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In 2016 WHO launched the priority assistive products list (APL) consisting of 50 products and recommended that using this as a reference, countries should develop their own contextually relevant national APLs. This paper describes the development of Malawi's APL. Two hundred and ninety-six persons with disabilities participated in a rapid Assistive Technology Assessment (rATA) survey. Six focus group discussions (FGDs) with people with various types of disabilities were conducted. The rATA questionnaire and FGDs collected data on assistive products (APs) participants used, APs they needed and the challenges they experienced. Data collection was done in six districts spread across the three regions in Malawi. All age groups were included in the survey. Persons with disabilities aged less than 18 participated but went with their guardians. All persons who participated in this study provided consent. Survey and FGDs results were presented at an APL consensus meeting with policymakers, service providers, disabled peoples' organizations and development partners in the disability sector. Based on the results and further discussions, a consensus was reached on the priority APs for Malawi. More than a third of respondents used wheelchairs (32%), followed by auxiliary crutches (25%), walking sticks (13%), reading glasses (11%), prosthesis (10%), elbow crutches (9%) and orthosis (8%). There is also a high demand for products such as pull-up underwear (incontinence products) (79%), hearing aids (70%), reading glasses (59%) and diapers (63%). After intensive discussions during a consensus meeting, an agreement was reached on the 22 priority APs for Malawi. There is a wide range of APs being used by people with different functional limitations in Malawi. There is also a demand for APs that are not readily available. When developing an APL, the list should include products in use, those in demand, and those recommended by service providers. Following the development of the priority assistive products list (APL) by WHO, member states should develop their own contextually based APL. The development of the APL should be based on research evidence. All key stakeholders including persons with disabilities and other functional limitations, government, and development partners should participate in this process. The APL should be part of the national health system or community services. The Department of Disability and Elderly Affairs in the Ministry of Gender, Community Development, being the Government of Malawi line ministry coordinating disability issues participated actively in this study including inviting participants in the stakeholders' validation workshop. [ABSTRACT FROM AUTHOR]

Background:Evidence on effective ways of improving maternal and neonatal health outcomes is widely available. The challenge that most low-income countries grapple with is implementation at scale and sustainability. Objectives:The study aimed at improving access to quality maternal and neonatal health services in a sustainable manner by using a participatory action research approach. Methods: The  study consisted of a quasi-experimental design, with a participatory action research approach to implementation in three rural districts (Pallisa, Kibuku and Kamuli) in Eastern Uganda. The intervention had two main components; namely, community empowerment for comprehensive birth preparedness, and health provider and management capacity-building. We collected data using both quantitative and qualitative methods using household and facility-level structured surveys, record reviews, key informant interviews and focus group discussions. We purposively selected the participants for the qualitative data collection, while for the surveys we interviewed all eligible participants in the sampled households and health facilities. Descriptive statistics were used to describe the data, while the difference in difference analysis was used to measure the effect of the intervention. Qualitative data were analysed using thematic analysis. Conclusions:This study was implemented to generate evidence on how to increase access to quality maternal and newborn health services in a sustainable manner using a multisectoral participatory  approach. [ABSTRACT FROM PUBLISHER]

This is a process paper that describes the development of a wellbeing brochure, shared between university researchers, a consumer research advocate, and fully informed by people who are living with mental illness (experts by experience). The purpose of this brochure was to provide strategies for maintaining wellbeing for EBEs, after attending a psychosocial intervention. Brochure development was guided by a mixed-methods research design, using a survey and focus group. The findings illustrate five key themes in EBEs strategies for maintaining wellbeing: good sleep hygiene, regular physical activity, maintaining a healthy lifestyle, relaxation techniques and social support. This process paper demonstrates how collaborating with experts by experience represents a valuable approach for developing mental health research and resources. [ABSTRACT FROM AUTHOR]

Inclusion is a core philosophy for health practitioners and human service users, and co-production is a way to achieve inclusion. Australia's assistive technology (AT) community seeks to include and amplify the voices of service and product users at multiple levels. Implementation of genuine partnerships for inclusion is however challenging. This paper describes the iterative co-design process undertaken to structure and deliver a peer-led information and support program, enabling AT users and supporters to build their AT decision making capability and share their expertise with each other and the broader community. A living labs approach was grounded in co-design principles and drew on the peer education, AT competency and capability-building knowledge base. Methods included embedding intersectional capabilities within the service, and the engagement of over 600 people in design thinking and program iterations through surveys, focus groups, journey mapping and think tanks. A national, peer-led, co-designed online community for AT users was established and has been running since 2017. The community of 5000 users contribute to a peer-led information and support initiative geared to share expertise and build AT decision making capability. Service delivery by the AT user community and for the AT user community requires a commitment to co-design, and an engagement with concepts of risk, competency, scope of practice and capability. The learnings from AT Chat have implications for AT services on this journey everywhere. Active co-design of AT services meets human rights and good practice benchmarks required by contemporary services. Foregrounding AT users within program design and delivery, brings a range of positive outcomes and possibilities for the way services are delivered. AT users have substantial untapped potential which brings tangible outcomes for other AT users, health professionals, service provider organizations and for society. Development of paid roles and pathways to recognize the skills of AT users, and indeed AT communities has potential to improve AT user self-efficacy as well as to contribute to the AT workforce. [ABSTRACT FROM AUTHOR]

Leadership by health professionals is key in any health system, but health leadership training programmes are varied in their conceptualisation, learning objectives, and design. This paper describes an undergraduate leadership and management module for health students at the University of Sierra Leone and provides lessons from the design process. Our methods included an initial scoping review and qualitative study, followed by a co-design process of 10 workshops and 17 consultation meetings. The result was a curriculum with learning outcomes emphasising leadership identity, proactiveness, management of people and of change, and the formation of peer relationships. Learning methods included group teaching, team quality improvement projects, mentoring, and reflective practice. Lessons from the design process included the importance of support from university leadership and extensive consultation. Virtual workshops enabled broader participation but limited relationship building. Integrating doctoral research into the process facilitated inclusion of evidence and theory but risked reducing ownership by faculty. The importance of interprofessionalism and management skills in leadership training emerged during the process, illustrating the effectiveness of a co-design approach. Our programme is broadly aligned with other health leadership frameworks and is distinctive due to its undergraduate focus, offering insights for leadership training design in other settings. [ABSTRACT FROM AUTHOR]

Online activities have spiked due to the COVID-19 pandemic, including language learning activities. As the world is aging, this affects senior citizens too. Yet, few studies have been conducted studying online (language) learning in this age-group. Moreover, no concrete pointers exist on how to go about such an online language learning course. This paper examines what should be considered when designing and implementing online language learning courses for seniors. To that end we present data from 73 senior language learners from two independent language learning contexts: the Netherlands and Scotland. The data were collected between May 2020 and August 2021. Data includes spoken and written samples from lessons, focus groups, interviews and questionnaires. Given the qualitative nature of the data and the aim of identifying patterns of meaning across the respective datasets, a reflexive thematic analysis (TA) approach was adopted. We employed an inductive approach to coding, using both semantic (explicit or overt) and latent (implicit, underlying) coding frameworks, in order to inform two overarching themes: "Navigating the digital highway" and "Camera ready for new friends." We discuss these themes and their sub-themes and arrive at concrete recommendations for the third-age language learning classroom. [ABSTRACT FROM AUTHOR]

