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Purpose: The traditional understanding of how coaches plan for sporting performance is rooted in the assumption that coaches create periodized plans underpinned by physiological principles, thereby providing scientific credibility to their work. In contrast, there remains a paucity of literature exploring how coaches understand or think about their planning practices. The purpose of this study was to generate new knowledge regarding what information coaches actually consider within their planning processes and how they actually approach the task of planning. Method: Using rigorous, in-depth interviews, this study examined athletics coaches' understandings of their everyday planning practices, in an attempt to contribute to narrowing the gap between academic research and real-world application. Twenty-eight highly experienced, high-performance track-and-field coaches based in England (female, n = 1; male, n = 27) were recruited. The coaches were from the throwing disciplines (n = 10) and endurance running (n = 18). Coaches were interviewed about their planning process, using a maximum of 3 semistructured interviews per coach, spaced across a full athletics season. In total, this generated 68 hours of data. Results: The analysis demonstrated that, while the participant coaches utilized the principles of periodization, their planning activities were not limited to this issue. The findings highlighted how the coaches conceptualized successful athletic performance in a holistic way; that is, planning is multifaceted in nature. Conclusion: This study presents a holistic picture of the complexity of coaches' planning, detailing the considerable time and attention given to planning for athletes' psychological, personal, and social development, to enhance athlete performance and development. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify contextual factors that negatively affect activity and participation among powerchair football (PF) players. Thirty-seven semistructured interviews were conducted with PF players (Mage = 27.9 ± 8.2 years) in France (n = 18) and the United States (n = 19). Participants reported acute back and neck pain as the primary morbidities resulting from PF participation, with sustained atypical posture in the sport chair as the primary cause. Competition-related physical and mental stress were also identified as participation outcomes. Accompanying the many benefits of PF, participants recognized negative impacts of discomfort, physical fatigue, and mental fatigue. Interventions such as seating modifications, thermotherapy to combat pain, napping to combat acute physical stress, and mental preparation to manage state anxiety were all identified as prospective interventions. [ABSTRACT FROM AUTHOR]

Background/Aims: Adolescent pregnancies are prevalent in Indonesia. This study aimed to explore perceptions from healthcare workers and pregnant adolescents of maternity services for pregnant adolescents. Methods: This qualitative exploratory study involved two policymakers, 10 midwives, five doctors, and 10 pregnant adolescents. Data were collected through structured interviews in public health centre consultation rooms. The data were analysed thematically to explore factors that promoted or hindered use of maternity services for pregnant adolescents. Results: The identified barriers included a lack of tailored directives, challenges in engaging adolescents, insufficient numbers of skilled healthcare professionals, adolescents' fears and compromised confidentiality. Opportunities for improvement included enhancing service quality through strategic planning and specialised training for midwives and psychologists. Conclusions: The study underscores the need to improve maternity services offered for pregnant adolescents by creating a conducive working environment and sensitising healthcare workers and the community to adolescent mothers' needs. Implications for practice: There is a need for guidelines in Indonesia specifically on providing care for pregnant adolescents. Healthcare professionals require specialised training and facilities should be made adolescent friendly. [ABSTRACT FROM AUTHOR]

This study investigated the experiences of communication officials at local health departments (LHD) in the US Midwest regarding the correction of health misinformation on Facebook during the COVID-19 pandemic. Through interviews with communication officials, this study examined how and why they corrected health misinformation, the challenges they encountered during the correction process, and the importance of having fact-checkers within LHDs. The analysis of the data revealed four major themes: factors influencing misinformation correction on Facebook, perceived effectiveness of health misinformation correction, the intersection of the First Amendment and health misinformation, and the role of fact-checking in LHDs. The LHD communication officials often faced conflicts and public rebuttals when directly correcting misinformation leading them to adopt the strategy of addressing misinformation through future posts instead of direct correction. These findings provide significant insights for communication officials to identify and correct health misinformation and emphasize the need for healthcare organizations to provide essential resources to information and communication professionals during times of crises. [ABSTRACT FROM AUTHOR]

Collaboration between the child welfare and court systems is critical. Using qualitative data, experiences of stakeholders were examined to identify areas where growth is needed. Stakeholders included: Local Department of Social Services (LDSS) child welfare workers (n = 28); LDSS supervisors (n = 32); LDSS directors and assistant directors (n = 13); judges and magistrates (n = 11); and attorneys (n = 16). Three main themes were identified: barriers to meeting mandated timeframes, a dependence on court orders, and the need for training and consultations. Findings suggest previously recommended improvement efforts have not been implemented successfully. Important implications for practice, specifically as it relates to achieving permanency, are provided. [ABSTRACT FROM AUTHOR]

The Canadian Association of Radiologists supports equity, diversity, and inclusion (EDI) in employment. It is imperative that institutions implement recruitment and retention practices to ensure a diverse workforce. This requires considerable attention to each step in the process, including the job posting, candidate search, hiring committee composition, interviews, hiring decision, and retention and promotion. Job postings must be widely distributed and visible to underrepresented groups. The candidate search should be completed by a diverse committee with expertise in EDI. All committee members must complete EDI and anti-bias training and conduct a broad search that ensures underrepresented groups are encouraged to apply. Interviews must be offered to all candidates. The hiring decision must avoid the use of subjective criteria. Recruitment of members of underrepresented groups ensures a diverse workforce, and organizations should commit resources to the retention and promotion of these members. Mentorship programs must be implemented and incentives provided to faculty members to serve as mentors. Transparent guidelines for promotion made universally available on department or institution websites. Recruiting a diverse workforce in Medical Imaging will only be achieved if EDI are central to the organization's goals and strategic plan. All organizational policies, practices, and procedures must be reviewed with an intersectional lens to identify potential gaps, areas for improvement, and areas of strength in the recruitment and retention of members of underrepresented groups. [ABSTRACT FROM AUTHOR]

Background: Decentralisation has increasingly been adopted by countries as an important health sector reform aimed at increasing community participation in decision making while enhancing swift response at decentralised levels, to accelerate the attainment of health system goals. Kenya adopted a devolved system of government where health services delivery became a function of the 47 semi-autonomous county governments with planning and budgeting functions practised at both levels of government. This study sought to explore challenges facing health sector planning and budgeting and how they affect immunisation service delivery at the county level. Methods: Data were collected through 77 in-depth interviews of senior county department of health officials across 15 counties in Kenya. We applied an inductive thematic approach in analysing the qualitative data using NVIVO software. Findings: The study found a lack of alignment between planning and budgeting processes, with planning being more inclusive compared to budgeting. Inadequate capacity in conducting planning and budgeting and political interference were reported to hinder the processes. Limited budget allocations and delayed and untimely disbursement of funds were reported to affect execution of health and immunisation budgets. Low prioritisation of preventive health interventions like immunisation due to their perceived intangibility influenced resource allocation to the programs. Conclusion: The findings highlight the need for effective strategies to align planning and budgeting processes, increased technical support to counties to enhance the requisite capacity, and efforts to improve budget execution to improve budget credibility. Counties should plan to increase their funding commitment toward immunisation to ensure sustainability of the program as Kenya transitions from GAVI support. [ABSTRACT FROM AUTHOR]

This paper presents the results of thirty-seven interviews of senior library leaders at American Association of University (AAU) institutions conducted in Spring 2023. The author replicated a 2016 study from portal , revealing an increased focus on strategic plan-based decision-making along with new priorities of open scholarship and diversity, equity, and inclusion (DEI). The COVID-19 pandemic had a drastic impact on staffing and budgets, requiring academic library leaders to balance internal operations and external collaboration. A younger, more diverse AAU library leadership population achieves success through strong advocacy to campus leadership and the inclusive leadership practices outlined in this paper. [ABSTRACT FROM AUTHOR]

