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Patients living with multiple myeloma (MM) have a substantial disease burden and face multiple barriers to care. Building upon our previous research using mixed methods, this focus group research aimed to identify patients' priorities regarding specific social and identity-related needs, map these prioritized needs to the disease journey, and describe patient-generated ideas to improve patient support. Participants noted that patients with MM need a range of emotional, social, and financial support throughout the disease journey. They identified initial MM diagnosis and treatment adherence as two critical points in the MM journey where patients need the most support and assistance. The findings of this research suggest that overall, patients with MM need comprehensive support, ideally from a multidisciplinary team consisting of health care providers, patient advocates, social workers, and psychologists to help patients understand their disease and treatment options, make informed treatment decisions, adhere to treatment, and ultimately reduce their disease burden and improve outcomes. This research revealed that patients with MM need varying types and levels of support, with the most common needs including information on disease and treatment, connections to financial resources and support systems, assistance with navigating insurance options, and transportation and logistical support for medical appointments. [ABSTRACT FROM AUTHOR]

Background: Nurses have a critical role to play in achieving the United Nations' 17 Sustainable Development Goals (SDGs). While Goal 3 (good health and well-being) is of particular importance to nursing, every SDG contributes to the advancement of universal health and well-being. Yet many nurses are unfamiliar with the SDGs and how they relate to everyday nursing practices. Purpose: The purpose of this study was to examine RNs' knowledge of and attitudes toward the SDGs. Methods: This study used a descriptive correlational cross-sectional design. A convenience sample of RNs from multiple countries completed an anonymous online survey that included eight demographic items and 25 items exploring participants' knowledge of and attitudes toward the SDGs. Descriptive, parametric, and nonparametric statistics were used to analyze the data. Results: The majority of nurses in this study perceived themselves as lacking knowledge of the SDGs. Most wanted to know more, including how they could take action to help achieve the goals. Overall, participants agreed that the SDGs are relevant to nursing practice and that nurses are integral to their advancement. Participants who were younger than age 50, those living in the United States, and those who practiced primarily in a clinical or community setting were more likely than others to self-report lower SDG knowledge scores. Conclusions: The study findings contribute to our collective understanding of RNs' knowledge and attitudes regarding the SDGs. They can assist nurse educators and leaders worldwide in developing targeted strategies to better inform nurses and prepare them for actions that will advance these goals. Increasing nurses' knowledge of the SDGs, especially as these goals relate to daily clinical practice, may lead to greater nursing engagement and impact. [ABSTRACT FROM AUTHOR]

Background: Hospice care leads to improved patient and family outcomes. Hospice use among older adults with end‐stage kidney disease (ESKD) is markedly lower than among older adults with other serious illnesses, and the majority of those with ESKD who use hospice enroll in the last days of life. Here, our aim was to explore barriers to timely receipt of high‐quality hospice care for older adults with ESKD. Methods: Utilizing a qualitative study design, we conducted a secondary analysis focused on hospice, a theme that we identified in our larger overarching study that involved semi‐structured interviews with 20 nephrologists in the United States focused on treatment decision‐making in older adults with advanced chronic kidney disease. We analyzed the interview transcripts using emergent thematic analysis to develop an understanding of barriers to high‐quality hospice. Results: With a couple notable exceptions, nephrologists voiced general support for the concept of hospice, but few recalled patients of theirs who had received hospice. Nephrologists' interviews revealed two interrelated contributors to the lack of timely access to high‐quality hospice care for seriously ill older adults with ESKD: (1) nephrologists view dialysis and hospice as mutually exclusive models of care; (2) nephrologists feel unsure who should manage hospice care for patients with ESKD. The first contributor was rooted in nephrologists' narrow vision of when to consider hospice (informed, in part, by policy barriers) and, in a couple of cases, strong discomfort with hospice. The second stemmed from nephrologists' belief that neither they nor hospice are adequately prepared to provide hospice care for ESKD. Conclusions: Our findings suggest that, in addition to Medicare policy change, nephrologists need to receive more training in primary palliative care skills including in indications for hospice, initiating conversations about hospice with patients, and collaborating with hospice clinicians to care for these vulnerable patients. [ABSTRACT FROM AUTHOR]

Wang and Conway (2006, Autobiographical memory, self, and culture. In L.-G. Nilsson, & N. Ohta (Eds.), Memory and society: Psychological perspectives (pp. 9–27). Psychology Press) posit that remembering takes place in a culturally modulated self-memory system in which working self-goals are shaped by society and, in turn, influence the encoding and construction of memories in a culturally canonical fashion. The current research examined the self-goal of competence, which manifests through self-enhancement versus self-improvement motivations, in influencing remembering in different cultural contexts. We conducted two cross-cultural studies to examine memories for personal successes and failures (Study 1) and autobiographical and vicarious experiences (Study 2) in connection with individuals' positive self-views. European Americans recalled a greater number of success than failure memories (Study 1) and US participants recalled a greater number of autobiographical than vicarious memories (Study 2), which was further associated with positive self-views at the individual level. In contrast, Asian (Study 1) and Chinese participants (Study 2) recalled even-handedly the different types of memories, and the memory retrieval was unrelated to individuals' self-views. We discuss the findings in light of the different manifestations of the competence goal in shaping memory in the culturally modulated self-memory system. [ABSTRACT FROM AUTHOR]

