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Google Docs is a widely used online word processing software. Despite its broad popularity in business and education, Google Docs is under-utilised as a tool to facilitate qualitative interviews within research. In this article, we reflect on our experiences as two PhDs using Google Docs to conduct synchronous, online, written interviews. We present two case studies, which, to our knowledge, are the first to utilise Google Docs to conduct web-based written interviews. In doing so, we (a) outline the development and implementation of the methodology, (b) highlight the key themes we identified when considering the benefits and challenges of conducting interviews using this technology and (c) discuss possible future uses of the methodology. We argue that synchronous web-based written interviews via Google Docs offer unprecedented opportunities for qualitative research.

HIV and substance use interact synergistically to exacerbate disease progression and contribute to poorer engagement in treatment. There is a lack of qualitative research exploring the complexity of systems that impact HIV patients' linkage to and retention in both substance use and HIV care. Data from qualitative individual interviews with 16 HIV and 13 substance use providers were analyzed using applied thematic analysis. Four themes emerged as barriers to linkage to care providers limited knowledge with appropriate referrals; limited access to treatment options within the community; difficult admission criteria to substance use facilities; and communication challenges across providers including power differential. Emergent themes as barriers to treatment retention were: unstable life of people who use drugs; providers' negative attitude and stigma towards patients; and transportation challenges. Interventions are needed to increase provider cross-training in HIV and substance use disorders, reduce barriers to accessing treatment, and improve communication across providers are needed.

Background Given the modest functional outcomes seen after surgical reconstruction and subsequent therapy, increasing attention is being directed to patient satisfaction and psychological aspects of recovery after brachial plexus injury (BPI). Purpose To better understand the recovery course after surgical reconstruction for BPI, we used qualitative interviews and focused on common points of frustration for patients. Study Design Qualitative, interpretive description study Methods We conducted semi-structured interviews with BPI patients who were 6+ months post-surgical reconstruction. The interview focused on the patients’ experience with BPI, focusing on emotional aspects of recovery. Interviews were transcribed and independently coded by 2 researchers. We used inductive and deductive analysis to organize codes into themes. Once thematic saturation was reached, no additional interviews were conducted. Results We interviewed 15 BPI patients at median 13 months after surgery (range: 6-43 months). Our analysis revealed: (1) BPI patients expressed variable degrees of participation during recovery, with the indeterminate state of function making it difficult to adjust to life after BPI. (2) The uncertainty while waiting for improved function is frustrating to BPI patients, with many patients expressing concern for activities and moments they are missing due to injury. (3) While many BPI patients feel left out of decision-making, those who felt engaged in the process expressed less frustration and more acceptance of their status. Conclusion Traumatic BPI patients those who felt engaged in decision-making were more receptive to adjustment to their new state of function. When coordinating multidisciplinary care, measures to encourage patients to feel agency over their outcome and to develop self-management skills have the potential to improve patient satisfaction.

Objective School-based vision programs (SBVPs) are one approach to increase access to vision care by providing vision screenings, eye examinations, and eyeglasses directly in schools. Few studies report on the perspectives of teachers and staff, who are important stakeholders, on SBVPs. We examined teacher and staff perspectives on their involvement in SBVPs. Design Qualitative study using focus groups. Participants Teachers and staff at Baltimore and Chicago public schools served by SBVPs between 2016 and 2018. Methods We conducted 21 semistructured focus groups with 117 teachers and staff in 10 Baltimore and 11 Chicago public preK–12 schools that participated in SBVPs. Sessions were recorded, transcribed, and coded using inductive thematic analysis. Results Participants identified 2 main themes regarding teacher and staff involvement in SBVPs: (i) program outreach, including using multiple communication modalities to engage parents, explaining program details to families, and helping with program consent form return and (ii) promoting vision health, including identifying vision problems in the classroom, encouraging eyeglasses wear, and supporting eyeglasses maintenance. Participants also discussed limitations in capacity to partake in these activities. Conclusion Teachers interact with parents and students throughout the SBVP process, undertaking important roles in outreach and health promotion to ensure uptake of SBVP services. SBVPs and other school-based health programs should explore strategies to support teachers in the roles they fill to optimize program impact.

Hallux rigidus is the second most common condition to affect the first ray with an incidence of 2.5% in those above 50 years. Metatarsophalangeal Joint (MTPJ) arthrodesis remains the standard surgery. There are currently no Patient Reported Outcome Measures (PROMS) or functional outcome measures specific to first MTPJ arthrodesis. Finding out what patients can and cannot do after surgery would help surgeons appropriately consent patients and manage expectations pre and post-surgery. A pilot group of 15 patients post arthrodesis agreed on the suitability of the questions developed by the authors. As no further changes were made, a further 35 patients were recruited. Median age was 68 years, 78% were females, and 68% of patients were retired. Median follow-up was 64.5 months. Complete or almost complete pain relief was reported by 92% of patients. No major difficulty was reported by 97% of patients using ladders, 95% of patients driving, 90% of patients standing, 86% of patients wearing shoes without heels. Fifty-seven percent of patients reported extreme difficulty running and 48% percent of patients reported moderate or extreme difficulties wearing shoes with heels. None of the men reported difficulty with shoe wear without heels compared to 18% of women (p=0.01). None of the men reported any difficulty in driving compared to 18% of women (p=0.06). Difficulty in walking was reported in 44% of women compared to 9% of men (p=N/S). Our study is the first to reflect patients’ own long term experiences following first MTPJ arthrodesis. Based on our study, following first MTPJ arthrodesis the majority of patients did not have trouble with pain, walking, standing and driving. More than half of patients did not have trouble wearing shoes without heels; up to a third didn't have trouble wearing heels. More women experienced difficulty compared to men wearing shoes without heels, driving, and walking.

Background:Conducting and/or disseminating research in partnership with potential research users is a popular approach to conducting useful and relevant research. Despite calls for guidance to support these research partnerships, evidence-based tools and resources remain limited. Aims and objectives:This study aimed to explore principles and related strategies for conducting and/or disseminating spinal cord injury (SCI) research in partnership with the SCI community, in order to gain insight into ways to support SCI research partnerships. This qualitative study included ten semi-structured interviews with SCI research partnership champions. The interviews focused on participants’ experiences with SCI research projects that are conducted or disseminated in partnership, and related principles and strategies to work in research partnerships. Participants mainly talked about principles related to: (1) the relationship between researchers and research users (for example, respect each other, avoid tokenism); (2) co-production of knowledge (for example, research user engagement early and throughout); and (3) meaningful engagement (for example, allowing flexibility). Examples of related strategies included attending collaborative conferences, research user engagement in refinement of research questions, training in research methods, and hiring people with SCI as part of the research team. Key conclusions:This qualitative study presents research partnership principles (norms) and related strategies (observable actions). This study can provide guidance for other researchers and research users who want to engage in (SCI) research partnerships. The findings of this study could be used to inform the development of evidence-based tools and resources to support future research partnerships.