As an interface between health and education, comprehensive sexuality education (CSE) offers a potent tool among other interventions to accelerate healthy transition of adolescents into adulthood. With increasing interest in in-school CSE provision/delivery, young people in out-of-school contexts may be left behind. This study forms part of implementation research to understand if the activities used to train and support the facilitators are feasible, appropriate, acceptable, and effective in enabling them to engage a defined group of young people, deliver CSE to them in the out-of-school context, and assist them in obtaining relevant services. This paper presents findings of mapping of out-of-school CSE interventions in Ghana, ongoing or completed between 2015 and 2020, and then discusses a needs assessment of two purposively selected groups of vulnerable out-of-school youth: young people living with HIV and AIDS (YPLHIV) and those living in detention (YPiD). We conducted 10 interviews with YPLHIV and three focus group discussions with YPiD in November 2020. Qualitative data were analysed thematically using both deductive and inductive approaches. The mapping yielded 29 interventions (18/62% were ongoing) focused extensively on the delivery of CSE-related knowledge and information; none were aimed at building facilitators' capacity and most targeted the northern regions. Among YPLHIV, living positively after diagnosis, disclosure skills and use of HIV/AIDS health services were critical. YpID sought clarification on personal hygiene, consent in sexual relationships, medium/channel to deliver CSE, and issues around same-sex sexual intercourse. Both groups sought skills in dealing with stigmatisation and discrimination. Implications of the findings for our own and other interventions are highlighted. [ABSTRACT FROM AUTHOR]

Purpose: Between 55–65% of residents living in residential aged care facilities (RACFs) experience dysphagia and are prescribed texture-modified diets by a speech-language pathologist (SLP). The aim of this study was to assess current adherence to prescribed texture modification for people with dysphagia; and explore barriers to implementation in a rural aged care setting. Method: Meal texture audits (N = 42) were completed with residents with dysphagia in a rural RACF who were prescribed texture-modified diets or fluids by a SLP. Semi-structured focus groups were conducted with nursing and food preparation staff (N = 11) to identify barriers to implementation. Result: Mealtime texture audits identified that 54.8% (n = 23) of residents' food modification requirements were incorrectly documented in the manual entry database (kitchen form) and 64.3% (n = 27) of meal trays contained foods that did not meet residents' dysphagia management plans. Focus group data revealed seven main themes impacting on the ability of staff to implement prescribed texture-modified diets. Complicated processes and communication between nursing, food services and SLP staff were identified as major barriers. These were complicated further by time pressures experienced by staff as well as staffing issues, resourcing of the kitchen, accommodating individual dietary preferences and the variety/presentation of dietary options at the aged care facility. Conclusion: There was low adherence to SLP prescribed texture-modified diets and fluids in the participating rural RACF. This study identified major barriers to implementing SLP prescribed texture-modified diets including complicated processes, communication breakdowns, time pressures and limited staffing. Implementation of an online menu management system and regular dysphagia-specific training may address barriers to communication and complicated paper-based menu systems and should be a priority for health services to ensure adequate dysphagia management. [ABSTRACT FROM AUTHOR]

This paper discusses the development and initial implementation of the Promotores de Bienestar (PDB) (Promoters of Wellbeing) training program, designed to increase outreach to and engage Latinx and other communities negatively affected by the opioid crisis in overdose prevention. This innovative culturally responsive and community-informed program is focused on increasing awareness of the intersections of mental health and substance use disorders, stigma reduction, strengthening-needed support systems, and administration of Narcan, the life-saving opioid reversal medication. The PdB Training Program provides a model for working with a broad range of partners, including community residents, as part of a collaborative program development process. [ABSTRACT FROM AUTHOR]

This paper aims to strengthen the student's peace-loving attitudes through Huma Betang Value-Based on General Education Curriculum. General Education (GE) at the Palangka Raya University consists of multicultural students. Historically, there have been conflicts between students at Palangka Raya University and horizontal conflicts of the Dayak and Madura ethnic groups. Through a qualitative approach, the procedure of this research included: 1) FGD examines the GE curriculum 2) Workshop on the development of GE curriculum models based on Huma Betang values 3) Expert Validation of assessment on devices that have been developed 4) implementation of the GE model 5) The reflection of the Huma Betang value-based GE implementation. The results showed that the introduction to Huma Betang underscored the values ofhonesty, harmony, tolerance, and togetherness in diversity. Huma Betang Dialogs encouraged the introduction of each other between students from across departments and faculties. The Huma Betang could develop identity performances collaboration on ethnic characteristics of the students. The Huma Betang trained the students to have problem solving skills through the Peace-Loving Project, consisting of a brief video on peace-loving. The strengthening of the students' peace-loving attitudes can be integrated in the curriculum because the activities can increase students knowledge and understanding of others,accept the diversity in accordance with their identity, improve communication with others, increase solidarity with others, increase cooperation with others, make students creative in providing solutions to the problems of peace-loving, make students have the peace-loving attitudes, and make students do the actions that uphold the attitude of peace-loving. [ABSTRACT FROM AUTHOR]

New public health approaches to palliative care highlight the role of communities in care, yet there is little evidence of studies on community-led initiatives in the palliative care context. Therefore, the aim of this study, which took place in Auckland, New Zealand, was to (1) explore Pacific family carers' views on what they need to feel supported as they care for older family members at the end of life and (2) to devise a resource that reflects their views that may be used to raise community awareness about these needs. This was achieved using a Participatory Action Research (PAR) framework in which a focus group was carried out and a work group formed to implement the focus group's recommendations that were informed by a thematic analysis of the focus group data. The analysis resulted in the foregrounding of four themes, with the focus of this paper being on the 4th theme, the centrality of spirituality for a group of Pacific caregivers. This emphasis was chosen due to it being an underexplored topic in the palliative care literature. Co-creating resources based on research with community members allows for the development of tailored approaches of significance to that community, in this instance, a music video. [ABSTRACT FROM AUTHOR]

The relationships that children in care have with social workers and how their experiences are recorded has been identified as a key area of development for social work practice. This paper reports on a small-scale, qualitative evaluation of an approach to working with children in care launched in Brighton and Hove called Me and My World. Core principles of the model are explained including continuity of relationship between social workers and children in care; a statutory review process which promotes participation of the child and young person and a recording system where social workers, IRO's and foster carers write reports for review directly to the child. The methodology is detailed including documentary analysis, focus groups with social workers, IRO's and foster carers and semi-structured interviews with children in care. This article focuses on findings from one area of the evaluation – writing to the child. It demonstrates how writing directly to the child supports child-centred, accessible reports which focus on strengths, achievements and promotes explanations and aids life story work. Findings also show how writing to the child provides meaning in role for social workers, IRO's and foster carers and enables them to hold in mind that the report will be read by the child. Opportunities for further development are explored including the importance of social workers and IRO's ensuring depth and breadth of information; consistent inclusion of children's own voice in reports and strategies to ensure reports have a life beyond the computer screen. [ABSTRACT FROM AUTHOR]