Adolescents go through a critical process of identity formation. This time in their life can be confusing and having a mentor to provide support and guidance has proven to be helpful and may increase self-esteem, self-efficacy, problem-solving and coping skills in youth. In this qualitative narrative study, at-promise youth from historically oppressed communities (ages 12 to 15) who participated in a 12-week therapeutic youth mentoring program, were interviewed utilizing a creative method called photo-elicitation. Photo-elicitation and semi-structured questions facilitated the narrative interview process allowing the youth to share experiences surrounding identity formation through photographs. Significant findings are presented in narrative form utilizing participant quotes to capture the emotion, language, and perspective of the participants' perceptions of self and identity. Implications for mental health professionals working with adolescents during a time of self-exploration and identity formation, and recommendations for future research are discussed. [ABSTRACT FROM AUTHOR]

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

Characterize experiences with cancer and perceptions of the preventable cancer burden attributable to diet among firefighters. A cross-sectional survey was distributed to assess cancer history and perceptions of cancer. US. US-based firefighters. History of cancer, perceptions of cancer, and perceptions of diet as a means to prevent cancer. Descriptive statistics and use of the Behaviour Change Technique Taxonomy v1 (BCTTv1) to evaluate qualitative responses. A total of 471 firefighters participated. Nearly half (48.4%) voiced they strongly agreed that they were at risk for cancer, whereas 44.6% agreed that changing diet could decrease cancer risk. The most common BCTTv1 codes focused on types of education, including "Instruction on how to perform the behavior" (45.1%, n = 189), followed by those centered on behavior execution (eg, "Action planning" [24.8%, n = 104]). Qualitatively, many were concerned about misinformation. Firefighters acknowledge the role of diet in cancer risk and have a desire for knowledge and behavioral support (eg, goal setting) that includes an emphasis on evidence and tackling misinformation. This information should serve as the basis of future interventions that target diet. [ABSTRACT FROM AUTHOR]

BACKGROUND: Under the Workforce Innovation and Opportunity Act of 2014 (WIOA), vocational rehabilitation (VR) agencies are required to evaluate their students' need for pre-employment transition services and use this information to inform their goals, priorities and strategies. OBJECTIVE: This manuscript presents the development and field testing of the Transition Self-Assessment Tool (TSAT), a web-based instrument designed to support VR agencies' evaluation and strategic planning initiatives by measuring the availability, accessibility, and coordination of school-based transition services. METHOD: Our methods describe the TSAT development procedures and the methods of conducting a TSAT field test. RESULTS: Findings suggest high schools offer a broad array of career-related services for their students. However, not all potentially eligible students with disabilities have access to those services and when these services are provided, they are frequently delivered without coordination with VR. Additionally, data show more services are available, accessed, and coordinated in high schools participating in a statewide transition program. CONCLUSION: Results from the TSAT field test suggest it is feasible to conduct a statewide needs assessment of school-based transition services using this instrument. Furthermore, the findings from the TSAT align with prior knowledge about school-based transition services, and can be used to inform a state's goals, priorities and strategies. [ABSTRACT FROM AUTHOR]

BACKGROUND: Physical activity (PA) is a promising intervention for disease modification and symptom management in multiple sclerosis (MS); however, there is a lack of research focusing on PA behavior change interventions for persons newly diagnosed with MS. Such PA behavior change interventions should be developed based on a strong empirical foundation of understanding the behavior and its determinants (ie, what to target for changes to occur). To that end, this qualitative study examined factors explaining PA in persons newly diagnosed with MS and identified potential targets for future behavior change intervention development based on the Capability-Opportunity-Motivation-Behavior (COM-B) model. METHODS: Twenty individuals diagnosed with MS within the past 2 years underwent one-on-one semistructured interviews using questions developed based on the COM-B model. Data were analyzed using reflective thematic analysis, and the identified themes were then mapped with the COM-B model. RESULTS: Factors explaining PA in the study sample were identified across the COM-B components. The typical factors include knowledge and skills to sufficiently engage in PA with appropriate approaches, ability to adapt and navigate through new environmental and social difficulties after diagnosis, and motivation resulting from a combination of factors, such as outcome expectation, belief of capabilities, role/identity, reinforcement, and emotions. CONCLUSIONS: The COM-B model was applied successfully in this study to understand PA behavior and identify potential targets for behavior change in individuals newly diagnosed with MS. Future behavior change interventions should consider addressing these factors to generate effective PA behavior change in this population. [ABSTRACT FROM AUTHOR]

AIMThis study explored the experiences of prelicensure nursing students for whom English is an additional language when preparing for and taking course examinations. BACKGROUND English-as-an-additional-language students face challenges related to language comprehension on nursing examinations. Recognizing their unique obstacles may assist in designing equitable assessments and processes that improve outcomes. METHOD Responding to 14 semistructured, guided questions, 16 students discussed their experiences preparing for and taking nursing examinations. RESULTS Three primary themes related to student academic success emerged: psychological factors, perseverance, and factors affecting outcomes. Data revealed language as a factor that affected outcomes. Positive factors of note included self-confidence and diligence to succeed. CONCLUSION The results outline challenges faced by nursing students for whom English is an additional language and include strategies for promoting equity and academic success. [ABSTRACT FROM AUTHOR]

