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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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

Supporting the global eradication of wildpoliovrisu (WPV), this project aimed to provide polio and measles vaccines to a population frequenty missed by immunization services and campaigns, ethnic Somali children living among mobile populations within Kenya's Northeastern Region. Additionally, nutritional support, albendazole (for treatment of intestinal parasites) and vitamin A were provided to improve children's health and in accordance with regional vaccination campaign practices. To better understand movement patterns and healthcare-seeking behaviors within this population, we trained community-based data collectors in qualitative and geospatial data collection methods. Data collectors conducted focus group and participatory mapping discussions with ethnic Somalis living in the region. Qualitative and geospatial data indicated movement patterns that followed partially definable routes and temporary settlement patterns with an influx of ethnic Somali migrants into Kenya at the start of the long rainy season (April–June). Community members also reported concerns about receiving healthcare services in regional health facilities. Using these data, an 8-week vaccination campaign was planned and implemented: 2196 children aged 0–59 months received polio vaccine (9% had not previously received polio vaccine), 2524 children aged 9–59 months received measles vaccine (27% had not previously received measles vaccine), 113 were referred for the treatment of severe acute malnourishment, 150 were referred to a supplementary feeding program due to moderate acute malnourishment, 1636 children aged 12–59 months were provided albendazole and 2008 children aged 6–59 months were provided with vitamin A. This project serves as an example for how community-based data collectors and local knowledge can help adapt public health programming to the local context and could aid disease eradication in at-risk populations. [ABSTRACT FROM AUTHOR]

Although evidence indicates that task-shared psychological interventions can reduce mental health treatment gaps in resource-constrained settings, systemic barriers have limited their widespread implementation. Evidence on how to sustain and scale such approaches is scant. This study responds to this gap by examining the experiences of South African health managers involved in the implementation of a task-shared counselling service for Project MIND. To qualitatively describe managers' experiences of implementing the MIND programme and their insights into potential strategies for supporting sustained implementation. Two focus group discussions (FGDs) and eight in-depth interviews (IDIs) were conducted with managers of urban and rural primary care facilities in the Western Cape province. All managers were female and 30–50 years old. FGDs and IDIs used an identical semi-structured topic guide to explore the experiences of the MIND programme and perceived barriers to sustained implementation. Normalisation process theory (NPT) guided the thematic analysis. Four themes emerged that mapped onto the NPT constructs. First, managers noted that their relational work with staff to promote support for the intervention and reduce resistance was key to facilitating implementation. Second, managers emphasised the need for staff reorientation and upskilling to foster openness to mental health practice and for adequate time for quality counselling. Third, managers underscored the importance of strengthening linkages between the health and social service sectors to facilitate delivery of comprehensive mental health services. Finally, managers recommended ongoing monitoring of the service and communication about its impacts as strategies for supporting integration into routine practice. Findings contribute to the emerging literature on strategies to support implementation of task-shared interventions in low- and middle-income countries. The findings highlight the leadership role of managers in identifying and actioning these strategies. Investing in managers' capacity to support implementation of psychological interventions is critical for scale-up of these mental health innovations. [ABSTRACT FROM AUTHOR]