Healthy ageing, which is the target of life' s later developmental stage, can be achieved through building a wise perspective towards life and existence. However, it may not be achievable for older people when the societal sources are limited. The TILDA project aimed to evaluate the associated factors with healthy ageing and to transfer that knowledge into practice. Hence, determining the perspectives of older people support and advocacy organisations on the enablers and facilitators of the healthy ageing strategies of TILDA is essential to gain a better understanding of the project and plan future strategies. This study aimed to investigate how the TILDA project has influenced or impacted upon these organisations from education, policy, or practice perspectives. The participants (n = 15) included in the study's sample were reached through representative organisations acting to support older people in the Republic of Ireland. Semi-structured interviews were conducted online via Zoom. A systematic thematic data analysis procedure was followed, and three themes emerged from the qualitative data, revealing the perceptions of participants about the TILDA project: (1) Limitations of TILDA, (2) Contributions of TILDA, and (3) Future recommendations for TILDA. In conclusion, among the disadvantages of TILDA, the most significant is not being representative and visible enough; it is evident that it is pivotal to develop a more inclusive culture of TILDA with close cooperation and effective marketing strategies. It is also apparent that TILDA has several advantages that include providing insights into ageing and rich data to plan future support for older people. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Care plans summarize a child with medical complexity's (CMC) medical history and ongoing care needs. Often, the health care team controls the care plan content, limiting caregivers' ability to edit the document in real time and potentially compromising accuracy and utility. With this study, we aimed to provide caregivers of CMC with online access and shared editing control of their child's care plan and to explore the experiences of caregivers and care team members (CTMs) after using an online collaborative care plan (OCCP). METHODS: Caregivers of CMC were recruited from a tertiary complex care program to use an online, patient-facing platform for 6 months, which included the ability to edit and share their child's care plan. Caregivers and CTMs participated in semi-structured interviews to explore their experiences in using the OCCP. Consistent with grounded theory methodology, a constant comparative analysis was used, which allowed for theoretical sampling and theory generation. RESULTS: A total of 15 caregivers and 20 CTMs completed interviews. Interviews revealed 3 major themes and 9 subthemes, including (1) the navigation of uncharted roles (trust, responsibility), (2) the requirements for success (electronic medical record integration, online access, collaborative care plan review), and (3) cohesive care (accessibility and convenience, being on the same page, autonomy). Themes informed the creation of a theoretical model for the implementation and utility of OCCPs. CONCLUSIONS: Online, collaborative care plans, when implemented safely and thoughtfully, promote shared understanding, improve caregiver autonomy, and increase the accessibility of health information. Together, these benefits facilitate cohesive care and authentic partnership between caregivers and CTMs in the care of CMC. [ABSTRACT FROM AUTHOR]

BACKGROUND: At the onset of the COVID‐19 pandemic, schools closed across the United States. Given the impact of virtual learning and lost access to school resources, schools eventually reopened with COVID‐19 mitigation protocols in place. This qualitative study sought to understand parental perceptions of school‐based COVID‐19 mitigation strategies. METHODS: Using a phenomenology approach, nine focus groups were completed with 40 parents of children in grades K‐8 representing eight Maryland counties. Based on acceptance of masking policies (as indicated on a survey), parents were sorted into 2 groups—lower and higher masking acceptance. A thematic analysis was conducted for each group and themes were compared between the 2 groups. RESULTS: The main themes were related to parents' general sentiments regarding COVID‐19, compliance, pandemic‐related changes over time, changes in personal opinions, and in‐person learning. Both groups described challenges related to inconsistent COVID‐19 mitigation policies and practices, the challenges of rapid and frequent changes in guidelines during the pandemic, and the benefits of in‐person learning. CONCLUSIONS: Parents of elementary and middle school children, regardless of general acceptance of masking policies, shared concerns about implementation and guidance regarding school‐based mitigation strategies. [ABSTRACT FROM AUTHOR]

Background: Physiatry is a specialty with high rates of burnout. Although organizational strategies to combat burnout are key, it is also important to understand strategies that individual physiatrists can use to address burnout. Objective: The aim of the study is to identify changes that resulted in improvement of occupational well-being of physiatrists over a 6- to 9- mo period. Design: We employed two quantitative surveys spaced 6-9 mos apart to identify physiatrists who experienced meaningful improvement in occupational burnout and/or professional fulfillment between the two survey time points. These physiatristswere subsequently recruited to participate in a qualitative study using semistructured interviews to identify changes that respondents felt contributed to improvements in burnout and professional fulfillment. Setting: Online surveys and interviews. Participants: Physiatrists in the AmericanAcademy of PhysicalMedicine and Rehabilitation (AAPM&R) Membership Masterfile. Main OutcomeMeasure: Burnout and professional fulfillment were assessed using the Stanford Professional Fulfillment Index. Results: One hundred twelve physiatrists responded to the baseline and follow-up surveys. Of these, 35 were eligible for interviews based on improvements in the Stanford Professional Fulfillment Index, and 23 (64%) agreed to participate. Themes fromthe qualitative interviews highlighted the importance of personal lifestyle choices, approaches to improve professional satisfaction, and strategies to foster work-life harmony. Personal lifestyle strategies included investing in wellness and mental health. Efforts to improve professional satisfaction included decreasing work intensity, prioritizing meaningful aspects of work, and building relationships with colleagues. Fostering work-life harmony also included making trade-offs in both domains, setting boundaries at work, setting expectations at home, and overcoming personal challenges. Conclusions: Our findings illustrate that in addition to organizational strategies demonstrated to be effective, there are actions that individual physiatrists can take to recover from burnout and foster professional fulfillment. [ABSTRACT FROM AUTHOR]

The growing number of older individuals with complex needs and chronic illnesses is a major challenge to the health sector. This has led to a transfer of responsibilities from specialist to the primary healthcare sector. The aim of the study was to explore how healthcare professionals experience setting up and operating a municipal acute bed unit (MAU) in primary healthcare. Three focus groups of health professionals were recruited through purposeful sampling in 2019, and the 10 participants came from different professions. The study has a qualitative design with a hermeneutic approach. The findings identified three themes: (a) Strategic planning and coordinated services, (b) collaborative practice and learning and (c) flexible and family-centred care. The healthcare personnel experienced strengthened quality in the health services, improved work processes and increased safety for patients with relevant diagnoses. The interplay between internal and external factors seems to have been a successful innovation in planning and implementing an MAU in a medical facility in Mid-Norway. We assessed that being prepared for challenges is an important part of innovation in health services. The presence of an 'inherent capital' to meet unforeseen challenges in the future should be a prerequisite for innovation. [ABSTRACT FROM AUTHOR]

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Introduction: Recent policy changes in Washington State presented a unique opportunity to pair evidence-based interventions with first responder services to combat increasing opioid overdoses. However, little is known about how these interventions should be implemented. In partnership with the Research with Expert Advisors on Drug Use team, a group of academically trained and communitytrained researchers with lived and living experience of substance use, we examined facilitators and barriers to adopting leave-behind naloxone, field-based buprenorphine initiation, and HIV and hepatitis C virus (HCV) testing for first responder programs. Methods: Our team completed semi-structured, qualitative interviews with 32 first responders, mobile integrated health staff, and emergency medical services (EMS) leaders in King County, Washington, from February-May 2022. Semi-structured interviews were recorded, transcribed, and coded using an integrated deductive and inductive thematic analysis approach grounded in community-engaged research principles. We collected data until saturation was achieved. Data collection and analysis were informed by the Consolidated Framework for Implementation Research. Two investigators coded independently until 100% consensus was reached. Results: Our thematic analysis revealed several perceived facilitators (ie, tension for change, relative advantage, and compatibility) and barriers (ie, limited adaptability, lack of evidence strength and quality, and prohibitive cost) to the adoption of these evidence-based clinical interventions for first responder systems. There was widespread support for the distribution of leave-behind naloxone, although funding was identified as a barrier. Many believed field-based initiation of buprenorphine treatment could provide a more effective response to overdose management, but there were significant concerns that this intervention could run counter to the rapid care model. Lastly, participants worried that HIV and HCV testing was inappropriate for first responders to conduct but recommended that this service be provided by mobile integrated health staff. Conclusion: These results have informed local EMS strategic planning, which will inform roll out of process improvements in King County, Washington. Future work should evaluate the impact of these interventions on the health of overdose survivors. [ABSTRACT FROM AUTHOR]