Grounded Theory (GT), a sociological research method designed to study social phenomena, is increasingly being used to investigate the human and social aspects of software engineering (SE). However, being written by and for sociologists, GT is often challenging for a majority of SE researchers to understand and apply. Additionally, SE researchers attempting ad hoc adaptations of traditional GT guidelines for modern socio-technical (ST) contexts often struggle in the absence of clear and relevant guidelines to do so, resulting in poor quality studies. To overcome these research community challenges and leverage modern research opportunities, this paper presents Socio-Technical Grounded Theory (STGT) designed to ease application and achieve quality outcomes. It defines what exactly is meant by an ST research context and presents the STGT guidelines that expand GT's philosophical foundations, provide increased clarity and flexibility in its methodological steps and procedures, define possible scope and contexts of application, encourage frequent reporting of a variety of interim, preliminary, and mature outcomes, and introduce nuanced evaluation guidelines for different outcomes. It is hoped that the SE research community and related ST disciplines such as computer science, data science, artificial intelligence, information systems, human computer/robot/AI interaction, human-centered emerging technologies (and increasingly other disciplines being transformed by rapid digitalisation and AI-based augmentation), will benefit from applying STGT to conduct quality research studies and systematically produce rich findings and mature theories with confidence., Comment: Accepted to IEEE Transactions on Software Engineering (Aug 2021); This author preprint is 26 pages, the final IEEE version is 25 pages due to reformatting, content is same. More details: https://rashina.com/

In recent years, qualitative research has gained ground as one of the main tools to analyze reality and propose innovation projects. This qualitative methodology has strengthened an innovative pedagogical structure, within the teaching of design disciplines. This is the specific case of our educational activity in the Modular System (UAM X), which facilitates the application of these tools in the design process. Reviewing the data in the analysis in a more qualitative way, promotes a more credible, reliable and valid vision to propose solutions to the problems detected. Thus, achieving a comprehensive understanding of the phenomenon and considering the factors involved in order to generate more relevant solutions. Within architecture, some projects that are addressed, such as the historical and cultural heritage of spaces and cities, use qualitative research techniques to discover and interpret the real vision of the inhabitant/visitor of these spaces. It is essential to understand how the city is lived from the point of view of the different actors that interact in the space, in order to generate plans and projects that reinforce and enrich social interaction. In industrial design, the students take these tools and apply them to the first phase of their project in search of insights that will allow them to bring forward innovative products with a real impact on society. This paper addresses these two cases, highlighting the importance of these tools being internalized by our students completing their training with a research profile focused on design.

As part of the Measurement Approaches to Partnership Success study, we investigated the relationship between benefits and costs of participation in long-standing community-based participatory research (CBPR) partnerships using social exchange theory as a theoretical framework. Three major findings were identified: (a) the concept of benefits and costs operating as a ratio, where individual benefits must outweigh costs for participation, applies to early stages of CBPR partnership formation; (b) as CBPR partnerships develop, the benefits and costs of participation include each other’s needs and the needs of the group as a whole; and (c) there is a shift in the relationship of benefits and costs over time in long-standing CBPR partnerships, in which partners no longer think in terms of costs but rather investments that contribute to mutual benefits.

DevOps is becoming a main competency required by the software industry. However, academic institutions have been slow to provide DevOps training in software engineering (SE) curricula. One reason for this is the fact that problems addressed by DevOps may be hard to understand to students who have not previously worked in the industry or on projects of meaningful size and complexity. This paper shows an experience that integrates DevOps in SE curricula through research-based teaching (RBT). We aim to expose students to the problems that have led companies to adopt DevOps by researching and analyzing real cases of companies, thereby placing students at the center of learning. The contribution of this work is to innovate the application of RBT in software engineering by using (i) qualitative analysis, specifically coding techniques, to discover knowledge and (ii) inter-coder agreement (ICA), specifically Krippendorffs coefficients, to measure the extent of students' learning. These techniques allow teachers to determine whether students' learning in the subject is homogeneous and to analyze disagreements among students during their analysis. This approach provides teachers with new tools (Krippendorff's coefficients) to identify those concepts that are less understood by students and to evaluate whether improvements in the research instruments (e.g., the codebook used in the qualitative analysis) also generate improvements in the students' agreement. This RBT experience shows evidence that can be used to assess whether a similar experience and the use of ICA could be applied in similar learning contexts with similar research contexts.

Jean Pierre Gafaranga,1,2 Felix Manirakiza,3,4 Emmanuel Ndagijimana,5 Jean Christian Urimubabo,6 Irénée David Karenzi,7 Esperance Muhawenayo,6 Phophina Muhimpundu Gashugi,8 Dancilla Nyirasebura,6 Belson Rugwizangoga3,4 1Department of Psychiatry, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda; 2Department of Psychiatry, University Teaching Hospital of Kigali, Kigali, Rwanda; 3Department of Clinical Biology, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda; 4Department of Pathology, University Teaching Hospital of Kigali, Kigali, Rwanda; 5Department of Epidemiology and Biostatistics, School of Public Health, University of Rwanda, Kigali, Rwanda; 6Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda; 7Department of Surgery, Ruhengeri Referral Hospital, Musanze, Rwanda; 8Department of Physical Rehabilitation, University Teaching Hospital of Kigali, Kigali, RwandaCorrespondence: Jean Pierre Gafaranga, Department of Psychiatry, University of Rwanda, Kigali, Rwanda, Department of Psychiatry, University Teaching Hospital of Kigali, Kigali, Rwanda, Tel +250788224864, Email j.p.gafaranga@ur.ac.rw; gafajepi@gmail.comBackground: Cervical cancer is a global public health problem with marked geographical disparity. High morbidity and mortality rates in developing countries are associated with low screening rates. In 2020, in Rwanda, 3.7 million women aged 15– 59 years were at risk of developing cervical cancer, the most commonly diagnosed female cancer in Rwanda. Despite Rwanda being the first African country to vaccinate against human papilloma virus with a three-dose regimen vaccination coverage of nearly 93% in the target population of girls aged < 15 years, and having established cervical cancer screening program, recent studies have found low screening rates. Our study sought to determine knowledge, motivators and barriers of cervical cancer screening.Methods: We conducted a qualitative descriptive study; using focus group interview in an urban health facility (Muhima district hospital) and a rural health center (Nyagasambu health center) offering cervical screening services in Rwanda. Participants were women seeking these services and other women attending the health facility for any reason, and female staff working in these facilities. Interviews were recorded and transcribed, and data were analyzed using content analysis.Results: Thirty women participated in focus group interview, with an average age of 39 years. Many of women showed knowledge about cervical cancer existence and prevention methods. However, fear for pain, lack of knowledge about screening, how and where the screening was done, and concern for privacy were recurring subthemes. Some participants also mentioned lack of health insurance as a barrier for cervical cancer screening.Conclusion: Barriers to uptake cervical cancer screening services in Rwanda are related to poor information about cervical cancer and the importance of screening as well as non-adherence to medical insurance. Population sensitization through campaign and community outreach activities could have a positive impact on increasing the usage of cervical cancer screening in Rwanda.Keywords: cervical cancer, screening, fear for pain, qualitative, acceptance, Rwanda

BACKGROUND: The COVID-19 pandemic has caused isolation, fear, and impacted on maternal healthcare provision. AIM: To explore midwives' experiences about how COVID-19 impacted their ability to provide woman-centred care, and what lessons they have learnt as a result of the mandated government and hospital restrictions (such as social distancing) during the care of the woman and her family. METHODS: A qualitative interpretive descriptive study was conducted. Twenty-six midwives working in all models of care in all states and territories of Australia were recruited through social media, and selected using a maximum variation sampling approach. Data were collected through in-depth interviews between May to August, 2020. The interviews were recorded, transcribed verbatim, and thematically analysed. FINDINGS: Two overarching themes were identified: 'COVID-19 causing chaos' and 'keeping the woman at the centre of care'. The 'COVID-19 causing chaos' theme included three sub-themes: 'quickly evolving situation', 'challenging to provide care', and 'affecting women and families'. The 'Keeping the woman at the centre of care' theme included three sub-themes: 'trying to keep it normal', 'bending the rules and pushing the boundaries', and 'quality time for the woman, baby, and family unit'. CONCLUSION: Findings of this study offer important evidence regarding the impact of the pandemic on the provision of woman-centred care which is key to midwifery philosophy. Recommendations are made for ways to preserve and further enhance woman-centred care during periods of uncertainty such as during a pandemic or other health crises.