To achieve universal health coverage, health system strengthening (HSS) is required to support the of delivery of high-quality care. The aim of the National Institute for Health Research Global Research Unit on HeAlth System StrEngThening in Sub-Saharan Africa (ASSET) is to address this need in a four-year programme, with three healthcare platforms involving eight work-packages. Key to effective health system strengthening (HSS) is the pre-implementation phase of research where efforts focus on applying participatory methods to embed the research programme within the existing health system. To conceptualise the approach, we provide an overview of the key methods applied across work-package to address this important phase of research conducted between 2017 and 2021. Work-packages are being undertaken in publicly funded health systems in rural and urban areas in Ethiopia, Sierra Leone, South Africa, and Zimbabwe. Stakeholders including patients and their caregivers, community representatives, clinicians, managers, administrators, and policymakers are the main research participants. In each work-package, initial activities engage stakeholders and build relationships to ensure co-production and ownership of HSSIs. A mixed-methods approach is then applied to understand and address determinants of high-quality care delivery. Methods such as situation analysis, cross-sectional surveys, interviews and focus group discussions are adopted to each work-package aim and context. At the end of the pre-implementation phase, findings are disseminated using focus group discussions and participatory Theory of Change workshops where stakeholders from each work package use findings to select HSSIs and develop a programme theory. ASSET places a strong emphasis of the pre-implementation phase in order to provide an in-depth and systematic diagnosis of the existing heath system functioning, needs for strengthening and stakeholder engagement. This common approach will inform the design and evaluation of the HSSIs to increase effectiveness across work packages and contexts, to better understand what works, for whom, and how. [ABSTRACT FROM AUTHOR]

Dance improves physical, psychosocial, and cognitive function, while increasing community participation among community-dwelling individuals post-stroke. Yet little is known about how to structure community-based dance classes to optimize benefits and participation. This study aims to gain stakeholders' perspectives about how to optimally structure community-based dance classes for individuals with chronic stroke. A qualitative descriptive approach utilizing focus group methods was implemented. Two focus groups were undertaken with each of three stakeholder groups: persons post-stroke (n = 9), rehabilitation therapists (n = 6), and dance instructors (n = 8). Focus groups were audio-recorded and transcribed verbatim, providing the raw data. Analysis of the focus group transcripts were completed using the DEPICT model of collaborative qualitative analysis. This study identified three main themes/topics requiring consideration when structuring community-based dance programs: the environment, flow of the class, and qualities of the dance instructor. The study findings highlight that the pedagogical skills and teaching philosophy of the dance instructor are integral for a successful dance program, as the dance instructor directly mediates both the environment and flow of classes. Recommendations generated from our study can inform the development of community-based dance programs that are practical, optimize health benefits, and meet the needs and interests of people post-stroke. Dance is an effective way to improve physical, psychosocial, and cognitive function for persons post-stroke while also promoting meaningful social relationships within the community. A dance instructor who is a skilled communicator and is willing to adapt to the needs of the class, is the most important factor for a successful dance class. Creating a safe and inviting environment for a dance program, includes both the physical and emotional aspects of environment facilitating individuals to create connections with others and feel more confident in themselves. The structure of a dance class, based on the abilities, interests, and goals of dancers, should include elements of predictability and variability to keep dancers progressing and motivated, and be two times a week for 3 months lasting 1–2 h. [ABSTRACT FROM AUTHOR]

For many public assistance recipients, engaging in work activities is mandatory to receive benefits. Although the goal of such activities, to assist recipients in finding employment quickly, matches the goal of many recipients, research indicates that few obtain long-term employment. Informed by earlier welfare studies and street-level organization theory, we conducted focus groups to understand recipients' experiences and perceptions of the relationship between frontline public policies and their employment-related goals. Our findings reveal that recipients perceive rules and services as mismatched with their needs and experience poor communication with staff, leaving them to advocate for themselves and impeding progress. [ABSTRACT FROM AUTHOR]

Purpose: This article aims to explore counsellor experiences using an idiographic assessment procedure implemented in adolescent mental health services. The procedure, Assert, is based on asking the adolescents the question "What matters to you?" to define important topics to address in treatment. Methods: Focus groups and interviews were conducted with counsellors who used Assert (N = 27), and the data were analysed with thematic analysis. Results: Five themes were identified: (a) "What Matters to You?" (b) "Professional Responsibility," (c) "Empowering the Adolescent," (d) "Practical Utility of Assert in Treatment," and (e) "The Implementation of Assert." Each theme had a number of associated sub-themes. Conclusions: Assert was perceived by the counsellors as enhancing collaboration and conveying to the adolescents that the counsellors took their concerns seriously. It also provided structure by giving the sessions a concrete focus. However, some counsellors found it difficult to surrender control to the adolescents, and finding a balance between helping and directing the adolescents to define topics could be challenging at times. Assert was generally considered a useful and simple way to assess adolescents' concerns, and it was accepted by the counsellors as a positive contribution to their existing methods. [ABSTRACT FROM AUTHOR]