Delivering effective healthcare requires healthcare professionals to reflect on their own cultural background and their patient's cultural needs. Culture is a determinant of health and if not considered, negative health outcomes can result. This is of particular importance when working with Aboriginal communities and caring for Aboriginal people whose views have been excluded from healthcare models, funding, and policy. Non-indigenous healthcare professionals, such as pharmacy students, benefit from understanding Aboriginal peoples' healthcare needs and models of holistic healthcare, as well as reflecting on their own cultures, assumptions, and experiences on placement. This article explores students' views to inform the development of a Toolkit to support students' learning prior to engaging in placements in Aboriginal communities. The study involved collaboration with students, Aboriginal community members, educators experienced in Indigenous health and allied health education. This paper is within a series exploring the development and evaluation of the 'Working Respectfully with Aboriginal People (WRAP): Student Toolkit'. [ABSTRACT FROM AUTHOR]

Purpose: An evidence-practice gap exists between the amount of active practice recommended and the amount completed by stroke inpatients. The aim of this paper is to describe steps in the design of a participatory, theoretically tailored staff behaviour change intervention to help staff use strategies to increase active practice by stroke inpatients. Methods: A staff behaviour change intervention was developed in one rehabilitation unit in Queensland, Australia using a six-step process guided by the Behaviour Change Wheel framework. Mixed methods were used including direct observation (behavioural mapping), and focus groups to identify barriers and facilitators to implementation. Barriers and facilitators were mapped to the behaviour change techniques, and a behaviour change intervention developed in participation with rehabilitation staff. Results: Staff chose to implement ward-based practice books. Barriers included patient factors (including low motivation and severity of stroke), environmental segregation and limited skills for motivating patients. Staff belief in increasing active practice was a facilitator to implementation. The staff intervention included a training programme about motivation, environmental restructuring, audit, and feedback. Conclusions: This example of collaborative implementation research can be used and adapted by clinicians and researchers in other rehabilitation services. Rehabilitation staff can be actively involved in designing behaviour change interventions. Behaviour change interventions should target local barriers to increase activity levels and practice completed by stroke inpatients. The process of co-designing behaviour change interventions has the potential to improve the uptake of a strategy such as ward-based practice books, by more precisely identifying local barriers and possible solutions. [ABSTRACT FROM AUTHOR]

Background: Participatory action research (PAR) is a credible, culturally appropriate methodology that can be used to effect collaborative change within vulnerable populations. Aim/objective: This PAR study was undertaken in a Western Australian metropolitan setting to develop and evaluate the suitability, feasibility and effectiveness of an Aboriginal peer-led home visiting programme. A secondary aim, addressed in this paper, was to explore and describe research methodology used for the study and provide recommendations for its implementation in other similar situations. Methods: PAR using action learning sets was employed to develop the parent support programme and data addressing the secondary, methodological aim were collected through focus groups using semi-structured and unstructured interview schedules. Findings were addressed throughout the action research process to enhance the research process. Results: The themes that emerged from the data and addressed the methodological aim were the need for safe communication processes; supportive engagement processes and supportive organisational processes. Conclusions: Aboriginal peer support workers (PSWs) and community support agencies identified three important elements central to their capacity to engage and work within the PAR methodology. This research has provided innovative data, highlighting processes and recommendations for child health nurses to engage with the PSWs, parents and community agencies to explore culturally acceptable elements for an empowering methodology for peerled home visiting support. There is potential for this nursing research to credibly inform policy development for Aboriginal child and family health service delivery, in addition to other vulnerable population groups. Child health nurses/researchers can use these new understandings to work in partnership with Aboriginal communities and families to develop empowering and culturally acceptable strategies for developing Aboriginal parent support for the early years. Impact Statement Child health nurses and Aboriginal communities can collaborate through participatory action research to develop peer-led support for the early years. Indigenous Australian peoples are people who identify as Aboriginal or Torres Strait Islander. Respectfully, throughout this paper, they will be described as Aboriginal. [ABSTRACT FROM AUTHOR]

Background: According to Slade's Personal Recovery Framework, mental health recovery involves developing a positive identity, reframing experiences, developing self-management and valued social roles. Aim: This study explored how developing a personal narrative can support mental health recovery through reframing and developing a more positive identity. This paper provides an overview of the study's three phases and the resultant Personal Narrative Workshop Programme. Method: Phase 1 involved developing and analysing my own recovery narrative using autoethnography. Phase 2 used Participatory Action Research (PAR) to explore the experience of other service users, with co-researchers recruited to two focus groups. Six co-researchers continued into Phase 3 (three cycles of PAR) to develop the workshop programme. Results: An eight-session workshop programme was co-produced and fully documented. Conclusions: Developing a narrative is not benign: it can involve reliving trauma; and dealing with the 'voice of others' in our narratives can be difficult. As a result, the workshop programme aimed to provide a supportive environment, promoting collaboration and validation. Methodological issues resulted from the complexities of using a PAR approach, and on the multiplicity of roles for the researcher. [ABSTRACT FROM AUTHOR]

There is growing recognition of the importance of addressing the mental health needs of young people attending university. Anonymous, scalable, and evidence-based online interventions can help to reduce burden on university services and increase access to care for marginalised or disconnected students. This paper reports the participatory design methods used to develop the Uni Virtual Clinic (UVC), a comprehensive online programme that was designed to prevent and treat mental health problems and related issues in university students. Data evaluating the participatory design process is also presented. The potential for the implementation of the UVC within university-based counselling services is strong, and has potential to reduce the prevalence of mental disorders in a high-risk group of young people. [ABSTRACT FROM AUTHOR]

There is a growing interest in intergenerational connectivity through intergenerational programs. In this work, a review of intergenerational programs was performed, with focus on the program design and objectives as well as in their outcomes. We used a systematic review method in which we screened 3,796 articles. After analyzing titles, abstracts, and full paper analysis, 16 articles were retained. Each study was reviewed, and data were extracted related to target population, study design, characteristics of intervention, outcomes, and effectiveness. Intergenerational programs included educational programs and art, Information technology development, cultural heritage, health education, and therapeutic activities. Most of the programs collected both quantitative and/or qualitative data. Seven studies collected data in the beginning and at the end of the program. Significant diversity in sample size and intervention length was found. Measurement of outcomes was performed in both young and/or elderly group of participants. Programs impact evaluation varied between studies, including validated scales, interviews, observation, focus groups, and conversation analysis, narratives, videotaped sessions, and field notes. Our study highlighted the diversity in the design of studies and in the program's effectiveness evaluation. More randomized design studies are required to support researchers and practitioners in the development of future intergenerational programs. [ABSTRACT FROM AUTHOR]

Screening, brief intervention and referral to treatment (SBIRT) in primary care is a burgeoning environmental treatment strategy for illicit and prescription drug abuse and a variety of other health behaviors. While clinical research on SBIRT's efficacy continues to produce positive results, translational research focusing on the integration of the evidence-based processes into primary care settings has been less prevalent. This paper describes the decisions made in the design of the Indiana SBIRT project and describes several barriers that prevented eligible patients from receiving services provided through SBIRT. It then elaborates on the qualitative mechanisms used to identify solutions to those barriers and provides preliminary quantitative evidence for the effectiveness of the solutions that were implemented. The intention of this translational research is to provide a broad perspective on program improvement so that other SBIRT projects in the United States and internationally might benefit from the lessons learned by Indiana SBIRT. [ABSTRACT FROM AUTHOR]