Goal: The COVID-19 pandemic, healthcare market disruptors, and new digital healthcare technologies have made a substantial impact on the delivery of healthcare services, highlighting the critical roles of leaders in hospitals and health systems. This study sought to understand the evolving roles of CEOs, CIOs, and other executive leaders in the postpandemic era and highlight the adaptability and strategic vision of executives in shaping the future of healthcare delivery. Methods: Between October 2022 and May 2023, 51 interviews were conducted with CEOs, CIOs, and other executives responsible for delivering technology solutions for 33 nonprofit health systems in the United States. They were asked to describe their backgrounds; how information solutions and technologies were viewed within their organizations' strategy, operations, and governance; and the key characteristics of executive leaders. Principal Findings: The study has found that effective CEOs have an authentic belief in technology's role in achieving their organization's mission and that contemporary CIOs are strategic executive partners who align strategy with culture to improve care. This study examines how healthcare systems are creating digitally savvy executive leadership teams that operate in a new, integrated model that unites previously siloed functions. Practical Applications: Some healthcare CIOs are unprepared for current and future business challenges, and some CEOs are unsure how to leverage digital technologies and C-suite expertise to transform their organizations. This research provides insights into how the nation's health systems are building and sustaining leadership teams capable of adapting to the healthcare environment and accelerating organizational transformation. [ABSTRACT FROM AUTHOR]

Introduction: In 2018, The Live Well Allegheny: Lifting Wellness for African Americans (LWA2) Initiative was developed to support six priority, Black communities in Allegheny County, Pennsylvania to address health equity in chronic disease. The LWA2 coalition members participated in ongoing anti-racism and racial equity sessions with a nationally recognized anti-racist facilitation team. The sessions included a 2-days experience in January 2020 along with follow up meetings throughout 2020. Methods: Surveys were administered to understand their perceptions related to anti-racism and oppression and subsequent actions as a result of the sessions. Additionally, we conducted nine in-depth interviews with organizational partners (January -May 2020) to evaluate the overall effectiveness of the coalition and inform future activities. Results: Ten participants completed the post session surveys. Seven out of 10 survey respondents felt they had a good understanding of how oppression (racism, sexism, capitalism) influenced their life and work. However, the majority indicated needing the tools to implement anti-racist strategies in their work. The in-depth interviews with organizational partners revealed that racial equity was of concern to all partners but there was variability in intentionality around racial equity as a core element of each organization's mission, goals and subsequent actions. Discussion: As a result of the interviews, coalition members developed a racial equity statement and theory of change for implementation in the coalition work and within individual organizations along with a plan for implementing an equity audit of the coalition. Coalitions of this kind should be intentional about implementing continuous strategies related to anti-racism for structural changes toward achieving racial equity in their overall work. [ABSTRACT FROM AUTHOR]

Background: In Oman, limited access to adequately prepared healthcare providers in primary healthcare threatens the provision of quality care to patients and families and access to healthcare services. Nurse practitioners (NP) are in an excellent position to address safety issues and ensure quality healthcare with their advanced nursing skills, knowledge, and acumen for acceptable cultural and religious practices. Aims: To explain Oman's national strategic plans, processes, challenges, opportunities, and both regional and global implications for the facilitation of NP role implementation and policies. Sources of evidence: The Nursing and Midwifery Human Resources framework guided the NP implementation project. Guided by the framework, the World Health Organization and the Omani Ministry of Health conducted multiple situational analyses (2004–2016). Later, the NP role was planned and implemented in Oman. During and after implementation, monitoring and evaluation of the NP role implementation were continuously conducted using multiple focus groups, individual interviews, and field visits. Discussion: The NP role implementation revealed multiple challenges and opportunities that either hinder or support NP role implementation. Additionally, the NP implementation project revealed various lessons learned. Implications for nursing and health policy: National and global nursing leaders and health policymakers should collaborate to discuss NP issues, especially NP role sustainability, legal approval and recognition, prescriptive authority, title protection, practice acts, and professional regulation. Conclusion: This paper informs nursing leaders and policymakers in the Middle East and other countries in the global community about Oman's experience regarding NP role implementation. [ABSTRACT FROM AUTHOR]

COVID-19 has heralded a health and socioeconomic crisis that has made it difficult for nonprofit human service organizations (NPHSOs) to play their social roles and achieve their goals. This article examines how the merger of NPHSOs can serve as a strategy for coping with an organizational crisis caused by external extreme events such as the COVID-19 pandemic. The study focused on eight mergers of Israeli NPHSOs. Using in-depth interviews and a survey methodology of senior managers and board members who have participated in the merger process, we explore the motives, challenges, and key processes characterizing these mergers. The findings are organized around three stages in the merging process – the Three P's in human service mergers: Pre-merger, when the motives and barriers were examined; Process, where decision-making mechanisms, issues of belonging and identity, and coping with conflicts and trust-building were examined; and Post-merger, where attitudes toward the outcomes of the merger and its success in various organizational areas were assessed. The findings also point to a lack of proper preparation and orientation for the merger, ego struggles between managers and workers, and the need for socializing the employees to the merger. We conclude by discussing the importance of planning for and attending to the human capital in the merged NPHSOs, the need to build a shared sense of belonging, and the value of shaping a new and shared organizational culture. Implications to theory, practice, and policy are discussed. Executives of nonprofit human service organizations considering a merger in response to a crisis should prepare, orient, and socialize executives, board members, and employees before entering the merger process; part of this socialization should include emotional dimensions of trust building, respect, and empathy. Executives should establish mechanisms for shared decision-making and for coping with conflicts. Executives and board members should collaborate to plan the merger strategically (i.e. establish goals before initiating the merger) to make the process more efficient, effective, and adjusted to expected and unexpected events in the external environments. Umbrella organizations, infrastructure organizations, government agencies, and funders should develop knowledge and support systems to help organizations consider mergers. Funders should be engaged in due diligence to assess the organizations' financial and economic resilience before the merger. They should also consider the synergies of the merger and its added value to the beneficiaries before entering the process. [ABSTRACT FROM AUTHOR]

The US Environmental Protection Agency Food Recovery Hierarchy suggests methods for diverting food waste from landfill. Knowledge of how hospital foodservices implement food waste management strategies could help modernize food waste practices. The aim of this study was to explore hospital staff members' experiences of implementing a food waste management strategy to divert food waste from landfill in their hospital foodservice, including the journey, challenges, and facilitators of this practice change. A qualitative study was conducted in 2022-2023 using semi-structured interviews. Eighteen participants were staff members with knowledge of the food waste management strategy from 14 exemplar hospitals in United States, Spain, Scotland, and Australia using strategies to divert food waste from landfill within the last 10 years. Mapping and thematic analysis were undertaken to code and identify themes from the interviews that described staff members' experiences of the journey to implement the strategy. Six hospitals donated food, 1 transferred food waste for animal feed, 4 used an industrial solution, and 3 sent food waste for composting. A common journey pathway for successful implementation was identified from participants' experiences. It features the following 6 phases: idea, preparation, roll out, maintenance, established practice, and evolution. Facilitators included legislation, enthusiastic staff members, executive support, and "luck." Challenges were smells, occasions when food waste was not collected, equipment breakage, and funding depletion. This study identified a common journey pathway for implementing a food waste management strategy in hospital foodservices that can be used to anticipate and prepare for the steps in the implementation process. [ABSTRACT FROM AUTHOR]