Purpose: The COVID-19 pandemic caused significant changes for family-- professional interactions. Many services shifted to telepractice, with new opportunities for parents and speech-language pathologists (SLPs) to partner for service delivery. Parent-coached models of augmentative and alternative communication (AAC) intervention provide positive outcomes for children; however, SLPs have reported difficulty building strong partnerships with families. The shift to telepractice during the COVID-19 pandemic provided a unique context to examine factors influencing parent--SLP partnerships, particularly for parents with children who use aided AAC. Method: Twenty-five parents and 25 SLPs who engaged in services with children and youth from 3 to 21 years of age who used aided AAC during the initial stages of the COVID-19 pandemic in June 2020 participated. Semistructured interviews were conducted individually with parents and SLPs to understand perspectives on whether the change in service delivery facilitated or hindered family-oriented practice. Inductive qualitative analysis was used to analyze information about the factors impacting parent--SLP partnerships. Results: The parent--SLP partnership was influenced by setting and systemic determinants, and intrinsic determinants to the parent and the SLP that included their history and rapport, beliefs about partnering, and knowledge and skills. These determinants served as barriers or facilitators to their partnership. Conclusions: It is essential to consider the relationship, expectations, and knowledge and skills that SLPs and parents bring to the partnership, along with extrinsic structural factors that can impact this partnership. Positive rapport, valued partnership, and an openness to sharing knowledge through teaming and collaboration provided for positive parent--SLP partnerships. [ABSTRACT FROM AUTHOR]

Persons with lower limb loss (PwLLL) must self-manage their residual limb and their prosthesis to prevent self-management related complications (SMRC). However, the experience of PwLLL as it relates to self-management has not been reported. Thus, the purpose of this study was to explore the experience of self-management from the perspective of PwLLL, prosthetists, and physical therapists. This study had a qualitative design. Twenty-three participants were interviewed (PwLLL = 10, prosthetists = 7, physical therapists = 6). Interviews were transcribed and then coded using constant comparison. Four prominent themes were developed from the transcripts: (1) embodying the duty of self-management, (2) being a vigilant self-advocate, (3) setting goals collaboratively, and (4) making informed decisions. Each of the four themes were influenced by the health beliefs of the PwLLL, specifically motivation and presence of an internal locus of control. Clinicians should emphasize the therapeutic relationship, including open communication, collaborative goal setting, and promoting an internal locus of control in interactions with PwLLL, as it may play a role in decreasing SMRC and improving clinical outcomes. Self-management is a crucial aspect of preventing secondary complications associated with limb loss and prosthesis use. Self-management requires an internal locus of control, problem-solving abilities, and foundational knowledge Clinicians can promote self-management through collaborative goal setting and systematic education. [ABSTRACT FROM AUTHOR]

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

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

In the present study, we examined the longitudinal stability and change in mastery-approach goals for running as offered in regularly scheduled physical education (PE) and athletics classes in the United States. There were five waves of data collection from 806 students (431 boys; 375 girls) who were tracked from fourth to eighth grade while participating in running activities in PE or athletics classes. We assessed the participants' mastery-approach goals using four items on a 5-point scale. We found acceptable longitudinal construct validity, measurement invariance, and scale reliability for the scores of mastery-approach goals, and we found these goals to have moderate stability across this 5-year period. Latent growth modeling revealed a linear decline in mean mastery-approach goal scores over the five school years. We concluded that the assessment of mastery-approach goals over time was both valid and reliable and that these running mastery-approach goals were stable in most respects but became less intense over time. [ABSTRACT FROM AUTHOR]

Arts-based training programs can aid in building observational skills, communication, team building, and leadership through targeted analysis of works of art. Furthermore, arts-based training programs are unique in that they highlight non-technical skills (NTS). The goal of this study was to investigate the extent to which NTS were developed through an arts-based training program among entry-level occupational therapy doctorate (OTD) students. This study used a mixed methodological approach to analyze retrospective data. Quantitative analysis of the Kentucky Inventory of Mindfulness Skills (KIMS) assessment was conducted. Qualitative analysis was completed through analysis of the participants’ reflection papers. Quantitative results (n = 69) from the KIMS show significance (p = 0.011; 0.013), and qualitative analysis (n = 32) resulted in five central themes: evolution of thinking, holistic approach, diverse perspective, lived reality of context, and development of NTS (collaboration, self-awareness, mindful of others, creativity, and effective communication). Quantitative and qualitative findings suggest arts-based training programs can improve students’ ability to reduce their bias through implementation of a mindfulness lens. Results and recommendations from this study can be used as an example for occupational therapy academic programs to implement an evidence-based teaching methodology. [ABSTRACT FROM AUTHOR]