In the USA, there has been a nationwide call for comprehensive sexual health education programs to be LGBTQ+-inclusive. The Chicago Public Schools (CPS) K-12 curriculum was intentionally designed to align with the National Sexuality Education Standards and to be inclusive of lesbian, gay, bisexual, transgender, and questioning as well as other (LGBTQ+) identities (Chicago Public Schools, 2013). This case study of CPS's policy and curriculum implementation, with a focus on 9th grade, examines the extent to which this curriculum is truly experienced as inclusive by students and teachers. Twenty-nine ninth grade sex education class-periods were observed in 4 schools, 12 teachers were interviewed and 5 student focus groups were conducted to assess perceptions of the nature of inclusivity of the curriculum and ongoing needs to ensure inclusivity going forward. Students wanted a more LGBTQ+-inclusive curriculum defined by 1) including identity topics integrated throughout the curriculum; 2) more holistic discussion of sexuality; 3) more information about identity development, and 4) the creation of a safe space through an accepting, non-judgmental tone from teachers. Implications for the sexual health education field as well as for the larger public health field are discussed. [ABSTRACT FROM AUTHOR]

The successful implementation of sexuality education policy for young people has been shown to depend on a sound legislative and institutional framework. This article shows that both institutional factors and contextual obstacles have impeded the implementation of sexuality education policy in Uganda. Qualitative research techniques were employed in the form of systematic document reviews and extensive field-work with 64 participants, of which 32 were in-depth interviews with policymakers and key stakeholders in Kampala and Mbarara districts. In addition, four focus group discussions (n = 32) were conducted with teachers. The analysis was carried out thematically and manually, using open and axial coding. It was found that policy success was primarily limited by two broad factors: firstly, by institutional weaknesses such as a lack of capacity, inadequate financial commitment, poor coordination between relevant ministries and ineffective monitoring, and regulatory frameworks; secondly, by social, cultural and religious norms that give informal power to religious and cultural leaders. Two strategies are suggested as potential ways forward: (i) a commitment to both the human and financial resources needed to monitor adolescent sexual, and reproductive health programmes, but more importantly (ii) the initiation of negotiations with cultural and religious leaders to yield more positive outcomes. [ABSTRACT FROM AUTHOR]

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Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based intervention that has been shown to reduce alcohol use. Extant literature has demonstrated that SBIRT can be effectively integrated and implemented in primary care settings. Relatively little research has focused on the implementation of SBIRT in college student health centers. The aim of this study was to identify challenges and facilitators of implementing SBIRT in a college student health center. An exploratory, case study design was used with data collected in 2016 – 2017 from a parent evaluation study. The study included focus group and interview data collected from 25 SBIRT staff and stakeholders, patient data from 2,944 students, and project documents. Findings revealed challenges related to implementing SBIRT within an college health care setting and combating the community norms around drinking common on college campuses. Adaptations included important workflow adjustments. Improved outcomes included more staff support for the model and increased numbers of students fully screened and receiving services. Recommendations and implications related to the study setting are discussed. [ABSTRACT FROM AUTHOR]