In 2023, the UK Government published its long-awaited reform strategy for England's children's social care system. Whilst the strategy set out planned reforms for several aspects of the wider system, an area requiring particular 'priority' was the purported workforce instability seen within child protection social work. However, the strategy has subsequently faced criticism on the basis that the suggested reforms were not satisfactorily informed by the testimonies of practicing social workers. This paper draws from a mixed-method study to report on the lived experiences of a sample of 201 child protection social workers practicing across England, in the context of better understanding the factors which they believed were impacting on workforce stability within England's child protection system. Implications that emerge are the need for an increase in the monetary commitment offered by the UK Government (especially in the context of tackling high caseloads, and improving local authority pay scales to reduce the allure of agency work); a targeted emphasis on challenging local cultures preoccupied with evidencing compliance over time spent with children; and the Government taking a more assertive role in tackling the often-counterproductive commentary perpetuated by politicians and media. [ABSTRACT FROM AUTHOR]

Background: Unsafe patient events not only entail a clinical impact but also lead to economic burden in terms of prolonged hospitalization or unintended harm and delay in care delivery. Monitoring and time‐bound investigation of patient safety events (PSEs) is of paramount importance in a healthcare set‐up. Objectives: To explore the safety incident reporting behaviour and the barriers in a hospital set‐up. Methods: The study had two sections: (a) Retrospective assessment of all safety incidents in the past 1 year, and (b) Understanding the barriers of safety reporting by interviewing the major stakeholders in patient safety reporting framework. Further root cause analysis and failure mode effect analysis were performed for the situation observed. Results were statistically analyzed. Results: Of the total of 106 PSEs reported voluntarily to the system, the highest reporting functional group was that of nurses (40.57%), followed by physicians (18.87%) and pharmacists (17.92%). Among the various factors identified as barriers in safety incident reporting, fear of litigation was the most observed component. The most commonly observed event was those pertaining to medication management, followed by diagnostic delay. Glitches in healthcare delivery accounted for 8.73% of the total reported PSEs, followed by 5.72% of events occurring due to inter‐stakeholder communication errors. 4.22% of the PSEs were attributed to organizational managerial dysfunctionalities. Majority of medication‐related PSE has moderate risk prioritization gradation. Conclusion: Effective training and sensitization regarding the need to report the patient unsafe incidents or near misses to the healthcare system can help avert many untoward experiences. The notion of 'No Blame No Shame' should be well inculcated within the minds of each hospital unit such that even if an error occurs, its prompt reporting does not get harmed. [ABSTRACT FROM AUTHOR]

Background Tuberculosis (TB) is a highly transmissible infectious disease killing millions of people yearly, particularly in low-income countries. TB is most likely to be transmitted in healthcare settings with poor infection control practices. Implementing TB infection prevention and control (TB-IPC) is pivotal to preventing TB transmission in healthcare settings. This study investigated diverse stakeholders' perspectives relating to barriers and strategies for TB-IPC in rural hospitals in Papua New Guinea. Methods Multiple qualitative case studies were conducted with 32 key stakeholders with experience in TB services. Data collection drew on three primary sources to triangulate data: semi-structured interviews, document reviews and field notes. The data were analyzed using hybrid deductive-inductive thematic analysis. Results Our results reveal that key stakeholders perceive multiple interdependent factors that affect TB-IPC practice. The key emerging themes include strategic planning for and prioritizing TB-IPC guidelines; governance, leadership and accountability at the provincial level; community attitudes towards TB control; institutional capacity to deliver TB care, healthcare workers' safety, and long-term partnership and integration of TB-IPC programmes into the broad IPC programme. Conclusions The evidence suggests that a multi-perspective approach is crucial for TB-IPC guidelines in healthcare institutions. Interventions focusing on addressing health systems strengthening may improve the implementation of TB-IPC guidelines. [ABSTRACT FROM AUTHOR]

In this article, we use Snell & Morris' (2021) new HR ecosystem framework to empirically examine strategic fit and alignment tensions for knowledge‐intensive organizations and professional knowledge workers. Rich data were collected through in‐depth interviews with 75 members of faculty engaged in knowledge‐intensive work for Business and Management Schools (B&M), and the analysis of strategy documents. The application of the framework enables us to contribute to dynamic capabilities theory and SHRM in four ways. Firstly, drawing on the findings, we propose an adapted HR Ecosystem framework for analyzing knowledge‐intensive organizations, which incorporates tensions across the four subsystems of an HR ecosystem (strategy, capabilities, composition, and cultures). These tensions are shaped by interactions within and between levels (meso, macro and micro) and ecosystems. Secondly, our findings underscore the need for knowledge‐intensive organizations to engage with a plurality of collaborative and competing internal and external stakeholder interests, including those of knowledge workers who constitute key organizational stakeholders. Thirdly, our analysis shows how the views and behaviors of internal organizational stakeholders are affected by ecosystem dynamics within and beyond the physical boundaries of an organization. Fourthly, we reveal how conflicting organizational cultures connect with other HR ecosystem subsystems to constrain collegialism and cohesion. By evidencing how knowledge‐intensive organizations are in a constant flux of alignment and misalignment, the article demonstrates the value of the HR ecosystem framework in examining and informing SHRM in organizations in other industries. [ABSTRACT FROM AUTHOR]

This study focuses on international development aid policies implemented by municipalities. By proposing a theoretical framework and addressing the Spanish context, it first explores the added value and the challenges involved with this kind of decentralised aid. Second, it discusses the implications in terms of the competencies required by social workers in order to leverage the potential of these aid policies. The research draws on the qualitative analysis of documents, interviews and discussion groups. It concludes that international social workers need knowledge, values and skills in widely different aspects in order to overcome the challenges entailed in aid from municipalities. [ABSTRACT FROM AUTHOR]

Background: Universal health coverage (UHC) improves national health outcomes while addressing social inequalities in access to quality healthcare services. The district health system (DHS) is critical to the success of UHC in South Africa through the National Health Insurance (NHI) scheme. Family physicians (FPs), as champions of primary care, are central to the DHS operation and implementation of NHI. Methods: This was a qualitative exploratory study that used semi-structured interviews to explore FPs views and engagement on NHI policy and implementation in their districts. Ten FPs were included through purposive sampling. Results: Most of the FPs interviewed were not engaged in either policy formulation or strategic planning. The NHI bill was seen as a theoretical ideology that lacked any clear plan. Family physicians expressed several concerns around corruption in governmental structures that could play out in NHI implementation. Family physicians felt unsupported within their district structures and disempowered to engage in rollout strategies. The FPs were able to provide useful solutions to health system challenges because of the design of their training programmes, as well as their experience at the primary care level. Conclusion: Healthcare governance in South Africa remains located in national and provincial structures. Devolution of governance to the DHS is required if NHI implementation is to succeed. The FPs need to be engaged in NHI strategies, to translate plans into actionable objectives at the primary care level. Contribution: This study highlights the need to involve FPs as key actors in implementing NHI strategies at a decentralised DHS governance level. [ABSTRACT FROM AUTHOR]

Most people strive toward establishing long‐term romantic relationships, and the majority eventually succeed in doing so, which raises the question of how people meet prospective mates. In the current research, we used in‐depth interviews and open‐ended questionnaires in a sample of 218 Greek‐speaking participants, and we identified 44 acts that people perform in order to meet prospective mates, and 17 categories indicating where people met their current or previous mates. In addition, we used quantitative research methods in a sample of 821 Greek‐speaking participants, and we classified these acts into eight broader strategies. The most frequently adopted ones, included demonstrating active interest to prospective mates, going out to bars, clubs and cafés, improving one's looks and asking friends to introduce one to available individuals. For several strategies, we found significant sex and age effects. Furthermore, most participants indicated that they met their current and previous partners from friends and acquaintances, in school or university, on social media, and on a night out. [ABSTRACT FROM AUTHOR]