Young people are at a high risk of developing mental health disorders or illnesses. Mental health promotion (MHP) interventions can reduce this risk. Using the Medical Research Council (MRC) framework for the development and evaluation of complex interventions, this study designed and acceptability tested a methodologically robust school-based mental health promotion intervention. A scoping review and focus groups with stakeholders were conducted during the development phase of the MRC framework. The scoping review involved identifying evidence for effective school-based MHP interventions. Focus groups were then used to determine the acceptability of components identified by the scoping review and to clarify the target or goal of taking part in the intervention. A logic model, showing the theory of change underpinning an intervention designed on the basis of this development phase, was subsequently developed. The scoping review established that MHP interventions typically focus on stigma and stereotypes, mental health literacy and knowledge and help-seeking, and use these foci to determine impact. Common intervention components include group discussion, videos, presentations, storytelling and handouts. Testing of these commonly occurring components targeting knowledge and attitudes towards mental health and stigma and stereotypes suggested all were acceptable to stakeholders. Using the MRC framework to guide the development and test the acceptability of a MHP intervention, this study has produced a complex evidence-based health promotion intervention using interactive activities and videos. Further phases will involve a process evaluation of the intervention fidelity and feasibility testing. [ABSTRACT FROM AUTHOR]

Despite four decades of global experience with community-based primary health care, the strategic details of community health worker (CHW) recruitment, training, compensation, and deployment remain the subject of continuing discussion and debate. Responsibilities and levels of clinical expertise also vary greatly, as well as contrasting roles of public- versus private-sector organisations as organisers of CHW effort. This paper describes a programme of implementation research in Tanzania, known as the Connect Project, which aims to guide national policies with evidence on the impact and process of deploying of paid, professional CHWs. Connect is a randomised-controlled trial of community exposure to CHW integrated primary health-care services. A qualitative appraisal of reactions to CHW implementation of community stakeholders, frontline workers, supervisors, and local managers is reviewed. Results highlight the imperative to plan and implement CHW programmes as a component of a broader, integrated effort to strengthen the health system. Specifically, the introduction of a CHW programme in Tanzania should draw upon community structures and institutions and strengthen mechanisms to sustain their participation in primary health care. This should be coordinated with efforts to address poorly functioning logistics and supervisory systems and human resource and management challenges. [ABSTRACT FROM PUBLISHER]

In adults prolonged sitting is detrimentally associated with a number of health sequela including type 2 diabetes, cardiovascular diseases and all-cause mortality, and it has been suggested these negative health consequences may not be fully protected against by participation in physical activity. Altering ubiquitous environments for children to increase their opportunities to break or reduce extended sitting is therefore of key public health interest. Emerging research shows that physical activity can be introduced into the school classroom, through short activity breaks and by integrating movement into the learning of core academic content. This may help to improve children’s time on task, enjoyment of learning, and in some cases academic outcomes. This discussion paper briefly highlights some of the key research on movement integration in the classroom, discusses potential challenges and facilitators of implementation at a variety of levels (e.g. teacher, school, external stakeholder) and presents an ongoing, innovative programme (CLASS PAL) as a case study of one approach to get research on classroom movement integration into routine teaching practice. [ABSTRACT FROM AUTHOR]

Competency-based assessment seeks to align measures of performance directly with desired learning outcomes based upon the needs of patients and the healthcare system. Recognizing that assessment methods profoundly influence student motivation and effort, it is critical to measure all desired aspects of performance throughout an individual’s medical training. The Accreditation Council for Graduate Medical Education (ACGME) defined domains of competency for residency; the subsequent Milestones Project seeks to describe each learner’s progress toward competence within each domain. Because the various clinical disciplines defined unique competencies and milestones within each domain, it is difficult for undergraduate medical education to adopt existing GME milestones language. This paper outlines the process undertaken by one medical school to design, implement and improve competency milestones for medical students. A team of assessment experts developed milestones for a set of focus competencies; these have now been monitored in medical students over two years. A unique digital dashboard enables individual, aggregate and longitudinal views of student progress by domain. Validation and continuous quality improvement cycles are based upon expert review, user feedback, and analysis of variation between students and between assessors. Experience to date indicates that milestone-based assessment has significant potential to guide the development of medical students. [ABSTRACT FROM PUBLISHER]

Despite the rapidly increasing burden of tobacco-related morbidity and mortality in low- and middle-income countries, tobacco control initiatives – especially cessation – receive little emphasis. This is true despite low-cost methods that have potential for widespread dissemination. The purpose of this paper is to provide a case study example of how lay interventionists may be trained and supported to facilitate tobacco use cessation, based on the successful Tobacco-Free Teachers–Tobacco-Free Society program (TFT–TFS) implemented in Bihar, India. This school-based program included multiple components, with lay interventionists having a crucial role. The lay interventionists included health educators and lead teachers, both of whom were selected based on formative research, underwent extensive training and received continuing support. We emphasized encouraging and supporting teachers to quit tobacco use and engaging both tobacco users and nonusers to create a supportive environment for cessation. We also stressed that neither the health educators nor lead teachers were being trained as counselors or as cessation experts. We focused on the importance of respecting teachers as individuals and identifying locally relevant methods of cessation. Although we cannot isolate the precise contribution of the lay interventionists to the successful TFT–TFS intervention, the abstinence findings in favor of the intervention at follow-up are highly encouraging. Teachers have been neglected as lay interventionists for tobacco cessation despite the fact that they tend to be highly respected and credible. The approach used for TFT–TFS could be disseminable in multiple low- and middle-income country contexts through train-the-trainer programs targeted to teachers. [ABSTRACT FROM AUTHOR]

Background: Experience-based co-design (EBCD) is a methodology for service improvement and development, which puts service-user voices at the heart of improving health services. Aims: The aim of this paper was to implement the EBCD methodology in a mental health setting, and to investigate the challenges which arise during this process. Method: In order to achieve this, a modified version of the EBCD methodology was undertaken, which involved listening to the experiences of the people who work in and use the mental health setting and sharing these experiences with the people who could effect change within the service, through collaborative work between service-users, staff and managers. Results: EBCD was implemented within the mental health setting and was well received by service-users, staff and stakeholders. A number of modifications were necessary in this setting, for example high levels of support available to participants. Conclusions: It was concluded that EBCD is a suitable methodology for service improvement in mental health settings. [ABSTRACT FROM AUTHOR]

This paper is an analysis of the social interaction between drug sellers, their clients and local health care workers within a medical trial that introduced rapid diagnostic tests for malaria into private sector drug shops in Mukono District, Uganda. It locates the introduction of a new technology to test blood and a system of referral within the context of local concerns about the choice and evaluation of treatment; and the socially legitimated statuses, roles and hierarchies within the local health care system. Based on the multi-layered interpretation of 21 focus group discussions, we describe three key aspects of the trial central to local interpretation: openly testing blood, supervisory visits to drug shops and a new referral form. Each had the potential to shift drug shop vendors from outsider to insider of the formal health service. The responses of the different groups of participants reflect their situation within the health care system. The clients and patients welcomed the local availability of new diagnostic technology and the apparent involvement of the government in securing good quality health services for them from providers with often uncertain credentials. The drug shop vendors welcomed the authorization to openly test blood, enabling the demonstration of a new skill and newfound legitimacy as a health worker rather than simple drug seller. Formal sector health workers were less enthusiastic about the trial, raising concerns about professional hierarchies and the maintenance of a boundary around the formal health service to ensure the exclusion of those they considered untrained, unprofessional and untrustworthy personnel. [ABSTRACT FROM PUBLISHER]