Background: Aspirations refer to wishes, ways of defining quality of life (QOL), and life goals. Living with chronic illness likely impacts a person's life aspirations. Duchenne Muscular Dystrophy (DMD) is an inherited disorder characterized by the inevitable and progressive loss of ambulation and independence. The present cross-sectional case–control study investigated how aspirations differed between people with DMD and a stratified comparison group of nationally representative children/adults. Methods: A web-based survey was administered October through December 2020. Recruitment was stratified by age group: 8–12, 13–17, and > = 18, reflecting the DMD disability trajectory. Aspirations were measured using qualitative (open-ended) and quantitative (closed-ended) questions. Qualitative prompts asked participants about wishes, how they would define "QOL"; and goals; answers to the prompts were then coded by six trained raters. Quantitative questions included 29 closed-ended goal-delineation items from the QOL Appraisal Profilev2. These data were analyzed using multivariate models adjusting for propensity scores (demographic differences), and testing for the effects of role (patient or comparison), age, and role-by-age interactions. Results: The study sample of DMD (n = 285) and comparison (n = 292) participants provided open-text data: 577 wishes statements, 283 QOL-definition statements, and 149 goals statements. Inter-rater reliability (kappa = 0.77) reflected good agreement between different raters' codes. Results suggested that people with DMD have aspirations that differ from their peers in several important ways. Both open-text and closed-ended data in both unadjusted and adjusted analyses generally showed that people with DMD were more focused on intrinsic aspirations such as health, healthcare, and independence than their peers. Compared to non-DMD persons, DMD individuals were much less focused on financial or housing concerns, community contributions, or spiritual growth. With age, patients' aspirations focused less on extrinsic aspirations such as careers and work and increasingly emphasized emotion-oriented goals. Patients were markedly less likely to give a direct answer to the open-ended goals question. Conclusion: There were important differences in aspirations between people with DMD and their peers. These findings may be helpful for developing psychosocial interventions. [ABSTRACT FROM AUTHOR]

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In the present study, we investigated the ways in which the ideographic goal descriptions and goal appraisals of European American high school seniors reflect potentials for intentional self-development during emerging adulthood (EA), a lifespan phase characterized by increasing levels of freedom and decreasing age-graded, socially sanctioned developmental norms. Additionally, we investigated whether variation in participants' goal appraisals and the motivational qualities emergent in their goal descriptions would predict variation in dimensions of identity development, both concurrently at age 18 and prospectively at age 23. Results of an exploratory, mixed method analysis of participants' (N = 129, 56.6% male, Mage = 18.24, SD = 0.37) goal data revealed diversity in education and work goals, strong potentials for intentional self-development reflected across goal appraisals, and more nuanced reflections of intentional self-development across the motivational qualities emergent in goal descriptions. Results partially supported the hypothesis that goal appraisals and motivational qualities that reflect potentials for intentional self-development would predict kindred processes of identity development across the first five years of EA. These findings contribute to a nascent empirical literature focused on the interrelationship of goal and identity constructs during EA and suggest new avenues for future research. [ABSTRACT FROM AUTHOR]

Stroke is a leading cause of disability in adults and third cause of death in the United States. Survivors face challenges postdischarge, including risks in self-management (SM) following prescribed regimens. Although SM education can help develop skills to control risk factors for stroke recurrence, little is known about lived experiences of patients adopting SM. To examine Veterans' lived poststroke experiences after discharge and their experiences in SM goal setting/attainment. Patients within one year of discharge from a Veterans Administration Medical Center in the United States with two risk factors for stroke recurrence were enrolled and received an SM workbook. Eight patients were interviewed (six males, two females; mean age 62: range 45–80). Part I concerned lived experience. Part II described experiences with goal setting and attainment. Data were analyzed inductively, identifying common experiences. Deductive analysis described goal setting and attainment. Transcript reviews identified SM themes and strategies. Lived experiences included 1) uncertainty about life, 2) anger and frustration, and 3) healthcare system challenges. Coping skills and setting goals to manage risks were critical for physical and emotional functioning. SM coping and goal setting aided recovery and improved life quality among Veterans after stroke. SM interventions assisted in regaining physical and emotional function. Findings may help in design of interventions for survivors, using SM and goal setting and attainment. Several implications for clinical practice were identified: Providers should acknowledge Veterans' challenges and struggles after their stroke and help Veterans to re-establish social identity, enhance self-esteem and improve mood. More emphasis should be given to the Veterans' caregivers' availability and willingness to help with their loved one's recovery, work reinstatement status and financial struggles. Recognition of the importance of the social context of recovery after a stroke is important, as nonmedical social interaction is often overlooked. Improvements are needed in the area of providers working with social workers and physical, occupational and mental health therapists to arrange more inpatient and outpatient treatments, including more frequent home visits. Veterans should be strongly encouraged to attend self-management diabetes education classes and smoking cessation and weight-loss programs offered for free within the Veterans Health Administration system. Self-management strategies using goal-setting and attainment concepts may assist individuals with stroke to regain physical and emotional functions, subsequently preventing another stroke. [ABSTRACT FROM AUTHOR]