Firearms are the leading cause of intimate partner violence-related murders of women in the US. This study aimed to understand differing consequences of partners' firearm possession on abused women and barriers women face in reporting threats to safety due to the partners' possession of a firearm. Additionally, the study explored participants' perceptions of effective approaches to risk assessments and safety planning with women who are at-risk for being harmed by their partners' possession of a firearm. Qualitative semi-structured interviews with 17 service providers and 45 immigrant women survivors of intimate partner violence were conducted. Data were analyzed using a content analysis procedure. Participants shared that the partners' possession of a firearm can increase risk for firearm-related injury or fatality in situations of escalation of violence. Abused women living with a partner with firearm possession live in constant fear or threat. The presence of a firearm can also be a trigger of unwanted memories of the past and can have legal and other consequences for survivors. Impediments to reporting threats to safety were barriers such as lack of knowledge of firearm-related risks and gender and social norms. The findings can be informative for safety planning with survivors of IPV whose partners own or have access to a firearm. Comprehensive assessment of risks and barriers can be used to develop individualized and tailored safety plans for survivors with a partner who possesses a firearm. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to examine nurses' motivation for leadership and explore important challenges nurses face in leadership positions. Design/methodology/approach: Semi-structured interviews were conducted with 20 nurses in leading positions. Thematic analysis was used to analyse the data. Findings: Nurse leaders are recruited from clinical settings, and the transition process from clinical nurse to leader is demanding. Their motivation for leadership seems to be in human values and caring for others. Lack of strategic focus might be a challenge. Nurses in leadership positions emphasize the importance of good relationships with the staff and require an increased focus on strategic leadership. Research limitations/implications: Studies have revealed the frustration associated with the role of a nursing leader. According to an evaluation of a clinical leadership development programme, nurses were found to be inadequately prepared for their roles. They had not experienced positive role models, they felt overwhelmed and they regarded colleagues and nursing management structures as unsupportive. There is a need for further research into effective measures to strengthen nurse managers. Practical implications: The role of leaders has changed over time. There are now increasing requirements and objectives with regard to laws, action plans, improvement projects and cost-effectiveness. A nurse leader has both many tasks and great responsibility. Good leadership relies on skilled nurse leaders meeting statutory requirements in patient care and delivering good quality and patient-safe services. Engaging in process-oriented guidance, such as mentoring, is one way to become more aware of oneself as a professional leader (Mathena, 2002). Originality/value: By identifying and understanding the specific challenges that nurse leaders face, this study can contribute to the development of interventions and strategies to improve leadership practices, thereby enhancing organizational effectiveness. [ABSTRACT FROM AUTHOR]

Background: The increasing complexity of the healthcare environment in recent years highlights the importance of cultivating in head nurses the leadership and management competencies necessary to effectively handle complicated administrative tasks and lead nurses in facing various challenges. Identifying the core administrative management competencies required of head nurses and evaluating competency level using behavioral indicators are fundamental to evaluating related training outcomes. Purposes: This study was designed to identify the core administrative management competencies required of head nurses as well as the associated job responsibilities, tasks, behavioral evaluation indicators, work outputs, and requisite knowledge and skills. Methods: This study was conducted in two phases using a qualitative method. The first phase identified the core administrative management competencies and their behavioral definitions. The second phase established competencyrelated job responsibilities, tasks, behavioral evaluation indicators, work outputs, and requisite knowledge and skills. Each phase consisted of (1) a qualitative interview (first stage) or focus group discussion (second stage) to establish the prototype content; (2) a head nurse workshop to obtain multiple perspectives to modify the prototype content; and (3) a focus group discussion to achieve consensus regarding the content. Results: Nine core competencies related to head nurse administration were identified, including: strategic planning, care supervision, quality improvement, communication, crisis management, responsible leadership, evidence-based practice, digital technology application, and presentation persuasion. Corresponding to these competencies, four responsibilities and associated work tasks were identified. Finally, the related behavioral evaluation indicators, work outputs, and requisite knowledge and skills were confirmed. Conclusion/ Implications for Practice: The results of this study may be used as the basis for head nurse administrative management training programs, while the identified behavioral evaluation indicators may be used to evaluate head nurse work performance and training outcomes. We recommend other institutions apply the results of this study and develop their own administrative core competencies and evaluation indicators for head nurses. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore financial strategies that intimate partner violence (IPV) survivors undertake when engaging in safety planning and to examine the relationship between these strategies and various survivor characteristics. As part of the cross-sectional study, a total of 425 female survivors of IPV were surveyed. To examine the relationship between financial safety planning strategies and participants' demographic characteristics, abuse experiences, and financial knowledge, binomial logistic regression analyses were conducted. Factors associated with financial safety planning varied by strategy; ethnicity and nativity were often significantly associated. Implications for practice and areas for future research are discussed. [ABSTRACT FROM AUTHOR]

Aim: To explore the recognition of pregnant nurses on how they managed their health conditions to examine safe working strategies. Design: A qualitative study with a grounded theory approach. Methods: Twenty‐one nurses engaged in work during their pregnancy were recruited and interviewed using a semi‐structured questionnaire from January to June 2021. The data were analysed using a constant comparative method. Results: The core category 'duelling roles' and the four other categories emerged. Pregnant nurses understand the 'weight of one' of being a professional in the workplace. Therefore, despite their health concerns, they struggle to complete their work as one team member to avoid inconveniencing others. However, through experiencing various nursing situations, they 'perceive one's limits' of working as they had done before pregnancy and protect their health and patients. Nevertheless, interactions with patients and their colleagues bring 'delight in nursing', which encourages them to continue working. Pregnant nurses thus develop a 'prioritizing the foetus' working style to continue being nurses while protecting their health. Implications for the Profession and/or Patient Care: These results provide meaningful guidance in considering safe job retention strategies for pregnant nurses. Sharing and developing the 'prioritizing the foetus' mindset and management skills gained by the participants may be beneficial for the appropriate health management of pregnant nurses. The study may also facilitate nursing managers' understanding of the experiences of pregnant nurses and encourage them to consider reviewing nursing practices. Reporting Method: The Consolidated Criteria for Reporting Qualitative Studies checklist was used to ensure the quality of research reporting. Patient or Public Contribution: Members of the nursing team were involved in the design, conduct and interpretation of the data in this study. [ABSTRACT FROM AUTHOR]

Background: Patients dealing with severe mental illnesses (SMI) often face suboptimal clinical outcomes and higher mortality rates due to a range of factors, including undetected physical health conditions. The provision of care for individuals with SMI is frequently disjointed, as they engage with diverse healthcare providers. Despite this fragmentation, primary care, particularly general practitioners (GPs), assumes a pivotal role in the care of SMI patients. Our study aimed to delve into the first-hand experiences of GPs in delivering somatic care to SMI patients, concentrating on the challenges they encounter and the strategies they employ to navigate these difficulties. Methods: We conducted in-depth interviews with fifteen GPs, utilizing a semi-structured interview guide, supplemented by ethnographic observations during clinical consultations in general practice. Through inductive coding, interview transcripts and observational field notes were systematically analysed using interpretative phenomenological analysis (IPA). The findings were then deliberated upon within the author group. Results: GPs revealed that managing the chronic somatic care of SMI patients posed significant challenges. These challenges encompassed the multifaceted needs of patients, their behavior tied to symptoms, a lack of care continuity, and overarching time constraints. To tackle these challenges, the GPs had devised various strategies. However, all participants underscored the critical importance of having adequate time to properly prepare for, conduct, and follow up on consultations. Conclusion: The GPs' interactions with SMI patients brought numerous challenges, although treating these patients were concurrently acknowledged as vital and fulfilling. The findings suggest that increased allocated time in general practice consultations for patients with SMI is important to support the somatic treatment requirements of this patient group. [ABSTRACT FROM AUTHOR]