Aim As burn self-stigma has not been addressed yet, the purpose of current study is to analyze dimensions of the concept using literature and lived experiences of Iranian burn survivors. Methods Using hybrid concept analysis method, we investigated self-stigma in three phases (i.e. theoretical, fieldwork, and final analytical phase). In the first phase we reviewed the literature using PubMed, SCOPUS, Web of Science, Cochrane Library, OVID, SID and Google Scholar. Thirteen semi-structured interviews with burn survivors were conducted during the fieldwork phase. Two extra interviews with health care providers were undertaken for the aim of data triangulation. Textual content analysis and inductive content analysis were used to analyze the data of the first and second phases of this study, respectively. The findings of both phases were combined in the final analytical phase and a comprehensive definition was emerged. Results We assigned all our findings into three content areas (i.e. antecedents, properties and consequences), which are dimensions of self-stigma. In final analytical phase antecedent, properties and consequences of the concept were formed in one (society's misconception about burns), three (negative definition of self, emotional responses, and behavioral responses), and three (negative individual effects, negative social effects, and negative familial effects) categories, respectively. Based on these categories and their corresponding subcategories, a comprehensive definition of the concept was presented. Conclusion Burn self-stigma is a state in which burn survivors experience unfavorable thoughts and feelings about themselves as a result of society's misconceptions about them. They give emotional and behavioral responses that define them in a negative way. In the end, the burn survivor's individual, familial, and social dimensions are significantly impacted.

Dietary intake is influenced by multiple systems, as highlighted in the Social- Ecological Model, including community influences like community programs. In this context, parks and recreation administrators may have a role in the types of snacks and beverages provided during youth sports. The current study focused on understanding park administrators’ experiences relative to the youth sports environment, including their responsibility and influence on the food environment. This was an exploratory qualitative case study conducted in Utah. Semi-structured interviews with parks and recreation administrators were completed via phone by a research assistant. A qualitative case study analysis was conducted by two researchers. In addition to the interviews, the websites of all the park and recreation sites were searched and phone calls were made to check physical locations for nutrition fliers/information. Three themes emerged through qualitative case study analysis. The first theme was the administrators’ role in the youth parks and recreation activities. The second theme was the administrators’ awareness of the food environment within youth sports. The final theme was the administrators’ role in influencing more nutritious snacks at these youth sporting activities. The results from this case study suggest that the parks and recreation administrators within Utah valued the importance of nutritional snacks and beverages within youth sporting activities and were supportive of the food environment improving. Several of the parks and recreation administrators in this study agreed that their further involvement (i.e., guidelines on snacks and beverages) in the youth sports food environment could improve the environment and better effect youth who are participating, thus enhancing opportunities to improve overall health and well-being. The results from this study show that administrators could bring awareness to youth sports nutrition and support guidelines for the types of snacks and beverages brought to youth sporting activities. Administrators could work with dietitians to develop information that would be appropriate to distribute to youth sports participants and parents. Providing information about what kinds of snacks to bring has the possibility to improve the conditions of the youth sports food environment. Additionally, consideration for policy changes in youth sports and recreation center facilities could be explored. Subscribe to LDMJ

Internet of Things based systems (IoT systems for short) are becoming increasingly popular across different industrial domains and their development is rapidly increasing to provide value-added services to end-users and citizens. Little research to date uncovers the core development process lifecycle needed for IoT systems, and thus software engineers find themselves unprepared and unfamiliar with this new genre of system development. To ameliorate this gap, we conducted a mixed quantitative and qualitative research study where we derived a conceptual process framework from the extant literature on IoT, through which 27 key tasks for incorporation into the development processes of IoT systems were identified. The framework was then validated by means of a survey of 127 IoT practitioners from 35 countries across 6 continents with 15 different industry backgrounds. Our research provides an understanding of the most important development process tasks and informs both software engineering practitioners and researchers of the challenges and recommendations related to the development of next-generation of IoT systems.

Purpose Approximately 800 children annually suffer unintentional firearm injuries and deaths from unsecured firearms in the United States. These injuries are preventable, and may be avoided by providing parents with firearm safety guidance (FSG). The purpose of this study was to evaluate the experience of pediatric providers in delivering FSG following incorporation of the American Academy of Pediatrics (AAP) infographic. Methods Qualitative study completed July 2019-December 2019. Community pediatricians in Houston, Texas were provided the AAP firearm safety infographic and encouraged to provide FSG routinely during well-child visits with firearm-owning parents. Efficacy, feasibility of use and barriers to FSG were assessed via focus groups. Content analysis was utilized to identify emergent themes from provider experiences. Results Forty-four pediatricians across eight clinics delivered FSG using the AAP infographic. Of these, thirty-four participated in focus groups discussing their experience. Only 34% of those in the focus groups had routinely provided FSG prior to the study. The AAP infographic was a useful tool because of its visibility, valuable information, and assistance with broaching the topic of firearm safety with parents. Three themes were identified from qualitative analysis: methods of successful delivery of FSG (62%), patient responses to FSG (25%), and barriers to delivery of FSG (13%). Parents were generally receptive to the guidance. Conclusions The AAP firearm safety infographic, which is free and publicly available, can be a valuable and satisfactory tool for delivery of firearm safety guidance by pediatric providers, including surgeons. Further study is needed to assess whether the guidance changes parental storage behaviors. Level of evidence Level VI

The lack of mutual communication and collaboration between academic research and management practice, and the limited implementation of the research findings in strategic and tactical decision-making in practice settings, known as the science-practice ‘gap’, remains an essential issue in management research. We challenge the primary focus on academics for the possibilities of bridging the gap by arguing that the picture remains incomplete without a closer look at the positions, perceptions, and attitudes of practicing managers toward the joint production of relevant management knowledge. Based on the inductive, grounded theory approach, we conducted a qualitative study of 47 practicing managers with different organizational and functional responsibilities across various industry sectors. Although practitioners perceived practice-engaged research design and execution, relevant management research, and benefits from complementary knowledge as enablers of fruitful science-practice collaboration, our emerging findings revealed limited trust, limited cognition, coping strategies, and heuristic information processing to be important barriers for practitioners that hamper the collaboration process. Relying on the cognitive and information processing framework and theory of the conservation of resources, we aimed to explain the antecedent of (un)successful collaboration on the practitioners' side, thus extending our understanding of the scholarship of integration.

Objective: Anticancer treatment may be associated with damage to the reproductive organs and risk of infertility in children with cancer. The collectivist cultural norms of Asian societies may lead...

