is a key aspect of leadership development for orthopaedic surgeons, but there are few formalized mentorship programs in medical training. The individualized development plan (IDP) is a tool that potentially improves mentorship opportunities through identifying specific competency deficiencies and facilitating communication with mentors. Purpose: To assess the views of prospective orthopaedic surgery sports medicine fellows on the skills necessary for career development and the utility of an IDP for longitudinal career mentorship during a sports medicine fellowship. Study Design: Cross-sectional study. Methods: Candidates who interviewed for an orthopaedic surgery sports medicine fellowship voluntarily completed an anonymous IDP as well as a survey to assess their perceptions of the IDP tool to define their career goals and its use for longitudinal mentorship. The IDP included quantitative and qualitative responses for the self-assessment of multiple skill domains (general research, teaching, professional, interpersonal, leadership, and management) using a 5-point Likert scale (1 = needs improvement, 5 = highly proficient). Quantitative results were analyzed using analysis of variance and Student t test. Results: A total of 25 candidates completed the IDP and survey. The mean ± standard deviation composite score of all skill domains was 3.62 ± 0.91. The candidates' greatest deficit was in grant writing (2.28 ± 0.94; P <.01), while their greatest strength was getting along with others (4.52 ± 0.65; P <.01). Candidates identified, as short-term goals, obtaining a fellowship training position, completion of research/academic projects, and improvement of surgical skills; their common long-term goals included having a role in an academic institution, professional society, and/or research and innovation environment. The majority of participants agreed that the IDP is a valuable tool to characterize career and personal goals (74%) and facilitate longitudinal fellowship mentorship (83.3%). Conclusion: The majority of candidates valued the IDP for their short- and long-term goals. Program implementation of an IDP could be beneficial in allowing trainees to effectively identify areas of weakness and strengths while facilitating efficient communication of these needs to mentors. [ABSTRACT FROM AUTHOR]

Objective: The overall aim of this study was to examine, among individuals living with severe asthma, the role of perceived competence in achieving their goals. Methods: Qualitative research methods were used to conduct in-depth semistructured interviews. Interviews were video and/or audio recorded, transcribed and analyzed inductively and deductively, informed by the self-determination theory construct of perceived competence. Thirty-six face-to-face interviews, lasting 1.5–4 h, were conducted across Australia. Results: Feeling competent to achieve asthma goals played a role in participants' ability to achieve broader goals. Their desire to achieve their broader goals was strongly driven by their perceived ability to master managing their condition, which at times required more than medical strategies. Two main themes were discerned from the analysis: (1) learning how to look after yourself: self-care is important and (2) reaching an agreement with severe asthma: being at one with the illness. Discussion: This study highlighted the influence of perceived competence on self-management and goal achievement in severe asthma. Healthcare providers could explore patients' perceived competence to set and achieve goals, as a self-management strategy. Future research should consider these findings when developing and implementing patient-driven, self-management interventions for those living with severe asthma. [ABSTRACT FROM AUTHOR]

Trans individuals experience unique stressors related to their careers, such as discrimination, workplace harassment, navigating transition, and disclosure of their identity. The current study examined the experiences of 30 trans graduate students with regard to career decision-making. In total, 19 identified as at least one nonbinary identity and 11 were binary trans-identified (trans men and trans women). Thematic analysis of in-depth interview transcripts revealed the following major themes: (a) Role of Gender Minority Stress During Graduate School in Career Development, (b) Key Considerations Related to Future Jobs or Career Paths (e.g., whether fields or specific jobs are trans-friendly), (c) Outness as a Key Consideration in the Job Application Process, and (d) the Role of Resources and Supports in Career Development. Our findings highlight the unique stressors for trans individuals in the career decision-making and job application processes and the unique challenges faced by nonbinary job seekers. [ABSTRACT FROM AUTHOR]

Background: Young adult cancer survivors have significant work-related challenges, including interruptions to education and employment milestones, which may affect work-related goals (WRGs). The study purpose was to explore posttreatment perspectives of WRGs in a sample of young adult hematologic cancer survivors. Methods: This qualitative descriptive study used social media to recruit eligible cancer survivors (young adults working or in school at the time of cancer diagnosis). Data were collected through telephone semi-structured interviews and analyzed using directed content analysis, followed by thematic content analysis to identify themes. Findings: The sample (N = 40) were mostly female (63.5%), White (75%), and diagnosed with Hodgkin lymphoma (57.5%); most worked in professional (40%) or health care (23%) roles. The overarching theme, "Survivors' Dilemma," highlights a changed perspective on work-related fulfillment and financial obligations, capturing survivors' decision-making process regarding work. Three subthemes illustrated questions that participants contemplated as they examined how their WRGs had changed: (a) Self-identity: Do I want to do this work? (b) Perceived health and work ability: Can I do this work? and (c) Financial toxicity: Can I afford to/not to do this work? Conclusions/Application to Practice: Participants experienced a state of dilemma around their WRGs, weighing areas around self-identity, perceived health and work ability, and financial toxicity. Findings suggest occupational health nurses should be aware of challenges surrounding WRGs, including how goals may change following a cancer diagnosis and treatment, and the potential stressors involved in the Survivors' Dilemma. Occupational health nurses should assess for these issues and refer young survivors to employee and financial assistance programs, as necessary. [ABSTRACT FROM AUTHOR]