Background and aim: Cognitive impairments following brain injury, including difficulty with problem solving, can pose significant barriers to successful community reintegration. Problem-solving strategy training is well-supported in the cognitive rehabilitation literature. However, limitations in insurance reimbursement have resulted in fewer services to train such skills to mastery and to support generalization of those skills into everyday environments. The purpose of this project was to develop and evaluate an integrated, web-based programme, ProSolv, which uses a small number of coaching sessions to support problem solving in everyday life following brain injury. Method: We used participatory action research to guide the iterative development, usability testing, and within-subject pilot testing of the ProSolv programme. The finalized programme was then evaluated in a between-subjects group study and a non-experimental single case study. Results: Results were mixed across studies. Participants demonstrated that it was feasible to learn and use the ProSolv programme for support in problem solving. They highly recommended the programme to others and singled out the importance of the coach. Limitations in app design were cited as a major reason for infrequent use of the app outside of coaching sessions. Conclusions: Results provide mixed evidence regarding the utility of web-based mobile apps, such as ProSolv to support problem solving following brain injury. Implications for Rehabilitation: People with cognitive impairments following brain injury often struggle with problem solving in everyday contexts. Research supports problem solving skills training following brain injury. Assistive technology for cognition (smartphones, selected apps) offers a means of supporting problem solving for this population. This project demonstrated the feasibility of a web-based programme to address this need. [ABSTRACT FROM AUTHOR]

In the United States, young people (ages 15–24 years) are disproportionately affected by human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs), due at least in part to inadequate or incorrect HIV/STD-related knowledge, attitudes, beliefs, and behavioral intentions (KABI). Comic book narratives are a proven method of HIV/STD prevention communication to strengthen KABI for HIV/STD prevention. Motion comics, a new type of comic media, are an engaging and low-cost means of narrative storytelling. The objective of this study was to quantitatively evaluate the effectiveness of a pilot six-episode HIV/STD-focused motion comic series to improve HIV/STD-related KABI among young people. We assessed change in HIV/STD knowledge, HIV stigma, condom attitudes, HIV/STD testing attitudes, and behavioral intentions among 138 participants in 15 focus groups immediately before and after viewing the motion comic series. We used pairedt-tests and indicators of overall improvement to assess differences between surveys. We found a significant decrease in HIV stigma (p < .001) and increases in both HIV knowledge (p = .002) and behavioral intentions to engage in safe sex (p < .001). In summary, this motion comic intervention improved HIV/STD-related KABI of young adult viewers by reducing HIV stigma and increasing behavioral intentions to engage in safer sex. Our results demonstrate the promise of this novel intervention and support its use to deliver health messages to young people. [ABSTRACT FROM PUBLISHER]

The Office on Women’s Health funded five pilot healthy weight intervention studies for lesbian and bisexual (LB) women, which included a program called Strong. Healthy. Energized (SHE). SHE was a 12-session program, targeted toward LB women age 60 and older, which focused on exercise, including a pedometer to track steps; nutrition; stress management; and group discussions. The program enrolled 39 participants. Waist circumference decreased by 3.7% across the group (p < .01). Participants with the lowest one-third baseline step count saw a marked step increase. This intervention was effective in improving health behaviors and short-term health outcomes for older LB women. [ABSTRACT FROM PUBLISHER]

Challenging HIV-infected patients, those neither adherent nor actively engaged in care, represent an important opportunity for intervention if the HIV epidemic is to be contained. This pilot study assessed the feasibility and acceptability of an adapted patient adherence intervention and a motivational interview-based provider intervention in urban Buenos Aires, Argentina, in order to optimize health benefits in challenging HIV-infected patients. To maximize implementation and uptake of both strategies, interventions were adapted to the local setting. Qualitative data and a short quantitative assessment from patients, staff, fellows, residents and physicians (n = 84) were examined to establish the feasibility and acceptability of offering patient and provider evidencebased interventions in both public and private health-care settings. Results identified key themes on provision of information, use of specialized communication techniques and group support in the utilization of the interventions. Both providers (n = 12) and patients (n = 120) endorsed the acceptability and value of the interventions, and the feasibility of their delivery. Findings support the use of both intervention modalities with challenging patients in diverse urban health-care settings. [ABSTRACT FROM AUTHOR]