Objectives To explore expert perspectives on risks associated with the pediatric electronic health record (EHR) for intimate partner violence (IPV) survivors and their children and to identify strategies that may mitigate these risks. Methods We conducted semistructured interviews with multidisciplinary pediatric IPV experts (nursing, physicians, social workers, hospital security, IPV advocates) recruited via snowball sampling. We coded interview transcripts using thematic analysis, then consolidated codes into themes. Results Twenty-eight participants completed interviews. Participants identified the primary source of risk as an abuser's potential access to a child's EHR by legal and illegal means. They noted that abuser's access to multiple pediatric EHR components (eg, online health portals, clinical notes, contact information) may result in escalated violence, stalking, and manipulation of IPV survivors. Suggested risk mitigation strategies included limited and coded documentation, limiting EHR access, and discussing documentation with the IPV survivor. Challenges to using these strategies included healthcare providers’ usual practice of detailed documentation and that information documented may confer both risk and benefit concurrently. Reported potential benefits of the pediatric EHR for IPV survivors included ensuring continuity of care, decreasing need to repeatedly talk about trauma histories, and communication of safety plans. Conclusions Our findings suggest the pediatric EHR may confer both risks and benefits for IPV survivors and their children. Further work is needed to develop best practices to address IPV risks related to the pediatric EHR, to ensure consistent use of these practices, and to include these practices as standard functionalities of the pediatric EHR.

Background Across the globe, many women including economic and humanitarian migrants receive inadequate antenatal care. Understanding the difficulties that migrant women encounter when accessing maternity care, including the approach of health professionals, is necessary because inadequate care is associated with increasing rates of morbidity and mortality. There are very few studies of migrant women’s access to and experience of maternity services when they have migrated from a low- to a middle-income country. Aim To examine the perceptions and practices of Thai health professionals providing maternity care for migrant Burmese women, and to describe women’s experiences of their encounters with health professionals providing maternity care in Ranong Province in southern Thailand. Methods Ethnography informed the study design. Individual interviews were conducted with 13 healthcare professionals and 10 Burmese women before and after birth. Observations of interactions (130 h) between health care providers and Burmese women were also conducted. Data were analysed using thematic analysis. Findings The healthcare professionals’ practices differed between the antenatal clinics and the postnatal ward. Numerous barriers to accessing culturally appropriate antenatal care were evident. In contrast, the care provided in the postnatal ward was woman and family centered and culturally sensitive. One overarching theme, “The system is in control’ was identified, and comprised three sub-themes (1) ‘Being processed’ (2) ‘Insensitivity to cultural practices’ and, (3) ‘The space to care’. Discussion and conclusions The health system and healthcare professionals controlled the way antenatal care was provided to Burmese migrant women. This bureaucratic and culturally insensitive approach to antenatal care impacted on some women’s decision to engage in antenatal care. Conversely, the more positive examples of woman-centered care evident after birth in the postnatal ward, can inform service delivery.

Background Process evaluation within clinical trials provides an assessment of the study implementation's accuracy and quality to explain causal mechanisms and highlight contextual factors associated with variation in outcomes. Objectives This study aimed to identify the barriers and facilitators of implementing early mobilisation (EM) within a trial. Methods This is a qualitative process evaluation study within the Trial of Early Activity and Mobilisation (TEAM) phase 3 randomised controlled trial. Semistructured interviews were conducted remotely with multiprofessional clinicians (physiotherapists, medical staff, and nursing staff) involved in the delivery of the TEAM intervention at Australian hospitals participating in the TEAM study. Inductive coding was used to establish themes which were categorised into the Behaviour system involving domains of Capability, Opportunity, and Motivation (COM-B), which allowed barriers and enablers affecting EM to be identified. Findings Semistructured interviews were conducted in three different states of Australia. There were 16 participants, including 10 physiotherapists, five physicians, and one nurse. The key themes that facilitated EM were mentoring, champions, additional staff, organisation of the environment, cultural changes, communication, and documented safety criteria. In contrast, the main factors that hindered EM were lack of expertise and confidence in delivering EM, heavy sedation, interdisciplinary conflicts, and perceived risks related to EM. Conclusion A wide range of barriers and facilitators that influenced EM within the TEAM study were identified using the COM-B framework. Many of these have been previously identified in the literature; however, participation in the study was viewed positively by multidisciplinary team members.

Objective We sought to systematically review the literature on values and preferences regarding contraception among individuals within selected key populations. Study design As part of a larger set of reviews on patients’ and providers’ values and preferences related to contraception globally, we searched ten electronic databases for articles from January 1, 2005 to July 27, 2020. No language restrictions were applied. Data was independently abstracted by two authors and study rigor was assessed using an 8-item measure developed by the Evidence Project for quantitative studies and an adapted CASP checklist for qualitative studies. Results We identified 12 studies that met our inclusion criteria examining selected key populations, including sex workers, transmasculine individuals, people who inject drugs, or those living in humanitarian contexts. Seven key themes that spoke to values and preferences emerged related to: autonomy, perceived effectiveness and safety, birth spacing and family outcomes, impacts on sexual experience, hormonal effects (e.g. desire for non-hormonal method or perception that the method is more natural as compared to hormonal methods), physical attributes (e.g. appearance and/or ease of use), and stigma. Six studies were of high rigor, five were of moderate rigor, and one was of low rigor. One study described the values and preferences of two of the selected key populations. The research available on the values and preferences of sex workers regarding methods of contraception was limited to female condoms. Conclusion Consideration of the values and preferences of individuals within selected key populations can inform providers, programme managers and policy makers participating in the delivery of contraceptive care. Contraceptive research among sex workers, transmasculine individuals, people who inject drugs, or those living in humanitarian contexts is quite limited; further research is needed to better understand the values and preferences of these populations.

Given the large numbers of people with HIV (PWH) with Medicaid coverage, it is important to understand the patient experience with Medicaid. Understanding experiences with and attitudes around the program have important policy and clinical implications. The objective was to understand the patient perspective of PWH in Virginia, who transitioned to Medicaid in 2019 due to Medicaid expansion. English-speaking PWH who gained Medicaid due to Medicaid expansion in 2019 were recruited at one Virginia Ryan White HIV/AIDS Program clinic. The goal was to enroll33% of those who newly were on Medicaid for 2019. Participants were surveyed about demographic characteristics, and semistructured interviews were performed. Descriptive analyses were performed for cohort characteristics. Using qualitative description and an open coding strategy, codebooks were generated for the interviews and themes were identified. The cohort (

Problem There is limited evidence regarding midwives’ confidence and practices in providing sexual and reproductive health care in Australia. Background Midwives provide important public health education to women regarding sexual and reproductive health care. Aim The aim of this study was to explore midwives’ confidence and practices around providing education to women on three key areas of sexual and reproductive health: contraception and family planning; sexual activity; and sexual health. Methods A cross-sectional exploratory study was conducted with responses from n = 164 midwives (43.1% response rate) working in a public tertiary maternity hospital in Western Australia. The survey included items measuring confidence; method and frequency of practice. Open-ended questions captured qualitative data. Data analysis was conducted using descriptive statistics for quantitative data and content analysis for qualitative data. Findings There was a significant association between age, years of clinical experience (p = 0.001) and work setting (p = 0.032) on the confidence to provide education on sexual activity. Most (92.1%) midwives indicated that they wanted further education. Lack of time, knowledge and language barriers were key factors preventing education. Discussion Midwives’ provision of education to women is essential for improving health literacy and health outcomes. Results reveal the necessity to include sexual and reproductive health education in entry to registration courses and the importance of continuing professional development. Conclusion Evidence of midwives’ confidence and current practices in the provision of sexual and reproductive health care offers utility for leaders and educators in midwifery to prepare and equip midwives to fulfil this important public health role.