Comprehending praxis is a critical step in developing interventions that can have a real-world impact on people's lives. In this paper, we reflect on the lessons learned in the development of a curriculum for young people living in informal settlements in eThekwini, who are exposed to numerous vulnerabilities, including HIV-related risks associated with precarious urban livelihoods. Behavioural interventions have not led to commensurate reductions in HIV incidence, and the impact of these approaches remains regulated by numerous contextual conditions affecting those participating. Our collaborative project tested the impact of implementing a combination of the well-tested gender transformation intervention, Stepping Stones, with a new livelihood transformation curriculum, Creating Futures, among young people in eThekwini's informal settlements. Creating Futures was grounded in the theory and practice of sustainable livelihoods, but equally in the experience of the multi-disciplinary project team members who have conducted both research and development work among youth in the eThekwini area. Our approach was founded on the work of Doug Kirby, and we are indebted to him for his inputs. His logical model approach ensured that the team remained orientated to specific curriculum outcomes. Analysis of the results at 12 months post-baseline indicates positive livelihood outcomes. [ABSTRACT FROM AUTHOR]

Suicide is a public health priority. International guidance on prevention, epidemiology and treatment-based research indicates the potential of gatekeeper training in this area. Whilst there is some evidence to suggest that interventions enhance the knowledge and skill set of gatekeepers, evidence regarding changes to intervention-related behaviour remains unclear. This disruption to the causal pathway between competency and action suggests the need to address contextual mediators of the implementation of gatekeeper training and to consider the individual as a situated agent, who is both enabled and constrained by the discourses and working practices of the organisation in which they work. To explore organisational influences on intervention behaviour, this paper draws upon a qualitative study of the applied suicide intervention skills training (ASIST) gatekeeper intervention in Wales. Thirty-three individual interviews and six focus groups (n = 25 individuals) with those employed by a range of statutory and non-statutory organisations and networks were included. Three key organisational influences were identified as impacting on gatekeeper’s intervention behaviour. These include: the democratisation of intervention; organisational attempts to enhance opportunities to intervene; and the creation of a positive context for intervention. This study concludes that both policy and practice need to move beyond a reductionist approach to gatekeeper training and attend to the organisational influences and contextual factors affecting intervention-related behaviour. [ABSTRACT FROM PUBLISHER]

The need to improve the sexual and reproductive health (SRH) and rights of women with disabilities is increasingly acknowledged. Unfortunately, women with disabilities in low- and middle-income settings, including Ghana, face several barriers (including structural, financial, physical, social and attitudinal) to accessing SRH services and care. This paper explores the enablers and barriers to accessing SRH services and care among visually impaired women in the Ashanti and Brong Ahafo Regions of Ghana. Qualitative data from in-depth interviews and focus group discussions were collected from 21 visually impaired women, selected through purposive and snowballing sampling techniques. Thematic analysis was used to develop codes, and data were further grouped into emerging themes. The barriers to accessing SRH services and care were financial difficulties and lack of preferential treatment. The enablers which facilitated access to SRH services and care were the support provided by caregivers and friendly relationships with health providers. To address these challenges and promote access, SRH related policies, services and programmes should be inclusive of the needs of visually impaired women, and measures to remove financial challenges to service utilisation and foster positive relationships with health workers, church and community members should be adopted. [ABSTRACT FROM AUTHOR]

To address child protection concerns countries often implement mandatory reporting (MR) laws. This ensures that relevant professionals alert child protection services of children who are at risk of or are currently experiencing abuse. However, these well-intended mandatory requirements can sometimes have unintended negative consequences that affect all those who are involved in the process. The current research investigated the experiences of Irish psychologists in implementing MR and examined if there was any personal or professional impact resulting from this process. All participants were qualified psychologists of various disciplines working in the HSE, the national health service of Ireland. A qualitative research design was implemented that consisted of thematic analysis of focus group transcripts. Three focus groups (n = 18) were conducted. Three major themes were identified within the data; the unintentional harm that is caused by MR, the contexts where reporting is needed, and the issues with the current MR system. Some benefits to MR exist but these advantages need to be considered within a greater context. The findings of the current study outlined how participants perceived aspects of MR as having significant detrimental consequences for victims of abuse. [ABSTRACT FROM AUTHOR]

Healthy eating (HE) and physical activity (PA) are essential for children's health and well-being. Innovative approaches, informed by formative research, are crucial to promoting these behaviors. Experiential learning, involving active, hands-on approaches, may be an effective way to encourage healthy behaviors in children. Children's museums could contribute to health education by providing a variety of educational opportunities. To inform the design of an experiential learning Healthy Living program for children at an Australian children's museum. A qualitative study involving focus group discussions with 23 caregivers and in-depth interviews with 6 staff were conducted to explore perceptions of caregivers and staff working in an Australian children's museum (Discovery Space) relating to potentially effective experiential learning strategies for promoting children's healthy behaviors. Data were transcribed verbatim and thematically analyzed in NVivo 12. Key considerations for promoting HE and PA children through experiential learning activities include involving caregivers, engaging children through processes such as providing choice and stimulating curiosity, and selecting appropriate activity types such as simple, engaging, fun, hands-on, sensory play, and music-based activities. Experiential learning activities that address these key considerations can promote HE and PA in children and should be studied in future studies. Competencies and sub-competencies in two areas of responsibility, (I) Assessment of Needs and Capacity and (V) Advocacy, were addressed. [ABSTRACT FROM AUTHOR]

Background: This study focuses on a decision support system (DSS) for home healthcare and the implementation of it. Aim: To describe home healthcare nurses’ experiences of the implementation and use of a new DSS, with a focus on how it influences decision making in everyday work practice. Design: A qualitative research design. Methods: Data was collected through three focus group interviews with six home healthcare nurses.The data analysis was drawn from Burnard’s method for content analysis. Results: The DSS was experienced as bringing support to decisions, but sometimes incompatible with home healthcare nurses’ work practice. Professional understanding and the DSS were sometimes experienced as parallel support systems not assisting work across healthcare organisations. Conclusion: When a DSS is used to transform work of healthcare organisations several aspects should be highlighted. If the organisation does not consider these aspects, nurses may adopt a role as mediator in the implementation process. [ABSTRACT FROM AUTHOR]