Intervention construct validity procedures test the efficacy of a program to impact on targeted theory constructs. To examine the intervention construct validity of the Planning to be Active (PBA) and Mentored Planning to be Active (MPBA) programs on high school youth residing in Appalachia. Twenty high schools in Appalachia were randomly assigned to either the teacher lead PBA program or the peer mentor led MPBA program. All participants (n = 633) completed a set of valid and reliable instruments assessing SCT variables: social support for exercise friends, social support for exercise family, self-efficacy for exercise and the self-regulation skills (behavioral goal setting, exercise self-monitoring, building social support, overcoming barriers, and self-reward). PBA and MPBA are effective approaches to increasing social support, self-efficacy for exercise and increasing the use of self-regulation skills to increase physical activity. The results identify constructs that were not improved suggesting areas for curriculum refinement. PBA and MPBA have established construct validity. Intervention construct validity methods identified program strengths and weaknesses. Intervention construct validity is an evidence-based approach to program improvement. Intervention construct validity establishes a foundation for testing theory impact on health behaviors. [ABSTRACT FROM AUTHOR]

Grit and resilience are related but separate concepts. Grit is a long-term commitment toward goals, and it impacts student success and academic achievement. Resilience is the ability of students to recover from stress. Both are important factors in nursing students. This descriptive study included surveys measuring demographics, grit, and resilience among two cohorts of senior nursing students in their last semester and explored challenges and difficulties experienced during the COVID-19 pandemic. The mean grit score for all students was 4.0 (0.52) and the mean resilience score was 3.63 (0.73). Directed content analysis of the ten open-ended survey questions revealed three themes: Impact on Education, Personal Impact, and Coping Mechanisms. Grit and resilience are important factors that can contribute to success in nursing programs and as graduate nurses in the healthcare settings. [ABSTRACT FROM AUTHOR]

Purpose: The purpose is to explore experiences transitioning home from acute hospital care from perspectives of younger traumatic brain injury (TBI) patients, family caregivers and healthcare providers (HCPs). Design/methodology/approach: The authors conducted 54 qualitative interviews (N = 36: 12 patients, 8 caregivers, 16 HCPs) and analyzed data using conventional content analysis. Findings: The transition from hospital to home was described as a negotiation, finding a way through these obstacles: (1) preparing for discharge home during acute hospital care; (2) navigating transitions in healthcare and health; (3) addressing recovery concerns, and (4) setting goals to return to normal. Factors influencing the negotiation process included social support, health-related knowledge or training, coping mechanisms, financial stability, and home environment stability. Originality/value: Younger TBI patients and caregivers have unique needs during the transition home from the hospital. Needed support from HCPs was inconsistently provided. Findings are foundational for integrated care research and practice with TBI. [ABSTRACT FROM AUTHOR]

Background: During October 2016 through May 2018, a learning community was convened to focus on policies and programs to increase access to the full range of contraceptive options for women of reproductive age. The Increasing Access to Contraception (IAC) Learning Community included 27 jurisdictions, with teams from each jurisdiction consisting of state health department leaders, program staff, and provider champions. At the kick-off meeting, teams from each jurisdiction created action plans that outlined their goals. Methods: We contacted jurisdictions during May–June 2019, 1 year after the learning community ended, and invited them to complete a post-assessment of goal achievement and sustainment through semi-structured interviews over the telephone or via email. Results: Follow-up information was collected from 26 jurisdictions (96%) that participated in the learning community. The teams from these jurisdictions had created 79 total goals. At the time of the learning community closing meeting in May 2018, 35 goals (44%) had been achieved. Three jurisdictions achieved all their goals by the close of the learning community. At the time of the post-assessment 1 year later, jurisdictions were sustaining efforts for 69 (87%) of the total goals. In every jurisdiction, work on at least one goal that originated in the learning community was sustained. Conclusions: The jurisdictions that participated in the IAC Learning Community continued the work of their action plan goals 1 year after the formal closure of the learning community, indicating sustainability of the learning community activities, beyond what jurisdictions accomplished during formal participation. [ABSTRACT FROM AUTHOR]

Importance: Occupational therapy practitioners can play a pivotal role in supporting breastfeeding mothers as they transition to and form new routines for this occupation. Objective: To explore whether occupational therapy programming can assist breastfeeding mothers in reaching their personal occupation-based wellness goals. Design: Mixed-methods design that involved development of an occupational profile and a goal attainment scale (GAS). After the intervention, participants rescored their GAS goals and completed a semistructured exit interview. Setting: Nonprofit lactation center located in the suburbs of a large mid-Atlantic U.S. city. Participants: Women recruited through convenience sampling who had been breastfeeding an infant for <6 mo, who were not currently weaning, and who had met with a lactation consultant at least once since giving birth were eligible (N = 17). Intervention: Group occupational therapy that consisted of 10 weekly 1-hr sessions. Topics were based on occupational profiles, GAS scores, and lactation consultant input. Outcomes and Measures: Each participant created and scored three goals using the GAS before and after the intervention. Results: Data from 14 of the 17 participants were analyzed. The average postintervention GAS score was 56.50 (M = 50), indicating that most personal wellness goals were reached. Thematic analysis revealed that occupational therapy programming helped mothers persevere with breastfeeding, feel more confident as new parents, and value both themselves and their baby. Conclusions and Relevance: There is an increasing role for occupational therapy practitioners in helping new mothers reach their personal wellness goals in ways that support their ability to continue breastfeeding. What This Article Adds: Maternal wellness and breastfeeding represent an emerging area of practice in which occupational therapy practitioners can provide new mothers with physical, social, and psychological supports that help them maintain self-efficacy related to breastfeeding and other meaningful occupations. This study provides foundational evidence in support of this collaboration. Maternal wellness and breastfeeding is an emerging area of practice in which occupational therapy practitioners can provide new mothers with supports that help them maintain self-efficacy related to breastfeeding and other meaningful occupations. [ABSTRACT FROM AUTHOR]