Background Women who were born overseas represent an increasing proportion of women giving birth in the Australian healthcare system. Problem Women from migrant and refugee backgrounds have an increased risk of poor pregnancy and birth outcomes, including experiences of care. Aim To understand how women from migrant and refugee backgrounds perceive and experience the continuum of maternity care (pregnancy, birth, postnatal) in Australia. Methodology We conducted a qualitative evidence synthesis, searching MEDLINE, CIHAHL, and PsycInfo for studies published from inception to 23/05/2020. We included studies that used qualitative methods for data collection and analysis, that explored migrant/refugee women’s experiences or perceptions of maternity care in Australia. We used a thematic synthesis approach, assessed the methodological limitations of included studies, and used GRADE-CERQual to assess confidence in qualitative review findings. Results 27 studies met the inclusion criteria, representing women in Australia from 42 countries. Key themes were developed into 24 findings, including access to interpreters, structural barriers to service utilisation, experiences with health workers, trust in healthcare, experiences of discrimination, preferences for care, and conflicts between traditional cultural expectations and the Australian medical system. Conclusion This review can help policy makers and organisations who provide care to women from migrant and refugee backgrounds to improve their experiences with maternity care. It highlights factors linked to negative experiences of care as well as factors associated with more positive experiences to identify potential changes to practices and policies that would be well received by this population.

Background After childbirth, most women do not lose the extra weight gained during pregnancy. This is important because postnatal weight retention contributes to the development of obesity in later life. Research shows that postnatal women living with overweight would prefer to weigh less, are interested in implementing weight loss strategies, and would like support. Without evidence for the benefit of weight management interventions during pregnancy, postnatal interventions are increasingly important. Research has focused on intensive weight loss programmes, which cannot be offered to all postnatal women. Instead, we investigated the feasibility of a brief intervention delivered to postnatal women at child immunisation appointments. This qualitative study explored the views of women who received the intervention and healthcare professionals who delivered it. Methods The intervention was delivered within the context of the national child immunisation programme. The intervention group were offered brief support encouraging self-management of weight when attending general practices to have their child immunised at two, three and four months of age. The intervention involved motivation and support from practice nurses to encourage women to make healthier lifestyle choices through self-monitoring of weight and signposting to an online weight management programme. Nurses provided external accountability for weight loss. Women were asked to weigh themselves weekly and record this on a weight record card. Nested within this trial, semi-structured interviews explored the experiences of postnatal women who received the intervention and nurses who delivered it. Results The intervention was generally acceptable to participants and child immunisation appointments considered a suitable intervention setting. Nurses were hesitant to discuss maternal weight, viewing the postnatal period as a vulnerable time. Whilst some caveats to implementation were discussed by nurses, they felt the intervention was easy to deliver and would motivate postnatal women to lose weight. Conclusions Participants were keen to lose weight after childbirth. Overall, they reported that the intervention was acceptable, convenient, and, appreciated support to lose weight after childbirth. Although nurses, expressed concerns about raising the topic of weight in the early postnatal period, they felt the intervention was easy to deliver and would help to motivate women to lose weight.

Background The COVID-19 pandemic has posed unprecedented challenges and threats to the health care system, particularly affecting the effective delivery of essential health services in resource-poor countries such as Nepal. This study aimed to explore community perceptions of COVID-19 and their experiences towards health services utilization during the pandemic in Province-2 of Nepal. Methods The semi-structured qualitative interviews were conducted among purposively selected participants (n = 41) from a mix of rural and urban settings in all districts (n = 8) of the Province 2 of Nepal. Virtual interviews were conducted between July and August 2020 in local languages. The data were analyzed using thematic network analysis in NVivo 12 Pro. Results The findings of this research are categorized into four global themes: i) Community and stakeholders’ perceptions towards COVID-19; ii) Impact of COVID-19 and lockdown on health services delivery; iii) Community perceptions and experiences of health services during COVID-19; and iv) COVID-19: testing, isolation, and quarantine services. Most participants shared their experience of being worried and anxious about COVID-19 and reported a lack of awareness, misinformation, and stigma as major factors contributing to the spread of COVID-19. Maternity services, immunization, and supply of essential medicine were found to be the most affected areas of health care delivery during the lockdown. Participants reported that the interruptions in health services were mostly due to the closure of health services at local health care facilities, limited affordability, and involvement of private health sectors during the pandemic, fears of COVID-19 transmission among health care workers and within health centers, and disruption of transportation services. In addition, the participants expressed frustrations on poor testing, isolation, and quarantine services related to COVID-19, and poor accountability from the government at all levels towards health services continuation/management during the COVID-19 pandemic. Conclusions This study found that essential health services were severely affected during the COVID-19 pandemic in all districts of Province-2. It is critical to expand and continue the service coverage, and its quality (even more during pandemics), as well as increase public-private sector engagement to ensure the essential health services are available for the population.

Drawing on a qualitative study with former federal prisoners in Ontario and key medical and community professionals from across the country, this commentary aims to build dialogue with the Correctional Service Canada on an essential harm reduction measure in prison, namely, prison needle and syringe programs (PNSPs). Research participants elucidated the main issues and challenges related to the implementation of PNSPs, listing correctional officers and the union that represents them as a central barrier. As the primary front-line workers in the prison setting and the staff with whom prisoners have the most frequent contact, correctional officers play a significant role in the success or failure of these indispensable programs. Yet despite the more than two decades of international evaluations that have demonstrated PNSP effectiveness in improving staff occupational safety, correctional officers and prison services remain resistant.

Conventional sex work research has tended to pathologize women in the sex industry by studying them as victims who lack the ability to make informed decisions about their lives and their work. Radical feminist research in particular has been successful in affecting public discourses, policy debates, and research agendas in this regard. While sex workers themselves contradict and critique conventional social science and radical feminist research, rarely are their voices heard and rarely have they been included in research processes. Given this context, it is not uncommon for sex workers to refuse to engage in research studies unless they are members of the research team. Action research philosophies and practices, therefore, are particularly relevant and important in supporting a growing wave of sex work research that has been endorsed, influenced, and supported by sex working communities. This article draws on my experiences conducting a research project with a Canadian sex workers' rights organization to demonstrate to how participatory research methods can work to build bridges, dismantle barriers, and establish new relationships of trust and support between feminists and sex workers. Ultimately, Iargue in favor of the fundamental importance of action research moving from research on sex workers to research with sex workers.

Male adolescents frequently present to the emergency department (ED) and many participate in behaviors increasing their risk of sexually transmitted infections and unintended pregnancies. Although the ED visit may represent an intervention opportunity, how best to design and deliver a sexual health intervention matching the preferences of adolescent male users is unclear. Our objective was to explore receptivity to and preferences for sexual health interventions among adolescent male ED patients.In this qualitative study, we asked sexually active male ED patients aged 14 to 21 years about their attitudes toward ED-based sexual health interventions and preferences for intervention modalities. Participants interacted with an early prototype of a digital intervention to gather specific feedback. Enrollment continued until saturation of key themes. Interviews were recorded, transcribed, and coded based on thematic analysis using NVivo.Participants (n = 42) were predominantly 18 to 21 years (63%) and Hispanic (79%). Although most (71%) had sex in the prior 3 months, 45% did not use a condom at last intercourse and 17% had impregnated a partner. Participants viewed the ED visit as unused time without distracting influences, suitable for educational sexual health interventions. They considered ED-based digital interventions a reliable and confidential source of information. Engaging interventions allowed user control and provided novel and relatable content.Adolescent male ED patients are receptive to ED-based digital sexual health interventions. These identified preferences should be considered when designing future user-informed sexual health interventions for the ED setting.