In Eswatini (formerly Swaziland), the increasing number of orphans and vulnerable children due to HIV/AIDS has spurred demand for psychosocial support services. When the Ministry of Education and Training assumed responsibility for delivering psychosocial support, educators were burdened with the additional role of looking after orphans and vulnerable learners. This exploratory, sequential, mixed-methods study was employed to analyse factors that enhance the provision of psychosocial support services and the perceptions of educators towards psychosocial support delivery. The qualitative study phase entailed 16 in-depth interviews with multi-sectoral psychosocial support specialists and seven focus group discussions with orphans and vulnerable learners. In the quantitative study phase, 296 educators were surveyed. Thematic analysis was used for the qualitative data, and the quantitative data was analysed using Statistical Package for the Social Sciences version 25 software. The findings reveal problems associated with psychosocial support service delivery at strategy, policy and operational levels. The results indicate that orphans and vulnerable children are offered material support (e.g. food and sanitary pads) and spiritual support, but were rarely referred for social and psychological needs. There were no proper counselling facilities and not all teachers received relevant training in children's psychosocial needs. Training of educators in specific psychosocial support areas was considered significant to enhance service delivery and the psychosocial well-being of the learners. Overall, accountability was difficult to establish because the administration of psychosocial support is split among the Ministry of Education and Training, the Deputy Prime Minister's office and Tinkhundla administration. There is unequal distribution of qualified early childhood development teachers to cater for early childhood educational needs. [ABSTRACT FROM AUTHOR]

Telerehabilitation has increasingly been used since the COVID-19 pandemic but with limited guidance available on undertaking physical assessments using remote methods. We aimed to provide such guidance by developing a Telerehab Toolkit, an online information and training resource for practitioners, patients, and carers on telerehabilitation for people with physical disabilities and movement impairment. Development and evaluation of the toolkit were informed by the Knowledge to Action framework and took place iteratively in two phases—knowledge creation and action. Information was collated from various sources including literature review, online survey, service evaluation, and focus group discussions. The toolkit has been evaluated using think-aloud interviews, e-mail and social media feedback from users, and analytics data on user engagement with the website. The Telerehab Toolkit focuses on remote physical assessments, and contains information on technology, digital skills, remote assessment tools, information governance, and safety for telerehabilitation. Resources include top tips from practitioners and patients, how-to guides, checklists, videos, and links to evidence. The Telerehab Toolkit has been well-received by practitioners, healthcare students, patients, and carers, is being disseminated widely, and is freely available (). Telerehabilitation has been increasingly used since the COVID-19 pandemic, but with limited guidance and training for practitioners on undertaking safe and effective remote physical assessments. The Telerehab Toolkit has been developed iteratively using the Knowledge to Action framework; it is a free online resource for practitioners and patients with specific guidance on telerehabilitation for physical disabilities and movement impairment. It is anticipated that the resource will help to improve the knowledge, skills, and confidence of the current and future rehabilitation workforce. [ABSTRACT FROM AUTHOR]

To explore the consequences, challenges, and future directions based on community health nurses' experiences during COVID-19. Qualitative study. Four focus group interviews were conducted with 27 community health nurses. Three major themes emerged: 1) Coordination of roles and duties, 2) Identifying deterioration of patients' health and increasing demand for visits, and 3) Changing service delivery strategies: a testing ground for new services. Community health nurses were essential public healthcare providers during the pandemic. The findings are informative for nurses and policy makers who can develop and suggest different services in the post-COVID era. [ABSTRACT FROM AUTHOR]

Background: Early integration of oncology and patient-centered palliative care is the recommended clinical practice model for patients with advanced cancer. General and specific communication skills are necessary to achieve integrated patient-centered care, but require organized training to be adequately mastered. Challenges and barriers on several levels, i.e. organizational, professional and individual may, however, hamper implementation. The development, implementation, and evaluation of such an educational program focusing on communication skills contain many steps, considerations and lessons learned, which are described in this article. Methods: A multi-professional faculty developed, implemented, and evaluated an educational program through a 5-step approach. The program was part of a Norwegian cluster-randomized controlled trial aiming to test the effect of early integration of oncology and palliative care for patients with advanced cancer. Results: The result is the PALLiON educational program; a multi-faceted, evidence-based, and learner-centered program with a specific focus on physicians' communication skills. Four modules were developed: lectures, discussion groups, skills training, and coaching. These were implemented at the six intervention hospitals using different teaching strategies. Evaluation in a subgroup of participants showed a positive appraisal of the group discussions and skills training. Conclusion:We present our experiences and reflections regarding implementation and lessons learned, which should be considered in future developments and implementations; (1) Include experienced faculty with various backgrounds, (2) Be both evidence-based and learner-centered, (3) Choose teaching strategies wisely, (4) Expect resistance and skepticism, (5) Team up with management and gatekeepers, (6) Expect time to fly, and (7) Plan thorough assessment of the evaluation and effect. Trial registration: ClinicalTrials.gov identifier: NCT03088202. [ABSTRACT FROM AUTHOR]

Interprofessional education (IPE) has potential benefits for improving the quality of patient care, but its implementation is challenged with multiple barriers. The primary objectives of this study were to explore the challenges, benefits, and incentives to establishing IPE from the perspective of healthcare faculty at King Saud University. Forty-five faculty members attended six focus groups, each consisting of 6–8 faculty members representing the five colleges. The focus group interview guide included the benefits of and barriers to establishing IPE in this academic institution, curricular design, and the feasibility of support from the colleges and University administration. A SWOC (Strengths, Weaknesses, Opportunities, Challenges) frame work was utilized to guide the focus group discussions, and the data were analyzed inductively using thematic analysis. Three main themes emerged and were related to (i) barriers, (ii) benefits, (iii) opportunities to facilitate the introduction of IPE, and (iv) suggestions on how to implement IPE and overcome challenges to establish an IPE curriculum. Participants were generally supportive of IPE and aware of the constraints that might impede its implementation. Moreover, they identified potential barriers and incentives to promote IPE. Although participants appreciated the long-term benefits of IPE, creating a supportive environment will require the involvement of the academic community, including students, faculty members, and the University's top management. [ABSTRACT FROM AUTHOR]

Since 2015 Médecins Sans Frontières (MSF) has been supporting the Ministry of Health (MoH) in Tonkolili district, Sierra Leone, with an integrated health care approach at the community, primary health centre (PHC), and hospital level. This programme is planned to be handed over to MoH. To prepare for this handover, a qualitative study exploring elements of a successful handover was undertaken in 2019. Focus group discussions (FGD) with the community members (n-48) and in-depth interviews (IDI) with MSF staff, community leaders, and MoH staff in Sierra Leone (n-15) were conducted. Data were audio-recorded, transcribed verbatim from English, Creole, and Themne, coded, and thematically analysed. Participants expressed that an optimal project handover and exit strategy should be a continuous, long-term, the staggered process included from the inception of the programme design. It requires clear communication and relationship building by all relevant stakeholders and demands efficient resources and management capacity. Associated policy implications are applicable across humanitarian settings on the handover of programmes where the government is functional and willing to accept responsibilities. [ABSTRACT FROM AUTHOR]

This article examines a programme for Bedouin youth in the unrecognised Bedouin villages in the Naqab/Negev desert in Israel, as a case study of the cultural adaptation and implementation of Westernised youth programmes among indigenous minority groups. Our analysis, based on an exploratory qualitative study that probes the accounts of 11 professionals involved in the project, 10 of whom are Bedouin, indicates that the facilitation of youth centres is related to 2 dimensions: cultural and political. Although the programme was shown to successfully address complex cultural aspects of the Bedouin community in the adaptation process and in daily routines (e.g. cultural values and norms), it does not address the political context in which the community lives. The programme thus articulates a social recognition of the particular needs of this population, yet does not promote social activism in a way that might challenge existing social hierarchies and power relations. Therefore, the change promoted by the programme is restricted to maintaining the existing social order. Our findings call for a politicising of the discourses of 'cultural adaptation' in order to promote social justice for oppressed groups. [ABSTRACT FROM AUTHOR]