There is a dearth of available supports and services aimed specifically at parents with disabilities. The Parent-Centered Planning (PCP) intervention was developed to fill this gap, aiming to enhance supports for parenting for parents with disabilities. This brief approach was modeled after person-centered planning, with a focus specifically on parenting. This qualitative paper explores the experiences of a sample of parents (N = 13) with physical, intellectual and/or developmental disabilities who participated in a pilot study of PCP. Our study found that nearly all parents participating in the intervention strengthened relationships during the process of participation in PCP, clarified their goals related to parenting, and made progress toward their identified goals. The study also found that parents had mental health concerns, often related specifically to their disability supports. The article describes the nuances of these findings and discusses the implications for practice and future research. [ABSTRACT FROM AUTHOR]

Problem: Medical students perceive honors grading during core clerkships as unfair and inequitable, and negatively impacting their learning and wellbeing. Eliminating honors grading, a powerful extrinsic motivator, and emphasizing formative feedback may address these problems and promote intrinsic motivation and learning. However, it is unknown how transitioning from honors to pass/fail grading with enhanced formative feedback in the core clerkship year may affect student learning experiences, wellbeing, and perceptions of the learning environment. Intervention: Core clerkship grading was transitioned from honors/pass/fail to pass/fail at one US medical school. In addition, the requirement for students to obtain formative supervisor feedback was formalized to twice per week. Context: This qualitative study utilized semi-structured interviews to explore the perceptions among core clerkship students of learning and assessment. Interview questions addressed motivation, wellbeing, learning behaviors, team dynamics, feedback, and student and supervisor attitudes regarding assessment changes. The authors analyzed data inductively using thematic analysis informed by sensitizing concepts related to theories of motivation (goal orientation theory and self-determination theory). Impact: Eighteen students participated, including five with experience in both honors-eligible and pass/fail clerkships. The authors identified three major themes in students' descriptions of the change in approach to assessment: student engagement in clerkships, wellbeing, and recognition of learning context. Student engagement subthemes included intrinsic motivation for patient care rather than performing; sense of agency over learning, including ability to set learning priorities, seek and receive feedback, take learning risks, and disagree with supervisors, and collaborative relationships with peers and team members. Positive wellbeing was characterized by low stress, sense of authenticity with team members, prioritized physical health, and attention to personal life. Learning context subthemes included recognition of variability of clerkship contexts with pass/fail grading mitigating fairness and equity concerns, support of the grading change from residents and some attendings, and implications surrounding future stress and residency selection. Lessons Learned: Students perceive a transition from honors grading to pass/fail with increased feedback as supporting their engagement in learning, intrinsic motivation, and wellbeing. Drivers of wellbeing appear to include students' feelings of control, achieved through the ability to seek learning opportunities, teaching, and constructive feedback without the perceived need to focus on impressing others. Ongoing evaluation of the consequences of this shift in assessment is needed. [ABSTRACT FROM AUTHOR]

Objective: Dual Eligible Special Needs Plans (D-SNPs) were intended to provide better care for beneficiaries eligible for both Medicare and Medicaid through better coordination of these two programs.Data Sources: 671 913 dual eligible (DE) respondents to the 2009-2019 Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.Study Design: We compared the 2015-2019 experiences of DE beneficiaries in D-SNPs relative to fee-for-service Medicare (FFS) and non-SNP Medicare Advantage (MA) using propensity-score weighted linear regression. Comparisons were made to 2009-2014. 12 patient experience measures were considered.Data Collection Methods: Annual mail survey with telephone follow-up of non-respondents.Principal Findings: More than 65% of DE beneficiaries enrolled in FFS. Of 12 measures, D-SNP performance was higher than non-SNP MA on two (P < .05), lower than non-SNP MA on two (P < .05), and higher than FFS on four (P < .01). DE beneficiaries did not report better coordination of care in D-SNPs. D-SNP performance was often worse than other coverage types in prior periods.Conclusions: Relative to FFS Medicare, DE beneficiaries report higher immunization rates in D-SNPs, but slight or no better performance on other dimensions of patient experience. New requirements in 2021 may help D-SNPs attain their goal of better care coordination. [ABSTRACT FROM AUTHOR]