Workers in Indonesia now really need a social security for themselves, because with the social security received by them makes them more focused in carrying out their duties to completion. The existence of social security provided will increase the welfare of the workforce itself and have a good impact on the survival of their families in the future if one day there is an accident of work from these workers when they carry out their duties the family can enjoy financial assistance from the government through social security. This study uses qualitative methods, namely research procedures that produce descriptive data in the form of written or spoken words from people or observable behavior. This method also comes from actions that are used as an understanding based on phenomena that occur in society, especially workers. In giving effect to the workers, BPJS Ketenagakerjaan has functions for workers, namely: Organizing work accident insurance programs, Organizing death insurance programs, Conducting old age insurance programs, Organizing pension insurance programs. The conclusion of this research is that there are still many companies that do not give rights to their workforce, that is, they do not take care of BJPS Ketenagakerjaan, which is a matter that must be obtained by each workforce. And the lack of awareness of the workforce about the benefits of BPJS Ketenagakerjaan for them in the event of a work accident.

PurposeThe issues associated with the production and dissemination of management research have been widely debated amongst administrators, scholars and policymakers for decades. However, few studies to date have examined this issue at the level of the individual scholar. The purpose of this paper is to view a management scholar’s choice of knowledge dissemination (KD) outlets as a legitimacy judgment embedded in their social structure and community norms.Design/methodology/approachTo explore this, the authors conduct a sequential mixed-methods study. The study uses qualitative methods, including one-on-one interviews (n=29) and five workshops (n=79) with administrators, management scholars, students and external community members (practitioners and policymakers). In addition, the authors analyzed the KD outcomes of 524 management scholars at seven Canadian universities drawn from a stratified sample of business schools.FindingsThe results of the research demonstrate the complex interaction between individual scholar-level factors, including socialization (degree type and practitioner experience) and tenure, and the institutional-level factors, such as strategic orientation and accreditation, and how these influence KD judgments. Specifically, the authors find that institutional factors (such as tenure and promotion) are a central predictor of scholarly KD; in contrast, the authors find that individual-level factors including degree, professional experience and career stage influence non-scholarly KD.Originality/valueThe results suggest that as management scholars face increasing pressure to demonstrate impact beyond academia, it may be more difficult than simply adapting the reward system. Specifically, the authors suggest that administrators and policymakers will have to consider individual factors, including their academic training (including interdisciplinary training), previous practitioner experience and career stage.

BACKGROUND AND PURPOSE: With an aging population, falls have become an increasing public health concern. While face-to-face exercise programs have demonstrated efficacy in reducing falls, their effectiveness is hampered by low participation and adherence. Digital technologies are a novel and potentially effective method for delivering tailored fall prevention exercise programs to older adults. In addition, they may increase the reach, uptake, and sustainability of fall prevention programs. Therefore, understanding older adults' experiences of using technology-driven methods is essential. This study explored the user experience of StandingTall, a home-based fall prevention program delivered through a tablet computer.METHODS: Fifty participants were recruited using purposive sampling, from a larger randomized controlled trial. Participants were selected to ensure maximum variability with respect to age, gender, experience with technology, and adherence to the program. Participants undertook a one-on-one structured interview. We followed an iterative approach to develop themes.RESULTS AND DISCUSSION: Eight themes were identified. These fall under 2 categories: user experience and program design. Participants found StandingTall enjoyable, and while its flexible delivery facilitated exercise, some participants found the technology challenging. Some participants expressed frustration with technological literacy, but most demonstrated an ability to overcome these challenges, and learn a new skill. Older adults who engaged in a technology-driven fall prevention program found it enjoyable, with the flexibility provided by the online delivery central to this experience. While the overall experience was positive, participants expressed mixed feelings about key design features. The embedded behavior change strategies were not considered motivating by most participants. Furthermore, some older adults associated the program characters with gender-based stereotypes and negative views of aging, which can impact on motivation and preventive behavior.CONCLUSION: This study found digital technologies are an effective and enjoyable method for delivering a fall prevention program. This study highlights that older adults are interested in learning how to engage successfully with novel technologies.

Objective: To describe key stakeholders’ perspectives on specialist palliative care and its integration into the management of amyotrophic lateral sclerosis (ALS). Methods: The study conducted was a qualitative, noninterventional, descriptive study. Data were collected via individual interviews of 42 stakeholders (n = 14 patients, n = 16 family caregivers, and n = 12 health-care providers). Transcribed interviews were analyzed using inductive thematic analysis techniques. Results: Stakeholders’ general impressions of specialist palliative care were highly variable. Many expressed limited or inaccurate understandings of palliative care’s definition and purpose. Perceptions of palliative care as hospice were common. Stakeholders generally supported the integration of specialist palliative care into ALS management, and many recognized the value of early integration of palliative services in both the community and the clinical setting. Conclusion: Key stakeholders readily identified a meaningful role for specialist palliative care in ALS management. Integration of specialist palliative care into existing systems of support would be facilitated by a more comprehensive understanding of the service among patients, family caregivers, and health-care providers.

Background The Prescribing Information (PI) is the US Food and Drug Administration (FDA)'s primary tool for communicating a summary of the essential scientific information needed for the safe and effective use of a prescription drug to healthcare providers.[1] One challenge with this type of communication is balancing the need to be thorough with the need to be concise. Objectives This study aimed to explore physicians' preferences for and understanding of specific content and formatting in the PI. This study also explored physicians’ use of and perceptions of the PI. Methods Seventy semi-structured qualitative interviews were conducted with primary care physicians (n = 35) and physicians from a wide range of specialties (n = 35) using web conferencing technology. Using fictitious PI examples, the guide assessed physicians’ interpretation of language and preferences for how certain information is organized and communicated in select sections of the PI. The interview guide also included questions about the resources physicians use to find information about prescription drugs, when and how physicians access the PI, and their perceptions of the PI. Results The findings suggest that of the content and formatting items surveyed, physicians had the greatest preference for: (1) uniformly specifying the age group for which the drug is indicated in the INDICATIONS AND USAGE section, even for medical conditions that are highly associated with only one particular age group (e.g., adult patients), and (2) uniformly including administration information in relation to food (e.g., “with or without food”) in the DOSAGE AND ADMINISTRATION section for drugs with oral dosing. The findings also suggest that including a long list of interacting drug examples in the DRUG INTERACTIONS section may be misinterpreted to be a comprehensive list. Conclusion This qualitative research suggests physicians may prefer more clarity in some sections of the PI.

Objectives People who are referred for colonoscopy, following an abnormal colorectal cancer (CRC) screening result, are at increased risk of CRC. Despite this, many individuals decline the procedure. The aim of this study was to investigate why. Methods As little is currently known about non-attendance at follow-up colonoscopy, and follow-up of abnormal screening results is a nurse-led process, we decided to conduct key informant interviews with Specialist Screening Practitioners ([SSPs] nurses working in the English Bowel Cancer Screening Program). Interviews were conducted online. Transcripts were assessed using inductive and deductive coding techniques. Results 21 SSPs participated in an interview. Five main types of barriers and facilitators to colonoscopy were described, namely: Sociocultural, Practical, Psychological, Health-related and COVID-related. Key psychological and sociocultural factors included: ‘Fear of pain and discomfort associated with the procedure’ and ‘Lack of support from family and friends’. Key practical, health-related and COVID-related factors included: ‘Family and work commitments’, ‘Existing health conditions as competing priorities’ and ‘Fear of getting COVID-19 at the hospital'. Conclusions A range of barriers and facilitators to follow-up colonoscopy exist. Future studies conducted with patients are needed to further explore barriers to colonoscopy. Practice implications Strategies to reduce non-attendance should adopt a multifaceted approach.