Objective: Client centered care (CCC) is strongly advocated for improving the quality of health care. The aim of the current study was to explore client and staff perspectives of a new model of CCC implemented in a residential alcohol and other drug (AOD) treatment service. Specifically, the study aimed to (i) describe the defining features of CCC, and (ii) describe the benefits and challenges of implementing CCC at the service. Methods: Participants were 18 clients and eight staff who took part in focus groups and interviews. Thematic analysis of four client focus groups and eight staff individual interviews was conducted. Results: Staff identified the defining features of CCC as flexible, comprehensive, open-minded, and inclusive. Clients and staff shared predominantly positive views on the CCC model. Shared themes included the challenge of balancing flexibility and structure, and delivering comprehensive and individualized care within the limits of staff knowledge, skills, and resources. Conclusions: Results suggest that implementing CCC across an AOD treatment setting has clear benefits to staff and clients, along with challenges that require careful consideration and planning. Future research should evaluate the effectiveness of providing guidelines that address many of the challenges associated with implementing CCC. [ABSTRACT FROM AUTHOR]

The use of recovery-oriented practice (ROP) in mental health is increasing globally. This study explored attitudes of peer workers about ROP's implementation. A narrative approach embracing the principles of co-production and using semi-structured questions in a focus group setting was used. Data were analyzed for themes and content from eight participants. Themes indicated structural and individual barriers and facilitators. Power imbalances, organizational structure, stigma and inequity prevented the ease of implementation. On an individual level, there was a need for active listening, positive regard, and recognition of uniqueness in peer workers, recognizing them as experts in their own lives. Some of the supportive values that were identified were hope, inclusive practice, and collaboration. In terms of implementing ROP, organizations, and clinicians need to embrace a holistic approach, practice inclusiveness, and recognize the uniqueness of lived experienced employees. Organizations need to address culture, stigma, wage disparity, role definition, and the biomedical framework that seems to pervade public mental health. These ideas are reflected in the literature. The lived experience of peer workers contribute to a service's implementation, and clinician uptake, of ROP. The study contributes to increasing evidence that encourages the adoption of peer workers in mental health services. [ABSTRACT FROM AUTHOR]

A lack of social interaction during early stroke recovery can negatively affect neurological recovery and health-related quality of life of patients with aphasia following stroke. A Communication Enhanced Environment (CEE) model was developed to increase patient engagement in language activities early after stroke. This study aimed to examine staff (n = 20) and volunteer (n = 2) perceptions of a CEE model and factors influencing the implementation and use of the model. This study formed part of a broader study that developed and embedded a CEE model on two hospital wards. Six focus groups and one interview with hospital staff were conducted and analysed using a qualitative description approach. Feedback emailed by volunteers was included in the data set. Staff and volunteers perceived the CEE model benefitted themselves, the hospital system and patients. Staff identified a range of factors that influenced the implementation and use of the CEE model including individual staff, volunteer and patient factors, hospital features, the ease with which the CEE model could be used, and the implementation approach. This study provides valuable insights into staff perceptions which may inform the implementation of interventions and future iterations of a CEE model. A CEE model may promote efficiency and increased patient engagement in stroke rehabilitation. The CEE model information session and aphasia communication partner training, and the provision of resources, may be useful strategies to increase staff confidence in using communication supporting strategies with patients with aphasia. Behaviour change and implementation science strategies may provide a framework to address barriers and promote facilitators to embed hospital-based interventions that require individual, ward, cultural and systems level change to reduce the evidence-based gap in clinical practice. [ABSTRACT FROM AUTHOR]

Programs of All-Inclusive Care for the Elderly (PACE) are an effective approach to improve care quality and delay institutional admissions especially for Black and Hispanic older adults who have seen a disproportionate rise in nursing home use. Guided by Andersen's Behavioral Model of Health Services Use and employing focus groups and one-on-one interviews, we qualitatively examined factors influencing access to and use of PACE by Black and Hispanic older adults. The study sample consisted of thirty-two PACE enrollees, six marketing-team members, and four family-caregivers from three PACE sites in a northeast urban city. Informed knowledge, cultural beliefs, and attitudes toward PACE were found to affect access. Community resources, available services, and care quality facilitated enrollment/participation. Barriers identified included poor dissemination of information and inadequate emphasis on staff's sensitivity to enrollees' cultural and disability differences. Findings will help healthcare leaders capitalize on facilitators and address barriers to enhance access and use of PACE by racial and ethnic minority older adults. [ABSTRACT FROM AUTHOR]

The physician and respiratory therapist function as an interprofessional team caring for patients on mechanical ventilation. There is a paucity of research devoted to interprofessional education (IPE) of students from different professions in mechanical ventilation during clinical rotations in the medical intensive care unit (MICU). Student interprofessional education could develop team communication and shared decision-making skills early in training. The uniqueness of this introductory IPE programme is that it occurs during a clinical rotation in a real MICU, as opposed to a pre-clinical simulated campus setting, and it blends students from various educational backgrounds. Medical students and respiratory therapy students from different academic institutions participated in traditional lectures, small interprofessional group case-based problem-solving sessions, MICU bedside teaching sessions, written assessments, and focus groups. Quantitative responses were analyzed using descriptive statistics. Qualitative responses were categorised using the core competencies for Interprofessional Collaborative Practice. The purpose of this introductory IPE programme was to foster opportunities for interprofessional interaction during the student clinical experience while improving knowledge about mechanical ventilation. Qualitative expectations and feedback were predominantly positive. Quantitative responses suggest that students from both disciplines gained knowledge about mechanical ventilation in an IPE setting. [ABSTRACT FROM AUTHOR]

Hypermobility Spectrum Disorders (HSD) and Hypermobile Ehlers-Danlos Syndrome (hEDS) are heritable connective tissue disorders associated with joint instability and pain, but with scant guidance for supporting patients. The aim was to determine recommendations for an HSD/hEDS self-management intervention. Barriers to self-management were mapped onto the Theoretical Domains Framework (TDF) and Capability, Opportunity, Motivation-Behaviour (COM-B) model in a behavioural analysis. A modified Nominal Group Technique was used to prioritise behaviour change technique (BCT) interventions (n = 9 women). Possible BCTs incorporated: Incorporating self-help strategies, education to improve their knowledge of HSD/hEDS, and how to judge information about HSD/hEDS. In activity pacing, assertiveness and communication skills, plus what to expect during pregnancy, when symptoms can worsen. Support from occupational therapists to maintain independence at work and home. That illustrates how other people with HSD/hEDS have coped with the psychosocial impact. This study is the first to apply theoretically-informed approaches to the management of HSD/hEDS. Participants indicated poor access to psychological support, occupational therapy and a lack of knowledge about HSD/hEDS. Future research should evaluate which intervention options would be most acceptable and feasible. Patients with Hypermobility Spectrum Disorders or Hypermobile Ehlers-Danlos Syndrome can be active partners in the co-design of behaviour change interventions. Behaviour change interventions should target psychological support and patient education, particularly patient information. Additional behaviour change interventions included environmental restructuring and enablement; adaptations to participants' environment with input from occupational therapy. Participants were keen to suggest opportunities for behavioural modelling; positive fist-person modelling narratives, written by those with HSD/hEDS, which addressed how they coped with the psychosocial impact of their condition. [ABSTRACT FROM AUTHOR]