It is important to understand what an interprofessional education (IPE) experience means to students and what makes it meaningful so that optimal use can be made of IPE opportunities and resources. This article reports qualitative data from a larger study evaluating an 11-hour IPE programme which focused on long-term condition management. Qualitative analysis aimed to explore students’ perspectives of the programme. Forty-one students from dietetics, medicine, physiotherapy, and radiation therapy were invited to participate in interprofessional focus groups. Data gathered from 34 students who participated in two focus groups were analysed inductively using thematic analysis. Three key themes emerged related to (i) learning, (ii) perceived long-term professional benefits, and (iii) the structure and content of the programme. Participants considered the programme to be a valuable learning opportunity with direct relevance to their future clinical careers. Findings indicated that providing students with an opportunity to learnabouteach other should be prioritised within IPE programmes and that this process should be student-led. This may help students to effectively learn with and from each other. Students perceived active learning activities, including interviewing a patient in their home and presenting findings to their peers, to be particularly valuable. [ABSTRACT FROM AUTHOR]

This study implemented a systematized, team-based Screening, Brief Intervention, Referral to Treatment (SBIRT) process in six primary care clinics that incorporated efforts of receptionists, medical assistants, and physicians. Focus groups were conducted to identify key facilitators of and barriers to successful implementation. Buy-in from physicians and clinic leadership and seamless integration of SBIRT into the electronic medical record were noted as the strongest facilitators. Time constraints and personal discomfort discussing substance use were cited as major barriers. A team-based approach to SBIRT in primary care settings capitalizes on the medical home model but also creates unique barriers. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to develop a group-based self-management programme for individuals with chronic fatigue syndrome (CFS) by using the participants' experiences with the initial version of the programme, which intends to promote coping with the illness in a primary healthcare setting. Methods: An initial programme was developed, based on self-efficacy theory and the concepts of client-centred practice and empowerment. Subsequently, the programme was tested and further developed by drawing on the participants' experiences with the programme. Focus-group interviews were applied. The interviews were analysed using thematic analysis. Results: The initial programme was found to be feasible, although several modifications regarding the content and practical organization of the programme were proposed. Conclusion: In line with the participants' experiences, the final self-management programme was developed, which includes short presentations of eight topics, exchange of experiences among participants, goal-setting, construction of action plans, and relaxation exercises, in addition to a meeting for relatives. The programme will be provided in eight biweekly sessions and be led by juxtaposed peer counsellors and occupational therapists. The effects of the final programme will be evaluated in a randomized controlled trial. [ABSTRACT FROM AUTHOR]

In this qualitative study the authors examine factors associated with the successful implementation and plans for continued use of an evidence-informed intervention, the 4Rs and 2Ss Program for Strengthening Families, in a sample of 29 New York State, Office of Mental Health licensed child mental health clinics. A learning collaborative (LC) approach was used as a vehicle for supporting training and implementation of the program. The PRISM theoretical framework (Feldstein & Glasgow, 2008) was used to guide the data analysis. Data were analyzed using a multi-phase iterative process, identifying influences on implementation at multiple levels: the program (intervention), the external environment, implementation and sustainability infrastructure, and recipient characteristics. Clinics that were more proactive evidenced staff with advanced organizational skills were able to take advantage of the trainings and supports offered by the LC and fared better in their ability to adopt the intervention. The ability to adapt the intervention to the specific constraints of the clinics was a strong influence on continued use following the end of the LC. These preliminary results suggest that the supports provided by the LC are useful in consolidating information about the process of implementing evidence-informed interventions in community mental health settings. The impact of these supports is also based on their interactions with specific clinic contextual factors. [ABSTRACT FROM AUTHOR]

Information Communication Technologies (ICT) have resulted in positive outcomes in a range of clinical studies, however, most have not had widespread subsequent uptake, partly because they were not developed with all stakeholder requirements in mind. In the current study, we engaged stakeholders in the concept development stage of a project to transform a psychosocial assessment into an ICT-enabled format. By engaging the stakeholders in this early process we were able to identify a range of software functionalities that are likely to improve the applicability for users, as well as identify possible barriers to implementation. [ABSTRACT FROM AUTHOR]