This study identifies the factors affecting volunteer retention and engagement. A dearth of research has focused on volunteering for not-for-profit organisations. These organisations are involved particularly in raising funds through public benevolence. There have been rising trends of not-for-profit organisations around the world while the number of volunteers decreases. Information on the factors influencing volunteer retention and engagement is expected to support the management of not-for-profit community services. Therefore, this study uses a case study of a not-for-profit organisation to identify the factors contributing to volunteer retention and engagement. The interview data is analysed using thematic data analysis. Benightedness, communication, management support, volunteer skills and volunteer participation in management decision making are associated with volunteer retention and engagement. These findings are expected to enhance the operation process of not-for-profit Community Fund Management Organisations. Future research is suggested to enhance the management of volunteers in other types of not-for-profit organisations.

Background In the strained actual economic context, all clinical pharmacy activities cannot be achieved for all patients of all care pathways. So finding a way to prioritize moments and patients needing those activities is essential. This is the challenge of the “5P project” (Patient personalized clinical pharmacy program integrated into care pathway). Objective To present adverse event (AE) risk management approach applied to develop clinical pharmacy programs integrated into care pathway, using two methods. Method Used as a priori AE risk management approach, the Delphi method and inductive approach analysis of semi-directed interviews were realized from April 1st to October 3rd, 2019, respectively in orthogeriatric (OG) and pediatric kidney transplantation (PKT) care pathways. Complementarily to bibliographic research, participants were medical and paramedical healthcare providers involved in the concerned care pathway. They have been interrogated regarding AE risks to identify the clinical pharmacy activities required, the patients who need them, and the appropriate steps of the care pathway. Results The Delphi method for OG care pathway has revealed: 1/. Patients were prioritized by the presence of at least 2 among the following 4 criteria: age ≥90 years old, cardiovascular diseases, prescribed potentially inappropriate medication for elderly patients, obesity or diabetes; priority steps were the post-operative and rehabilitation care steps. 2/. Prescription reviews, medication reconciliation and targeted pharmaceutical informative interview about oral anticoagulants were required. Nine semi-directed interviews used for PKT care pathway has revealed: 1/. Clinical pharmacy activities were carried out for all patients. Priority steps were pre-transplantation, immediate post-operative, and post-transplantation. 2/. Prescription reviews and educative interviews were required. Conclusions The two presented methods can be used to both develop patient prioritization and targeting steps for clinical pharmacy activities, and integrate it into care pathway. Today, those two developed programs have been executed in our teaching hospital.

Objective Existing quality of care frameworks insufficiently integrate the perspectives of physicians, nurses and patients. We collected narrative accounts from these three groups to explore if their perspectives might add new content to these existing definitions. Methods Ninety-seven descriptions of “good” and “poor” care episodes were collected from a convenience sample of physicians, nurses and outpatients at eight regional hospitals. Two coders classified the narrative contents into themes related to structures, processes and outcomes of care. Results The physicians, nurses and patients raised the following “quality of care” aspects: Successful communication among staff, with patients and care companions; staff motivation; frequency of knowledge errors; prioritization of patient-preferred outcomes; institutional emphasis on building “quality cultures”; and organizational implementation of fluid system procedures. Conclusion Respondents primarily referred to care processes in their descriptions of “quality of care.” “Hippocratic pride” (in response to care successes) and “Rapid reactivity” (in response to (near) failures) emerged as two new outcome indicators of high-quality care. Practice implications This study provides a first qualitative fundament for understanding the components of “quality of care” from a triangulated frontline perspective. Future research needs to validate our findings with quantitative data to explore their usefulness for completing existing quality frameworks.

INTRODUCTION Reflective learning is the cognitive process whereby information from new experiences is integrated into existing knowledge structures and mental models. In our complex healthcare system, reflective learning (specifically ‘reflection on action’) is important for postgraduate learners. We observed that our anaesthesiology residents were not building on their competence through deliberate experiential and reflective practice. This qualitative study explored the current state and challenges of reflective learning in anaesthesia training in Singapore. METHODS This study was conducted at KK Women’s and Children’s Hospital, Singapore, from 1 January 2018 to 31 October 2018. A semi-structured interview format was used in focus groups. Information collection continued until data saturation was reached. The interviews were coded and analysed, and themes were identified. Seven focus group interviews involving 19 participants were conducted. RESULTS Reflective learning was found to be poor. It was of concern that the stimuli for reflection and reflective learning emerged from medical errors, critical incidents and poor patient outcomes. Challenges identified were: (a) lack of an experiential learning framework; (b) need for reflective training; (c) quality of experiential triggers; (d) clinical pressures; and (e) poor learner articulation and feedback. We described some strategies to frame, teach and stimulate reflective learning. CONCLUSION This study described the state and challenges of reflective learning in anaesthesia training. We advocate the implementation of reflective training strategies in postgraduate training programmes in Singapore. Research is warranted to integrate patient feedback and outcomes into reflective practice.

BACKGROUND Hospital wards are a complex and dynamic environment which rely on optimal staff performance. However, there is little research evaluating group interventions to improve staff attention and teamwork. AIMS To evaluate whether a regular, short and guided group mindfulness practice for staff in an acute general medicine team improves attention and teamwork. METHODS A 10-min program comprising mindfulness exercises and techniques was delivered daily to a multidisciplinary general medicine team based in a tertiary hospital for four weeks. This was undertaken immediately prior to the team's interdisciplinary ward round. We used a mixed-method design, with self-rated surveys to measure mindfulness and staff perception of hospital safety culture, and a focus group to understand participants' experiences. We estimated mean differences using Kruskal-Wallis tests across 10 time-points and thematically analysed recorded transcripts. RESULTS There was an increase in staff attention to the team meeting as measured by the decentering domain across time (p

Decision-making for treatment of rheumatoid arthritis (RA) is complex, with multiple beneficial medication options available, but with the potential for treatment-related adverse effects and significant economic considerations. Indigenous patients make treatment decisions informed by an interplay of clinical, family, and societal factors. Shared decision-making may represent an approach to support treatment decisions in a culturally congruent manner. Our objective was to identify aspects of arthritis care that Indigenous participants found relevant for shared decision-making and to explore preferences for shared decision-making strategies.A purposive sampling from rheumatology clinics that provide services to Indigenous patients in a Canadian urban center was used to recruit participants for interviews. Seven participants were recruited to reach content saturation. Interview content was coded by 2 individuals, including an Indigenous patient with RA, and the data were analyzed via thematic analysis.Participants were all women ages 37-61 years living with RA. Participants supported the idea that shared decision-making would be beneficial, primarily to support decisions around treatment plans and medication changes. Shared decision-making approaches would need to reflect Indigenous-specific content areas, such as benefits and risks of therapy informed by data from Indigenous patient populations and inclusion of traditional modes of healing. All participants were interested in having a decision coach and preferred that decision aids be in both paper and electronic formats for accessibility.This study advances knowledge in the priority areas and specific content needed in the shared decision-making process and the preferences of shared decision-making strategies relevant and appropriate for urban Indigenous women living with RA in Canada.