Society has progressed in universal design guidelines and assistive devices for individuals with disabilities yet challenges due to affordability and attractiveness concerns remain to incorporate them into existing residences. Repurposing (i.e., replacing or adapting problematic fixtures or spaces, with others not originally intended for that purpose) may be the action to address the concerns of consumers. The purpose of this study was to elicit information on problems and solutions regarding home modifications and identify ways that consumers and professionals implement repurposing, that residents deemed accessible, affordable, and attractive. This convergent parallel design study consisted of focus groups who rated images of repurposed spaces. The focus groups included consumers with functional mobility and visual limitations (n = 8); and professionals who devised or recommended home modifications (n = 8). Participants reviewed three images of home modification solutions and completed a Likert-scale rating based on accessibility and attractiveness. Focus group data indicated that high contrast, heights of fixtures, doors, and flooring – all pose threats to accessibility in the home. Consumers placed more value on attractiveness than professionals. Participants were aware and receptive to repurposing as a home modification technique but focused their discussion on adaptations. Overall, adoption and implementation of home modifications promote accessibility, but professionals need to consider individualized needs and preferences, before suggesting modifications. Repurposing existing spaces, features, and fixtures can serve as a method of home modification. Consumer home modification recommendations are perceived to be more effective when collaboratively and individually developed with professionals. Data gathered through focus groups can be valuable for informing practice and research in home modifications. [ABSTRACT FROM AUTHOR]

Standard Western demographic survey protocols fail to capture dynamics, such as circular migration and support networks, that profoundly influence the health of non-Western domestic social groups, typically called households. Enhanced protocols are needed because survey data provide the primary evidence base for health policy and planning globally. We present the participatory development, implementation and analysis of a novel demographic survey protocol, that aimed to better capture domestic social dynamics in rural Eswatini, southern Africa. The multiple-method study incorporated participatory health research about a community affected by HIV/AIDS, of which the survey formed part, and an ethnography of the participatory survey development process. Analysis of the data revealed limitations in the reliability and validity of standardised survey questions for measuring household membership, in contexts where circular migration and polygamy are common. Standard survey protocols potentiate double-counting members and misclassifying 'child-headed' and 'female-headed' households. They neglect social and economic dynamics that are known to influence health. Our novel demographic survey protocol provides a simple alternative method for capturing core data about circular migration and its impact on health. The study illustrates the contributions participatory and ethnographic research can make to enhancing demographic surveys. [ABSTRACT FROM AUTHOR]

Guidelines recommend that carers of stroke survivors should be engaged early in rehabilitation. There has been limited research implementing exercise programs that include carers. The aims of this study were to develop, facilitate, and evaluate an intervention, the Carers Count group, an exercise-based group for stroke survivors and their carers. Over a 5-month period, a staged approach was used to design the intervention and implementation strategies which would maximise the chances of embedding the intervention within an inpatient stroke ward. Implementation strategies included planning, educating, restructuring, financing, and managing quality. Following development and facilitation of the intervention, outcomes were evaluated through collecting data about therapy time, surveys (n = 30) and interviews (n = 18) with participants, and a focus group with staff. Thirty stroke survivors and their carers participated in the Carers Count group. Analysis of time spent in therapy showed that participation led to increased dose of physiotherapy time (service outcome). Survey and interview data suggested that participation in the group was a rewarding and engaging experience for participants (client outcomes). Using multifaceted strategies, a group designed to include carers was implemented on a stroke rehabilitation ward. The intervention provided positive outcomes in terms of increased therapy dose and satisfaction according to participant feedback. ANZCTR12620000708954 It is possible to develop modes of delivery in rehabilitation that include the carers of stroke survivors and these interventions are considered enjoyable and beneficial. Health professionals should consider interventions that are engaging and fun for stroke survivors and their carers. Health professionals should carefully plan and utilise appropriate implementation strategies when aiming to introduce a new intervention into an established health service. Health professionals should ensure stroke survivors and their carers have an understanding of recovery following stroke and how to maximise outcomes through increasing amount of practice. [ABSTRACT FROM AUTHOR]

The aim of this work was to co-develop an Acceptance and Commitment Therapy (ACT) intervention to support medication adherence and quality of life in breast cancer survivors (BCSs). The research approach was intervention co-development. The sample consisted of BCS focus groups (n = 24), health care provider (HCP) interviews (n = 10), and a co-development workshop (BCSs, n = 12; HCPs, n = 9).We conducted 6 BCS focus groups and 10 HCP interviews to understand the acceptability of ACT. We co-designed the intervention in a workshop. Participants reported high acceptability of an ACT intervention. BCSs preferred ACT exercises focused on values and self-compassion. Both groups recommended face-to-face intervention delivery, by a clinical psychologist, with a mixture of individual and group sessions. BCSs requested advice on side-effect management. We effectively used patient and HCP co-design to configure an ACT intervention to support medication adherence and quality of life for BCSs. If feasible and efficacious, this ACT-based intervention could support breast cancer survivorship. [ABSTRACT FROM AUTHOR]

The iWalk study showed that 10-meter walk test (10mWT) and 6-minute walk test (6MWT) administration post-stroke increased among physical therapists (PTs) following introduction of a toolkit comprising an educational guide, mobile app, and video. We describe the use of theory guiding toolkit development and a process evaluation. We used the knowledge-to-action framework to identify research steps; and a guideline implementability framework, self-efficacy theory, and the transtheoretical model to design and evaluate the toolkit and implementation process (three learning sessions). In a before-and-after study, 37 of the 49 participating PTs completed online questionnaires to evaluate engagement with learning sessions, and rate self-efficacy to perform recommended practices pre- and post-intervention. Thirty-three PTs and 7 professional leaders participated in post-intervention focus groups and interviews, respectively. All sites conducted learning sessions; attendance was 50-78%. Self-efficacy ratings for recommended practices increased and were significant for the 10mWT (p ≤ 0.004). Qualitative findings highlighted that theory-based toolkit features and implementation strategies likely facilitated engagement with toolkit components, contributing to observed improvements in PTs' knowledge, attitudes, skill, self-efficacy, and clinical practice. The approach may help to inform toolkit development to advance other rehabilitation practices of similar complexity. Toolkits are an emerging knowledge translation intervention used to support widespread implementation of clinical practice guideline recommendations. Although experts recommend using theory to inform the development of knowledge translation interventions, there is little guidance on a suitable approach. This study describes an approach to using theories, models and frameworks to design a toolkit and implementation strategy, and a process evaluation of toolkit implementation. Theory-based features of the toolkit and implementation strategy may have facilitated toolkit implementation and practice change to increase clinical measurement and interpretation of walking speed and distance in adults post-stroke. [ABSTRACT FROM AUTHOR]