Background and Objectives: The passage of the Affordable Care Act has ignited a shift from the pay-for-performance model to value-based care with a particular relevance in critical care settings. Provider incentive programs are widely considered as a means to reward providers based on the achievement of preset quality metrics. This article aims to demonstrate the effects of a provider incentive program in the critical care delivery system in a large academic center in the Northeastern United States. Methods: This article describes the results of a retrospective analysis of a performance-driven quality improvement initiative at a critical care facility of an academic medical center using a quasi-experimental pre-/posttest design. A set of quality measures was selected as outcome metrics. Selection criteria for the process measures are as follows: (i) the metric goals should be influenced by the physician's input to a large degree; (ii) the measure must be transparent and accessible within the hospital-wide data reporting system; (iii) the metric that required group effort and interdisciplinary collaboration to achieve; and (iv) the measure must directly affect patient outcome. The outcome metrics are central line--associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs), standardized infection ratio (SIR), Foley catheter and central line utilization standardized utilization ratio (SUR), hand hygiene compliance, and adherence to respiratory recovery pathway goals. These metrics were tracked from for 3 years with success defined as achieving set benchmarks for each metric. Results: The average CLABSI SIR and CAUTI SIR across all intensive care units (ICUs) decreased by 44% (P= .05) and 87% (P= .02) over 3 years as well as the central line and Foley catheter utilization falling by 41% and 30%, respectively. Hand hygiene compliance in the ICUs improved for the same period by 27 percentage points, as did compliance with the respiratory recovery pathway program by 4 percentage points. Conclusion: The use of a physician-driven financial incentive model in a critical care setting measured by outcome metrics dependent on physician input is successful with rigorous implementation and careful evaluation. [ABSTRACT FROM AUTHOR]

Background: Goal Attainment Scaling (GAS) is advocated as a meaningful outcome measure for parents and clinicians using an Ayres Sensory Integration® Intervention (ASI) approach. Although used in several treatment effectiveness studies, reliability of therapist goal writing and scoring has not been established in this area. Method: Ten occupational therapists and 40 parents of children receiving ASI participated across two clinical sites. The interview therapists and inter-rater therapists wrote GAS goals based on the same goalsetting interviews conducted with parents. Follow-up parent interviews were conducted post-ASI intervention, and the GAS goals were rated by both the interview therapists and inter-rater therapists. Results: Seventy-eight percent of interview therapist and inter-rater therapist-written goals agreed on content. Intra Class Correlation coefficient of agreement between the two sets of raters was .70 for the total score. Control of bias for establishing and rating the projected level of performance and scaled GAS goals was within an acceptable range. Conclusion: Findings contribute reliability evidence for use of GAS with children with sensory processing and integration challenges. Two therapists, from different clinical sites who were unfamiliar with the child, identified goal areas, wrote similar GAS goals based on the same parent interview, and scored goals post intervention with good inter-rater reliability. [ABSTRACT FROM AUTHOR]

Context: Height velocity (HV) is difficult to assess because growth is very slow. The current practice of calculating it from measurements taken at several-month intervals is insufficient for managing children with growth disorders. We identified a bone growth by-product (collagen X biomarker, CXM) in blood that in preliminary analysis in healthy children correlated strongly with conventionally determined HV and displayed a pattern resembling published norms for HV vs age.Objective: The goal was to confirm our initial observations supporting the utility of CXM as an HV biomarker in a larger number of individuals and establish working reference ranges for future studies.Design, Settings, and Participants: CXM was assessed in archived blood samples from 302 healthy children and 10 healthy adults yielding 961 CXM measurements. A total of 432 measurements were plotted by age, and sex-specific reference ranges were calculated. Serial values from 116 participants were plotted against observed HV. Matched plasma, serum, and dried blood spot readings were compared.Results: A correlation of blood CXM with conventional HV was confirmed. Scatter plots of CXM vs age showed a similar pattern to current HV norms, and CXM levels demarcated the pubertal growth spurt both in girls and boys. CXM levels differed little in matched serum, plasma, and dried blood spot samples.Conclusions: Blood CXM offers a potential means to estimate HV in real time. Our results establish sex-specific, working reference ranges for assessing skeletal growth, especially over time. CXM stability in stored samples makes it well suited for retrospective studies. [ABSTRACT FROM AUTHOR]

Purpose: Development of individualized student goals is integral to special education. Although United States federal legislation and state, local, and professional guidelines outline preferred goal development processes, actual practice does not always reflect ideal practice. The purposes of this research were to understand how physical therapists develop student goals and to identify facilitators and barriers to development of participation-based goals. Methods: Twenty school-based physical therapists participated in one of five semi-structured focus groups. Two researchers conducted thematic analysis of transcriptions of audio recordings to identify qualitative themes; a third researcher reviewed the analysis. Results: Five themes emerged related to therapists' recommendations for goal development: (1) Understand the student: The foundation for individualized goal development, (2) Teaming: The critical component to integrate varied perceptions and establish a common vision, (3) Relevant focus of goal: Addressing what is meaningful for a student's day, (4) Best practices: Embracing professional advances, and (5) Develop and write the goal: The art and science of writing goals. The first four themes also reflected facilitators and barriers to development of participation-based goals. Conclusions: Therapists' comments reflected striving to follow ideal practice recommendations despite identified challenges. This research helps educational teams understand and reflect on goal development processes. Although writing goals is a foundational task in school-based practice, meaningful goal development is a complex process. School-based physical therapists recommend working closely with students, parents, teachers, and other members of the educational team to establish good communication, trust, and a shared philosophy of collaboration and responsibility for student goals A thorough understanding of the student serves as the foundation for developing individualized student goals. Educational teams are encouraged to understand professional, federal, state, and local guidelines and embrace professional advances in goal development practices. [ABSTRACT FROM AUTHOR]