Background: The United States Veterans Health Administration National Center for Ethics in Health Care implemented the Life-Sustaining Treatment Decisions Initiative throughout the Veterans Health Administration health care system in 2017. This policy encourages goals of care conversations, referring to conversations about patient's treatment and end-of-life wishes for life-sustaining treatments, among Veterans with serious illnesses. A key component of the initiative is expanding interdisciplinary provider roles in having goals of care conversations. Aim: Use organizational role theory to explore medical center experiences with expanding interdisciplinary roles in the implementation of a goals of care initiative. Design: A qualitative thematic analysis of semi-structured interviews. Setting/participants: Initial participants were recruited using purposive sampling of local medical center champions. Snowball sampling identified additional participants. Participants included thirty-one interdisciplinary providers from 12 geographically diverse initiative pilot and spread medical centers. Results: Five themes were identified. Expanding provider roles in goals of care conversations (1) involves organizational culture change; (2) is influenced by medical center leadership; (3) is supported by provider role readiness; (4) benefits from cross-disciplinary role agreement; and (5) can "overwhelm" providers. Conclusions: Organizational role theory is a helpful framework for exploring interdisciplinary roles in a goals of care initiative. Support and recognition of provider role expansion in goals of care conversations was important for the adoption of a goals of care initiative. Actionable strategies, including multi-level leadership support and the use of interdisciplinary champions, facilitate role change and have potential to strengthen uptake of a goals of care initiative. [ABSTRACT FROM AUTHOR]

COVID-19 infection can cause psychological distress and profoundly impact patients' lives, but it can also lead to positive changes and post-traumatic growth (PTG), or positive psychological change in response to challenging life circumstances. Current research on the influence of COVID-19 infection has mainly focused on its negative effects. Therefore, the aim of this study was to investigate whether patients with COVID-19 in China experienced PTG and, if so, what changed for them during the process of PTG. We used a qualitative descriptive approach to conduct this study. Using the purposive sampling recruitment method, patients with a confirmed COVID-19 diagnosis were recruited from a COVID-19 designated hospital in Shanghai, China, from April to July 2020. Data were collected using semi-structured, in-depth interviews conducted via cell phone or in person while social distancing to prevent the spread of COVID-19. Forty confirmed COVID-19 patients (19–68 years old) were recruited. Several prominent themes and subthemes were extracted from the interview responses regarding participants' experiences of PTG. The following are among the positive changesthat occurred for these participants after their diagnosis of COVID-19: (1) Reevaluation of their life priorities, which included a greater appreciation of being alive and re-evaluating their values and goals, (2) Improved relationships within their social circles, which included establishing or maintaining closer relationships with family and friends and a greater willingness to help others, and (3) Perceived changes regarding themselves, which included personal growth and increased awareness of the importance of their health. The study identified potential positive impacts of COVID-19 on patients, which could be helpful in the implementation of interventions to facilitate PTG among COVID-19 survivors. [ABSTRACT FROM AUTHOR]

Objectives: Goal setting and motivational interviewing (MI) may increase well-being by promoting healthy behavior. Since we failed to show improved well-being in a proactive assessment service for community-dwelling older adults applying these techniques, we studied whether implementation processes could explain this. Methods: Goals set during the comprehensive geriatric assessment were evaluated on their potential for behavior change. MI and goal setting adherence wasassessed by reviewing audiotaped interactions and interviewing care professionals. Results: Among the 280 goals set with 230 frail older adults (mean age 77 ± 6.9 years, 59% women), more than 90% had a low potential for behavior change. Quality thresholds for MI were reached in only one of the 11 interactions. Application was hindered by the context and the limited proficiency of care professionals. Discussion: Implementation was suboptimal for goal setting and MI. This decreased the potential for improved well-being in the participating older adults. [ABSTRACT FROM AUTHOR]

This research explores the dissonance between feminist ideology and practice as it manifests in an activist group of intimate partner violence/aggression (IPV/A) survivors under a state coalition on domestic violence serving multiple stakeholders. A gendered organizations framework reveals the activist group resisting paternalism and colonization in their efforts to achieve their goals and maintain their identity. Two-and-a-half years of observational field work reveals a complex dynamic, simultaneously feminist and patriarchal, with the activist group experiencing growing pains and internal conflict, emotion regulation, as well as empowerment. We offer suggestions for further exploration of the ways survivor–activist groups and coalitions can pursue collaborative partnerships. [ABSTRACT FROM AUTHOR]

Background: In 2020, the COVID-19 pandemic caused an acute risk of deterioration and dying for many, and an urgent need to start advance care planning. Aim: To explore how general practitioners (GPs) experienced discussing values, goals and preferences with patients during COVID-19. Design and setting: Qualitative research in general practice. Methods: Semi-structured interviews for which Dutch GPs were recruited via purposive sampling. Content analysis was used. Results: Fifteen GPs were interviewed. Six themes were identified: (i) urge of advance care planning, (ii) the GP's perceived role in it, (iii) preparations for it, (iv) (proactively) discussing it, (v) essentials for good communication and (vi) advance care planning in the (near) future. Calls for proactively discussing advance care planning in the media and in COVID-guidelines caused awareness of it's importance. GPs envisaged an important role for themselves in initiating it, especially with patients at risk to deteriorate or die from COVID-19. Timing advance care planning appeared difficult but crucial. The recommended digital way of communication was considered problematic due to missing nonverbal communication and difficulties in involving relatives. It was noted that admission to the ICU, which was hardly discussed before the COVID-19 pandemic, should remain a topic during advance care planning. Conclusion: The COVID-19 pandemic brought advance care planning into a new light, GPs were more experienced with discussing it and patients were more aware of their frailty. Because of the nearing 'grey wave', advance care planning should remain top priority. Therefore, it should be central in GP and post-academic training. [ABSTRACT FROM AUTHOR]