Background: Missed nursing care is a pervasive issue in hospitals, nursing homes, and communities, posing a significant threat to patient safety and the quality of nursing care. It has adverse effects on patient satisfaction and the motivation of nursing staff. Understanding the causes and nature of these care omissions in clinical settings is essential for implementing effective interventions. This study aims to develop and validate a tool for assessing missed nursing care in adult intensive care units. Methods: Semi-structured interviews, expert consultations conducted via the Delphi method and item analysis were used to develop the initial scale. Our analysis involved data collected from 400 nurses and employed correlation coefficient analysis, critical ratio assessment, Cronbach's α coefficient evaluation, discrete trend analysis, and factor analysis, which were grounded in both classical test theory and item response theory, allowing us to scrutinize and refine the items in the scale. To validate the scale, we conveniently sampled 550 nurses and assessed structural validity, internal reliability, split-half reliability, and test-retest reliability to ensure the scale's robustness and accuracy. Results: The Missed Intensive Nursing Care Scale (MINCS) comprises three distinct components. Part A serves to collect general information about the participants. In Part B, the missed care elements are categorized into five domains, following the framework of Maslow's hierarchy of needs theory: physiology, safety, belongingness, esteem, and cognition. Part C is dedicated to detailing the reasons behind missed care, which encompass labor resources, material resources, communication factors, and managerial factors. Remarkably, the Cronbach's α coefficient for the MINCS stands at an impressive 0.951, with S-CVI values of 0.988 and 0.977 in Part B and C, respectively, underscoring the scale's exceptional reliability and validity. This demonstrates the scale's effectiveness in measuring missed nursing care while upholding rigorous standards of quality. Conclusions: The MINCS emerges as a robust and dependable instrument for quantifying instances of missed care within the ICU. Its efficacy makes it a valuable resource for informing the development of strategies aimed at averting and mitigating the adverse effects associated with missed nursing care. [ABSTRACT FROM AUTHOR]

Physician advocates for sexual and reproductive health (SRH) care have been active in the United States for decades. Despite such activism, access to SRH services has been fraught with persistent restrictions, particularly for abortion care. We sought the perspectives of key stakeholders on what makes for an effective SRH physician advocate and thoughts about the successes, failures, and needs of the abortion advocacy movement. We interviewed 15 SRH key informants (KIs) in sectors with expertise in organizational policy and advocacy (n = 6); clinical leadership and education (n = 3), media (n = 3), and reproductive justice (n = 3). The analytic team coded repeating ideas and conducted a thematic analysis, organizing findings within KI perspectives on the role of physician advocates in the field of abortion and contraception; successes, failures, and needs in abortion and contraception advocacy; and recommendations on the composition and components of an ideal clinician advocacy training program. KIs relayed that skill building related to communication, developing relationships with changemakers, and understanding political systems was critical for effective advocacy. They felt clinician advocacy training programs should include providers other than physicians and be designed for trainees to build relationships with one another over time. KI perspectives can be valuable in informing advocacy training programs and for contributing strategic approaches to increasing equitable and widespread access to SRH services. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand the detrimental effects that compassion fatigue can have on emergency nurses and the quality of patient care they provide • To learn about the findings of a mixed-methods study that explored emergency nurses’ experiences and perceptions of compassion satisfaction and compassion fatigue • To recognise the importance of providing strategic resilience training and well-being interventions for emergency nurses. Background: Compassion fatigue can have detrimental effects on emergency nurses and the quality of patient care they deliver. Ongoing challenges such as operational pressures and the coronavirus disease 2019 (COVID-19) pandemic may have increased nurses’ risk of experiencing compassion fatigue. Aim: To explore and understand emergency nurses’ experiences and perceptions of compassion satisfaction and compassion fatigue. Method: This study used an explanatory sequential mixed-methods design comprising two phases. In phase one, the Professional Quality of Life (ProQOL-5) scale was used to obtain information on the prevalence and severity of compassion satisfaction and compassion fatigue among emergency nurses. In phase two, six participants’ experiences and perceptions were explored via semi-structured interviews. Findings: A total of 44 emergency nurses completed the ProQOL-5 questionnaires. Six respondents had a high compassion satisfaction score, 38 had a moderate score and none had a low score. In the interviews, participants revealed different explanations regarding their compassion satisfaction levels. Three main themes were identified: personal reflections; factors identified as maintaining stability; and external factors affecting compassion. Conclusion: Compassion fatigue needs to be prevented and addressed systemically to avoid detrimental effects on ED staff morale and well-being, staff retention, patients and care delivery. [ABSTRACT FROM AUTHOR]

Background: The COVID pandemic is an example of a crisis challenging healthcare systems worldwide. The impact of the pandemic on providing high-quality palliative care calls for a deeper understanding of specialist services during crises. This is essential in preparation for further crises. Aim: To develop a conceptual understanding of the impact of the pandemic on specialist palliative care as an example for arising future crises. Design: Qualitative interview study across Germany, following a constructivist grounded theory methodology. Setting/participants: Eleven semi-structured interviews with experts with overarching knowledge of structures and processes in specialist palliative care between 05–07/2020 and between 02–06/2021, 23 semi-structured interviews with healthcare professionals working in a specialist palliative care setting. Results: The complex system of palliative care provision during crises has properties that cannot be understood as separated parts of the care process. The pandemic led to unique structural and processual challenges characterized by interconnectedness, uncertainty, dynamic, underlying dilemmas, and unclear long-term goal. In response to the pandemic, teams experienced different phases, which enhanced adaption, innovation, and progress within complex care situations. Creative strategy approaches and dynamic responsiveness facilitated innovative development and could lead to long-lasting improvement within services. Availability of information, transparent communication, comprehensible instructions, participation in decision-making, and search for solutions contributed to teams' proactive development throughout the pandemic. Conclusion: Addressing the complex problems in specialist palliative care caused by crises requires system thinking and a learning mindset. This can facilitate teams to overcome the crisis and move forward rather than bounce back to normal. [ABSTRACT FROM AUTHOR]

This study aims to assess COVID-related communication by Swiss public health institutions (PHI) as well as the challenges they faced in implementing their communication strategies. This study uses a two-part mixed methods design, combining automated content analysis of press releases by PHI and semi-structured interviews with PHI communication experts. The automated content analysis uses natural language processing techniques to measure semantic themes and linguistic properties of 1882 press releases from national and regional PHI during the first year of the COVID-19 pandemic. The semi-structured interviews with 25 communication experts from key PHI explore the challenges faced in implementing their communication strategies. The content analysis reveals key themes in press releases, including non-pharmaceutical interventions, quarantine, testing, contact tracing, hospital situations, and the pandemic's impact on the economy. The linguistic measures indicated a decrease in complexity and readability over time, with no significant differences between national and regional PHI. Interviews revealed challenges arising from organizational structures, the multi-systemic nature of the pandemic, and from expectations of the public. The study highlights the importance of agility in public health communication and the need for efficient coordination within and between PHI. Organizational structures should be adapted to allow for more agile modes of operation during crises. Policymakers should clarify roles and responsibilities of different actors in public health frameworks to ensure streamlined communication. Understanding the communication efforts and challenges faced by PHI during the pandemic helps preparing for future health crises and improve public health communication practices. [ABSTRACT FROM AUTHOR]

The present research explores the experience of positive psychological change i.e., posttraumatic growth (PTG) among the suicide survivors. Semi structured interview method was used to understand the process of PTG. Twelve young adults were recruited with the help of snowball sampling. Five themes emerged after data analysis i.e., social support, coping strategies, spiritual/religious change, changed priorities, and changed interpersonal relationships. Findings can provide new perspective to mental health professionals. [ABSTRACT FROM AUTHOR]