This manuscript summarizes an iterative process used to develop a new intervention for low-income urban youth at risk for negative academic outcomes (e.g., disengagement, failure, drop-out). A series of seven steps, building incrementally one upon the other, are described: 1) identify targets of the intervention; 2) develop logic model; 3) identify effective elements of targets; 4) vet intervention with stakeholders; 5) develop models for sustaining the intervention; 6) develop measures of relevant constructs currently missing from the literature; 7) assess feasibility and usability of the intervention. Methods used to accomplish these steps include basic research studies, literature reviews, meta-analyses, focus groups, community advisory meetings, consultations with scholarly consultants, and piloting. The resulting intervention provides early adolescents in low-income urban communities with a) training in contextually relevant coping, b) connection to mentors who support youth's developing coping strategies, and c) connection to youth-serving community organizations, where youth receive additional support. [ABSTRACT FROM PUBLISHER]

Objective: Attention deficit hyperactivity disorder (ADHD) is common among adult patients with a substance use disorder, yet often goes undetected. This is a qualitative study to explore implementation barriers to a guideline developed in Belgium for the recognition and treatment of ADHD in adult patients with substance use disorder and to gain a better understanding of the strategies to overcome these barriers. Methods: Focus groups were conducted with caregivers and patients to explore experiences with comorbid substance use disorder and ADHD. The barriers reported in these focus groups became the subject of further study in focus groups with addiction professionals (physicians, psychiatrists, and psychologists) who had tried the guideline and with psychiatrists specializing in addiction but without experience with ADHD. Results: Our analysis revealed a number of barriers to the implementation of this guideline, including lack of information from the family, pressure from patients and caregivers to make an ADHD diagnosis, and the potential for abuse of ADHD medication. Furthermore, diagnostic instruments for ADHD have not been validated in people with substance use disorder. Although patients with ADHD are usually treated in an outpatient setting, patients with ADHD comorbid with substance use disorder are difficult to identify in an outpatient setting for various reasons. Finally, there is a lack of specific ADHD expertise in substance use treatment organizations. Conclusions: Despite the availability of an approved guideline for recognizing and treating adult ADHD in patients with a substance use disorder, underdiagnosis and inadequate treatment still persist. As in general substance use treatment, medication only plays a supportive role in the treatment of substance use disorder with comorbid ADHD. An integrated approach and further improvements in the competence of practitioners may help to reduce the resistance to diagnosing ADHD in substance use treatment centers. Practitioners who specialize in addiction medicine and therapists without medical education view the problem from different perspectives and therefore each group needs specific information and training. Targeted interventions need to be developed to keep these patients in treatment. [ABSTRACT FROM AUTHOR]

Puerto Ricans are the second largest Hispanic group in the United States, and older adults have significant health disparities. Educational programs that address heart disease risk for this population have rarely been developed and implemented. Purpose To address this gap, the Heart Healthy Initiative for Puerto Rican adults is being developed. To develop it as a participatory program, the community members were asked about their perspectives. Methods Five focus groups with 28 participants, aged 45 to 60, were conducted, transcribed, and analyzed using thematic analysis. In-depth analysis of meanings of health-promoting behaviors in the context of cultural beliefs and values was carried out. Results The following themes were identified: health as balance and integration; health as connection of self, connection with others; cultural meanings of lifestyle choices; stresses and struggles. Participants suggested that the program should have significant variety and a holistic perspective, be sensitive to different needs and motivations, and stimulate mutual understanding and shared cultural meanings. Discussion The program needs to support lifestyle changes that maximally preserve traditions and to introduce multilevel changes. Translation to Health Education Practice The identified cultural meanings of diet, physical activity, and relationships were taken into account to develop the educational curriculum. [ABSTRACT FROM PUBLISHER]