Suffering holds a central place within pain research, theory, and practice. However, the construct of pain-related suffering has yet to be operationalized by the International Association for the Study of Pain and is largely underdeveloped. Eric Cassell's seminal work on suffering serves as a conceptual anchor for the limited pain research that specifically addresses this construct. Yet, important critiques of Cassell's work have not been integrated within the pain literature. This Focus Article aims to take a preliminary step towards an updated operationalization of pain-related suffering by (1) presenting key attributes of pain-related suffering derived from a synthesis of the literature and (2) highlighting key challenges associated with Cassell's conceptualization of suffering. We present four key attributes: (1) pain and suffering are inter-related, but distinct experiences, (2) suffering is a subjective experience, (3) the experience of suffering is characterized by a negative affective valence, and (4) disruption to one's sense of self is an integral part of suffering. A key outstanding challenge is that suffering is commonly viewed as a self-reflective and future-oriented process, which fails to validate many forms of suffering and marginalizes certain populations. Future research addressing different modes of suffering - with and without self-reflection - are discussed. PERSPECTIVE: This article offers a preliminary step toward operationalizing the construct of pain-related suffering and proposes priorities for future research. A robust operationalization of this construct is essential to developing clinical strategies that aim to better recognize and alleviate suffering among people living with pain.

Background and objective Axial spondyloarthritis is an immune-mediated disease with a high cost, diagnostic delay and associated complications that makes it a particularly important condition. This work aims to establish a certification standard (SpACE Project) for monographic consultations in its diagnosis and treatment. Materials and methods Qualitative study of consensus, through the technique of the nominal group. First, a pragmatic review of the literature was carried out. Second, professionals involved throughout the care process (rheumatology, ophthalmology, gastroenterology, traumatology, family medicine, physical therapy, and nursing) were included. Results Thirty-seven possible standards were extracted from the pragmatic review of the literature. During the consensus phase only those standards with high feasibility and importance in the care process were prioritized. Finally, the group of 26 experts agreed on the inclusion of 14 standards. Discussion and conclusions SpACE is a consensus-based certification standard that seeks to improve health outcomes and more integrated care.

Background: Chinese American adults experience health disparities at the end of life. Culturally tailored advance care planning (ACP) may promote goal-concordant care across the continuum of serious illness. However, seriously ill Chinese Americans' preferences for ACP remain unknown. Objective: To explore barriers and facilitators to ACP among Chinese patients with advanced cancer and their caregivers. Design: Informed by socioecological theory, we conducted an exploratory qualitative study using semistructured interviews that were thematically analyzed. Setting/Participants: We recruited participants at one U.S. comprehensive cancer center. Of 27 eligible patients approached, we recruited 20 patients (74.1%) and 8 accompanying caregivers. Overall, participants were middle aged (55.6 ± 13.5 years), 60.7% female, 85.7% partnered/married, 89.3% college educated, and had low acculturation (mean Suinn-Lew Asian Self-Identify Acculturation = 2.0 ± 1.6/5.0). More patients were privately insured (35%) than self-pay (30%), Medicare (25%), and Medicaid (10%). Caregivers were split between "spouse" and "child." Results: Findings highlight participants' trust in their clinicians and the study institution as primary supports for clinicians to lead ACP. However, participants' preconceptions of clinicians' professional responsibilities and participants' belief in an uncertain future may hinder an open discussion of goals and values for future medical care. A key moderating factor in how participants view ACP may be their level of acculturation to local care, behavioral, and communication norms. Conclusions: Chinese patients may prefer a routinized clinician-led ACP approach that supports their actionable priorities in the present by leveraging patient-clinician trust, gauging acculturation level, and using indirect communication strategies. Future studies should investigate preferred communication strategies to support in-the-moment care planning.

Objectives : While COVID-19 had a profound impact on healthcare, its effects on medical students are less clear. This study explored the effects of COVID-19 safety measures on medical students’ specialty selection and career choices. It further considers the potential differential effects of COVID by gender. Design Between June and November 2020 at a Midwestern medical university, medical students with an anticipated graduation in 2021 through 2023 participated in virtual focus group sessions, which explored students’ transition to remote learning during COVID-19, perception of gender bias within medical education, and personal and professional goals. Nine focus groups were held, with two to six students per session (N = 22). Focus groups were video recorded, transcribed verbatim, and data were deidentified. Transcripts were coded and analyzed using consensual qualitative analysis to identify themes. Results : Our analysis captured three themes: (1) Impact of Institutional Decision-Making due to COVID-19, (2) Impact of Unstructured Time on Professional and Personal Decision Making, and (3) Impact of Societal Pressures, Gender Bias, and Mentorship on Career Planning. Conclusions : COVID-19 disrupted important learning opportunities for medical students. Mentorship and shadowing are critical in helping students make career and specialty decisions, particularly for women. The loss of these opportunities may have lasting career impacts for all students.

Background Australian dentists are among the frontline healthcare workers providing dental and oral health care during the COVID-19 pandemic, and therefore have been affected in multiple ways. In this study, we explore their experiences of practising and living in this pandemic. Methods A qualitative study analysed responses of 333 Australian dentists' who participated in a survey with open-ended questions about the challenges and positive outcomes of practising during the COVID-19 pandemic. The questions were embedded in a national online survey of Australian dentists' knowledge, preparedness and experiences conducted between March and April 2021. Data were analysed using content analysis. Results Australian dentists reported their challenging experiences to be four-fold, including ‘public health orders and restrictions', ‘Infection prevention and control measures (IPC), ‘Personal concerns about COVID-19' and ‘Detracting opinions about COVID-19'. Conversely, they reported positive outcomes in relation to their practice during COVID-19, including ‘Awareness of and adherence to IPC practices', ‘Teamwork and interpersonal dynamics', ‘Decompressed workload', ‘Perceived support' and ‘unintended positive outcomes'. Conclusion The COVID-19 pandemic generated several challenges for Australian dentists, but it also engendered some positive outcomes. Understanding of these can help tailor the professional support plans to address the needs and priorities of Australian dentists during the current and future pandemics.

PURPOSE To explore and report on the quality-of-life (QoL) issues encountered by adults with childhood glaucoma. DESIGN Exploratory qualitative study. PARTICIPANTS Forty-seven participants with childhood glaucoma (defined as disease onset

Background Obesity in older adults contributes to increasing comorbidities and decreased quality of life. There is limited research including older adult perspectives on weight loss. Objective The purpose of this qualitative study was to gain a better understanding of older adults’ perceptions and experiences related to weight loss immediately following a 6-month weight loss intervention. Design A qualitative research design utilizing semi-structured interviews conducted as part of a larger research study exploring weight loss and/or aerobic exercise on muscle inflammation. Participants /setting A sample of community-based older adults (n=11) in Southwestern Ohio were recruited from September 2018 through August 2019 following completion of a 6-month weight loss intervention. Eligible participants were >58 years, BMI > 27 kg/m2, sedentary with no cognitive deficits. Exclusions included cancer, heart disease, diabetes, and tobacco use. Analysis Interviews were recorded, transcribed verbatim, and analyzed using thematic analysis. Descriptive statistics were used for demographic data. Results Three emergent themes included barriers and challenges to weight loss, which included caregiving roles, challenges with increasing protein intake, and ambivalence to change; personal strategies for success (portion control and meal flexibility); and external strategies for success (visual graphs as feedback measures, alternate measures of success, and social support). Conclusions The results of this qualitative study provide insight into older adults' experiences with weight loss which may be considered when designing weight management interventions. However, more research is needed to examine strategies to address the challenges identified by participants in this research study. Future qualitative research should also focus on weight loss perspectives of older adults in other racial and ethnic groups.