Aim: To generate, test and refine programme theories that emerged from a rapid realist review investigating practising UK Nurses' and Midwives' experiences of effective leadership strategies during the COVID‐19 pandemic. Background: The realist review of literature generated six tentative theories of healthful leadership practices reflecting, working with people's beliefs and values; being facilitative; multiple means of communication and; practical support. The review yielded little insight into the actual impact of the leadership approaches advocated. Methods: A realist study, informed by person‐centredness using mixed‐methods. Online survey (n = 328) and semi‐structured interviews (n = 14) of nurses and midwives across the UK in different career positions/specialities. Quantitative data analysed using descriptive statistics and exploratory factor analysis. Framework analysis for qualitative data using context (C), mechanism (M), outcome (O) configurations of the tentative theories. Results: Three refined theories were identified concerning: Visibility and availability; embodying values and; knowing self. Healthful leadership practices are only achievable within organisational cultures that privilege well‐being. Conclusions: Leaders should intentionally adopt practices that promote well‐being. 'Knowing self' as a leader, coaching and mentoring practice development is important for leadership development. Implications for Clinical Practice: Nurses who feel valued, heard, cared for and safe are more likely to remain in clinical practice. Job satisfaction and being motivated to practice with confidence and competence will impact positively on patient outcomes. Impact: The study addresses the role of leadership in developing healthful workplace cultures. The main findings were six leadership practices that promote healthful cultures. The research will have an impact on strategic and clinical leaders, nurses and midwives. Reporting Method: This study used EQUATOR checklist, RAMASES II as reporting standards for realist evaluations. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: To explore registered nurses' thinking strategies during the drug administration process in nursing homes. Design: An exploratory qualitative design. Methods: Eight registered nurses, one male and seven female, in five nursing home wards in Mid‐Norway were observed during 15 drug dispensing rounds (175 drug dispensing episodes). Think Aloud sessions with follow‐up individual interviews were conducted. The Think Aloud data were analysed using deductive qualitative content analysis based on Marsha Fonteyn's description of 17 thinking strategies. Interview data were used to clarify missing information and validate the content of Think Aloud data. Results: The registered nurses used all 17 thinking strategies described by Fonteyn, including several variants of each strategy. The three most frequent were 'providing explanations', 'setting priorities' and 'drawing conclusions'. In addition, we found two novel thinking strategies that did not fit into Fonteyn's template, which were labelled 'controlling' and 'interacting'. Among all strategies, 'controlling' was by far the most used, serving as a means for the registered nurses to stay on track and navigate through various interruptions, while also minimising errors during drug dispensing. Conclusion: The study highlights the diverse thinking strategies employed by registered nurses in nursing homes during medication administration. The findings emphasise the multifaceted nature of medication administration and underscore the importance of skilled personnel in ensuring medication safety. Recognising the significance of these findings is crucial for maintaining patient well‐being and upholding medication safety standards in healthcare settings. Relevance to Clinical Practice: Understanding the thinking strategies employed by registered nurses can inform training programmes and enhance the clinical judgements of health care professionals involved in medication administration, ultimately leading to improved patient outcomes and reduced medication errors in practice. Patient or Public Contribution: Patients were involved in this study as recipients of drugs which the nurses distributed during the observations. The patients were involved as a third party and consent to the observations was either given by the patients themselves or relatives in cases where the patient was not competent to consent. No personal information was collected about the patients. Reporting Method: The reporting of this study adhered to the COREQ checklist. [ABSTRACT FROM AUTHOR]

Background: Living in the digital era, young adults with intellectual disabilities use diverse digital products, the Internet, and social media in their daily lives. However, they may need support in digital undertakings as in other aspects of life. In a disability service context, staff are primary support providers but are restricted and guided by organisational goals and strategies. Previous research has shown that staff have dual roles as support providers and executors of organisational ambitions. This study analyses the motivations and prerequisites, as well as the obstacles to the implementation of digitalisation at a strategic level of disability services. Method: Qualitative semi‐structured interviews were conducted with public officials and municipal politicians responsible for providing disability services. A thematic analysis was performed using a constructionist perspective. Findings: Three themes were identified: Intertwined ideals of digital infrastructures in disability contexts, culture of vertical governance, and developing competencies. These themes can be seen as pillars of the digitalisation of digital services at the organisation's strategic level. In addition to shedding light on specific issues, these themes reveal underlying issues relating to conceptions of support practices and organisational culture. Conclusion: Digitalisation is motivated by a desire to preserve the organisation's legitimacy and be a relevant service provider. Digital infrastructure is required for digitalisation but is lacking because of intertwined legal and moral issues. Digitalisation also appears to be hindered by organisational structures and organisational culture, whose impact greatly outweighs that of digital issues. Accessible summary: People with disabilities face problems arising from inaccessibility and lack of support with digital issues.We studied how disability organisations work on digitalisation at the strategic level.The creation of digitally inclusive disability organisations presents legal, moral, and institutional challenges.It is difficult to identify and plan for the digital competencies needed to support staff and persons with intellectual disability when implementing digitalisation.Digital competence among support staff and people with intellectual disabilities is difficult to measure and plan forImplementation at the strategic level is important because it strongly affects whether and how people with intellectual disabilities become digitally included. [ABSTRACT FROM AUTHOR]

There is an unmet need for HIV prevention among Black cisgender women. From January to November 2020, we conducted formative research to develop locally informed implementation strategies to enhance pre-exposure prophylaxis (PrEP) uptake among Black cisgender women in New Orleans, Louisiana. Following an iterative process, we conducted in-depth interviews (IDIs) with Black women who were not taking PrEP and used those findings to inform IDIs with Black women taking PrEP. We asked about PrEP awareness, social support, PrEP-related norms, medical mistrust, motivation to take PrEP, and potential implementation strategies. Data were analyzed using applied thematic analysis. We established the Black Women and PrEP (BWAP) Task Force—a diverse group of 25 Black female community representatives who reviewed the IDI findings and identified strategies to address these determinants of PrEP uptake. We interviewed 12 Black women who were not taking PrEP and 13 Black women who were taking PrEP. Two main PrEP uptake barriers were identified from the IDI findings and Task Force discussions. First, Black women do not know of other Black women taking PrEP. Women perceived PrEP as a drug for gay men. Most said that testimonials from Black women taking PrEP would make its use more relatable. Second, Black women are not frequently offered PrEP by their providers. Many preferred accessing PrEP through women's health providers. The Task Force identified two strategies to address these barriers: a social media campaign for women and an educational initiative to train providers to discuss and prescribe PrEP. These implementation strategies require further study. [ABSTRACT FROM AUTHOR]

The most at-risk population among women for human immunodeficiency virus (HIV) diagnosis in the United States are Black women, accounting for 61% of all new HIV cases. Pre-exposure prophylaxis (PrEP) is a safe and effective HIV prevention method for people at risk of HIV acquisition. Although disproportionately affected by HIV, Black women's knowledge, perceived benefits, and uptake of PrEP remain low. The socioecological model (SEM) may be useful for understanding why there is a low uptake of PrEP among Black women. The current study used the SEM to explore provider perspectives on the barriers and facilitators of PrEP uptake among Black women in Eastern Virginia. Semistructured interviews were conducted with a total sample of 15 community health care providers. Barriers of PrEP uptake at the societal (e.g., PrEP advertisements focus on gay men), community/organizational (e.g., time constraints in the workplace), interpersonal (e.g., perceived monogamy), and individual (e.g., unmet basic needs) levels were identified. Providers also identified facilitators of PrEP uptake at the societal (e.g., PrEP advertisements that target women), community/organizational (e.g., PrEP education), interpersonal (e.g., HIV-positive partner), and individual (e.g., PrEP awareness and perceived susceptibility to HIV) levels. These findings highlight unique barriers to accessing and taking PrEP for Black women in the United States, and potential factors that could facilitate PrEP use. Both barriers and facilitators may be important targets for interventions to improve PrEP uptake. Future research focused on improving PrEP uptake among Black women in the United States should consider multi-level interventions that target barriers and facilitators to reduce rates of HIV infections. [ABSTRACT FROM AUTHOR]