Tobacco cessation treatments have not been evaluated among Alaska Native (AN) adolescents. This pilot study evaluated the feasibility and acceptability of a targeted cessation intervention developed for AN youth. Intervention components were informed by prior focus groups assessing treatment preferences among AN youth, a social cognitive theoretical framework and feedback obtained from a teen advisory group. The intervention consisted of a weekend program where youth traveled by small airplane from their villages to stay overnight with other adolescents who quit tobacco use together. The program included recreational activities, talking circles, personal stories from elders and teen advisors, and cognitive behavioral counseling. Two intervention pilots were conducted from October 2010 to January 2011 using a non-randomized, uncontrolled study design with assessments at baseline and six-week follow-up. One village in Western Alaska was selected for each pilot with a targeted enrollment of 10 adolescents each. Participants were recruited for each pilot within five days, but recruitment challenges and 'lessons learned' are described. The first pilot enrolled nine adolescents (all female) aged 13-16 years; all nine attended the intervention program and 78% (7/9) completed follow-up. The second pilot enrolled 12 adolescents (eight females, four males) aged 12-17 years, of which seven attended the intervention program. Six of these seven participants (86%) completed follow-up. In both pilots, participants rated the intervention as highly acceptable. A targeted cessation intervention was feasible and acceptable to AN youth. The intervention will be tested for efficacy in a subsequent randomized controlled trial. [ABSTRACT FROM AUTHOR]

Rarely has substance use prevention programming targeted Asian-American adolescents. Using a focus group methodology, we explored perceptions of substance use and preferences for prevention programming among 31 Asian-American adolescents in New York City. Participants considered substance use common in the community. Factors contributing to substance use among Asian-American adolescents (e.g., peer pressure, pressure to achieve, family factors, and community influence) were identified, and the need for prevention programs tailored for the Asian-American community was highlighted. Participants discussed preferred program content, delivery settings, and recruitment and retention strategies. Despite the favorable attitude for family-based prevention programming, participants raised potential issues concerning the feasibility of such a program. Study findings facilitate understanding of Asian-American adolescents' substance use behavior and shed light on prevention program development for this underserved population. [ABSTRACT FROM AUTHOR]

This article describes the planning and implementation of a mixed-method community needs assessment with the intent of creating a system of care for gay, lesbian, bisexual, transgender, and questioning (GLBTQ) youths in an urban area. Flowing from qualitative to quantitative research strategies, this needs assessment utilized key informant interviews, focus groups, and survey research in a countywide initiative. Rather than outline each set of findings, this article provides a brief description of the four phases of research activities and the action steps that were completed during each phase. Community context for the needs assessment is described in detail and a final system of care is proposed. Notable barriers and challenges associated with the community needs assessment are also articulated. [ABSTRACT FROM AUTHOR]

Background: Competency-based assessment innovations are being implemented to address concerns about the effectiveness of traditional approaches to medical training and the assessment of competence. Aim: Integrating intended users' perspectives during the piloting and refinement process of an innovation is necessary to ensure the innovation meets users' needs. Failure to do so results in no opportunity for users to influence the innovation, nor for developers to assess why an innovation works or does not work in different contexts. Methods: A qualitative participatory action research approach was used. Sixteen first-year residents participated in three focus groups and two interviews during piloting. Verbatim transcripts were analyzed individually and then across all transcripts using a constant comparison approach. Results: The analysis revealed three key characteristics related to the impact on the residents' acceptance of the innovation as being a worthwhile investment of time and effort: access to frequent, timely, and specific feedback from preceptors. Findings were used to refine the innovation further. Conclusion: This study highlights the necessary conditions for assessing the success of implementation of educational innovations. Reciprocal communication between users and developers is vital. This reflects the approaches recommended in the Ottawa Consensus Statement on research in assessment published in Medical Teacher in March 2011. [ABSTRACT FROM AUTHOR]