Few studies have explored the experiences of family caregivers of persons living with dementia (PLWD) in acceptance and commitment therapy (ACT). This study aimed for in-depth exploration on experiences of family caregivers of PLWD in ACT. Individual interviews were conducted with eight family caregivers of PLWD who were women and participated in an eight-week video conferencing ACT program. Data were analysed using interpretative phenomenological analysis. Two overarching themes emerged, including improved strategies in responding to emotions and thoughts in challenging caregiving situations and taking better care of myself. Participants perceived that ACT skills training improved their coping strategies and, subsequently, their daily emotions and relationship with their relatives with dementia. Participants also perceived ACT strategies and exercises as helpful and applicable resources for daily use in challenging caregiving situations. In addition, ACT helped participants feel comfortable taking the time to take care of themselves without feeling guilty and acknowledge that they must take care of themselves first to take better care of their relatives with dementia. These changes helped caregivers increase their participation in valued activities. This study contributes to the literature by exploring experiences of family caregivers of PLWD in ACT, including its perceived benefits on themselves. Trial registration: ClinicalTrials.gov ID: NCT04847986 () What is already known about this topic: Adverse mental health outcomes in family caregivers of persons living with dementia (PLWD) can result from caregivers' difficulties in accepting challenges and emotions and the lack of strategies for managing their own emotions and balancing care demands with other important aspects of life. Acceptance and commitment therapy (ACT) is an evidence-based practice that can promote mental health and engagement in personally valued activities through acceptance and mindfulness processes and behaviour change processes for valued living. There have been only two studies that involved a qualitative approach to explore the experiences of family caregivers of PLWD in ACT. These feasibility studies found that contents covered and the online delivery formats for ACT were acceptable to family caregivers of PLWD. What this topic adds: The present study contributes to the literature with in-depth exploration on experiences of family caregivers of PLWD in ACT with thick descriptions, including the benefits of ACT from the perspectives of family caregivers of PLWD. ACT helped family caregivers of PLWD improve strategies for responding to their emotions and thoughts that arise from challenging caregiving situations. Caregivers also perceived ACT as helpful and applicable for daily use in challenging caregiving situations. ACT helped these caregivers feel comfortable taking the time they needed to take care of themselves without feeling guilty and acknowledge that they must take care of themselves first to take better care of their relatives with dementia; these changes helped caregivers increase their participation in valued activities. [ABSTRACT FROM AUTHOR]

School-based physical therapists (SBPTs) rapidly transitioned to telehealth during the pandemic. This study explored the perceptions of, and strategies utilized by, SBPTs delivering therapy via telehealth. Using a grounded theory qualitative design, semi-structured interviews were completed with 13 SBPTs. Interviews were transcribed and theme coded until saturation was achieved. The following themes emerged: supports and education, challenges, strategies promoting success, and the outcomes of telehealth. SBPTs overcame challenges including those associated with technology, communication, space, equipment, and examination. Coaching techniques, incorporation into the daily routine, and the sharing of demonstrations promoted success. Telehealth service delivery was perceived to improve communication with educational teams and families, improve efficiency and productivity, increase access to students, promote an appreciation of the family and home context, and enhance family engagement. SBPTs believe incorporating elements of telehealth in conjunction with in-person delivery is ideal. While the COVID-19 pandemic forced a rapid transition to telehealth for SBPTs, lessons learned could have a long-lasting positive impact on school-based services. The benefits of telehealth should be considered in the delivery of school-based physical therapy services. [ABSTRACT FROM AUTHOR]

Prior to a multifaceted implementation strategy for a healthy lifestyle-promoting practice the expectations of primary health care managers, appointed internal facilitators and health care professionals on supporting change was explored. This study had an explorative qualitative design using data gathered from individual interviews and focus groups. Qualitative content analysis with a deductive category development was applied using the Consolidated Framework for Implementation Research. The study was conducted in a primary care setting in central Sweden as a part of the Act in Time research project. Prior to a multifaceted implementation strategy, we held 16 individual interviews with managers and appointed facilitators and five focus groups with 26 health care professionals. Managers, facilitators, and professionals held similar expectations, where their expressed need for support corresponded to three constructs: Readiness for implementation, Implementation climate, and Engaging. Our findings indicate the need for strong leadership engagement to focus on how the healthy lifestyle-promoting practice can be anchored among the professionals. Managers at all levels should communicate the vision and goals, enable facilitators and professionals to improve their competencies, build inter-professional teams, and jointly plan the new practice. To change to a healthy lifestyle promoting practice professionals request support from their managers, who in turn need support from the middle and top managers. The requested support includes helping to prioritise health promotion and enabling the primary care centres to build competence and take ownership of the implementation. ClinicalTrials.gov NCT04799860 This study revealed that primary health care managers and health care professionals had mutual expectations of supporting a change into a healthy lifestyle-promoting practice before implementation. Strong leadership engagement was perceived as essential across all manager levels, including assistance in prioritising health promotion. The support should enable primary health care centres to build competence and have ownership of implementing a healthy lifestyle-promoting practice. [ABSTRACT FROM AUTHOR]

A long history of empirical research demonstrates that children of low-socioeconomic status (SES) begin school behind their peers and that enrichment activities in the home environment mediate these disparities. This past work overlooks the considerable heterogeneity in the parenting practices of families from low-SES backgrounds. To address this limitation, this study examined home enrichment practices among families with low-SES in greater detail to obtain a nuanced view of the experiences and challenges facing socioeconomically disadvantaged parents. We conducted in-depth, qualitative interviews with 13 mothers of three- to five-year-old children with low-SES, addressing their enrichment activities in the home and any challenges or barriers that interfere with enrichment activities. Parents were also asked to report on their home enrichment practices through a survey measure. All parents described substantial challenges in attempting to provide opportunities for learning with their young children but also described activities that they did engage in, along with a variety of strategies for overcoming challenges. Comparable challenges and strategies were noted by mothers with both high and low scores on a traditional survey measure of home learning activities, suggesting these measures may miss important learning opportunities that parents in low-SES contexts provide for their children. Highlights: Few studies address the heterogeneity of low-SES families home learning practices. In this qualitative study, we interviewed low-SES mothers with children between three and five years of age. All mothers described activities they engaged in, along with a variety of strategies for overcoming SES-related challenges. Traditional measures of home learning did not fully capture the learning opportunities that the low-SES mothers provided. [ABSTRACT FROM AUTHOR]

Background: Conflict and violence can impact on the mental health of children and young people, who are in a crucial stage of their personal growth. Not much is known about the provision of mental health care to young people in conflict-affected areas. Community-based care can be essential, as state-led services are often scarce in conflict contexts, like Colombia's Pacific region where this research was conducted. According to the WHO, such care is ideally provided in the form of a network of interconnected services, offered by different actors beyond the formal health sector. This article describes the relationship between the formal and community mental health systems in Colombia's Pacific region, and identifies ways of improving their interaction. Methods: Qualitative data were collected through 98 semi-structured interviews with community organisations, schools, international organisations and state institutions. These interviews aimed to identify the strategies used to promote young people's mental health and the interactions between the different providers. Boundary spanning theory was used to analyse how different actors and forms of mental health care provision could coordinate better. Results: Community organisations and schools use a wide array of strategies to attend to the mental health of children and young people, often of a collective and psychosocial nature. State institutions offer more clinically focused strategies, which are however limited in terms of accessibility and continuity. International organisations aim to strengthen state capacity, but often struggle due to high staff turnover. Although mental health care pathways exist, their effectiveness is limited due to ineffective coordination between actors. Conclusions: To make sure that the variety of strategies to improve young people's mental health effectively reach their beneficiaries, better coordination is needed between the different actors. Mental health care pathways should therefore integrate community organisations, while community connectors can help to manage the coordination between different actors and forms of clinical and psychosocial support. [ABSTRACT FROM AUTHOR]