Purpose: To identify components of the patient-centered medical home (PCMH) model of care that are associated with lower spending and utilization among Medicare beneficiaries.Methods: Regression analyses of changes in outcomes for Medicare beneficiaries in practices that engaged in particular PCMH activities compared with beneficiaries in practices that did not. We analyzed claims for 302,719 Medicare fee-for-service beneficiaries linked to PCMH surveys completed by 394 practices in the Centers for Medicare & Medicaid Services' 8-state Multi-Payer Advanced Primary Care Practice demonstration.Results: Six activities were associated with lower spending or utilization. Use of a registry to identify and remind patients due for preventive services was associated with all 4 of our outcome measures: total spending was $69.77 less per beneficiary per month (PBPM) (P = 0.00); acute-care hospital spending was $36.62 less PBPM (P = 0.00); there were 6.78 fewer hospital admissions per 1,000 beneficiaries per quarter (P1KBPQ) (P = 0.003); and 11.05 fewer emergency department (ED) visits P1KBPQ (P = 0.05). Using a patient registry for pre-visit planning and clinician reminders was associated with $29.31 lower total spending PBPM (P = 0.05). Engaging patients with chronic conditions in goal setting and action planning was associated with 4.62 fewer hospital admissions P1KBPQ (P = 0.01) and 11.53 fewer ED visits P1KBPQ (P = 0.00). Monitoring patients during hospital stays was associated with $22.06 lower hospital spending PBPM (P = 0.03). Developing referral protocols with commonly referred-to clinicians was associated with 11.62 fewer ED visits P1KBPQ (P = 0.00). Using quality improvement approaches was associated with 13.47 fewer ED visits P1KBPQ (P =0.00).Conclusions: Practices seeking to deliver more efficient care may benefit from implementing these 6 activities. [ABSTRACT FROM AUTHOR]

Nonprofit and governmental relations become increasingly formidable with a nonprofit's number of public funding streams. Complexity of conflicting funding regulations traps the nonprofit in a state of dysfunction. Interviews with managers currently working in domestic violence advocacy organizations (DVAOs) in the United States are analyzed with a grounded analysis approach to identify the outcome of policy conflict tied to their multiple public funding streams. An unspoken policy narrative emerges that underlies more overt social policy narratives. This emergent narrative drives organizational activities toward accountability tasks and away from mission fulfillment tasks. DVAOs are bound within institutional gridlock. [ABSTRACT FROM AUTHOR]

Nearly 80% of persons with multiple sclerosis (MS) do not engage in sufficient amounts of exercise for managing symptoms and improving quality of life. We have addressed this problem by developing a systematic line of qualitative research targeting the patient–provider interaction for promotion of exercise within comprehensive MS care. This research resulted in a conceptual model that guides health care providers in promoting exercise among persons with MS. The current study involves a final evaluation of the model based on semistructured interviews with 28 MS health care providers. Providers perceived that the model was a strong conceptualization of practice that reflected the MS illness course and supported exercise behavior change, but more steps were required to translate the model from concept into practice, including improved clarity of the model, and the development of practice models. The evaluation yielded a final conceptual model for exercise promotion in MS through the patient–provider interaction. [ABSTRACT FROM AUTHOR]

Internships are widely promoted as a "high-impact" practice, yet the literature is limited by insufficient attention to the impacts of program format on student outcomes. In this mixed-methods study survey (n=1,129) and focus group (n=57) data from students in three U.S. colleges were analyzed using inductive thematic analysis, chi-square, and hierarchical linear modeling to document intern characteristics, access-related problems, program structure, and impacts on student outcomes. Results indicate that internship participation varied significantly by race, institution, enrollment status and academic program, and that high degrees of supervisor support, supervisor mentoring, and relationship between internships and academic programs were significant predictors of students' satisfaction with internships and perceived value for their career development. Consequently, colleges and universities should work to ensure equitable access to internships and that additional research be conducted on how individual, institutional, and programmatic factors influence student participation in internships and their subsequent outcomes. [ABSTRACT FROM AUTHOR]

Objective: The study aims were to identify maternal perceptions about the influence of a hospital-based breastfeeding peer support group in addressing breastfeeding concerns, assisting them to achieve their breastfeeding goals, and providing additional benefits. Methods: A descriptive, cross-sectional, online survey was conducted with a convenience sample of women who attended a hospital's breastfeeding support group. Participants reported their breastfeeding concerns and breastfeeding goals prior to and after their attendance at the breastfeeding support group. Changes in reported breastfeeding concerns and breastfeeding goals were analyzed with chi-square statistics. Results: After participating in the support group session, survey participants (N = 100) expressed less concern about latching (81%–66%), mother's milk production (77%–62%), breastfeeding while apart from infant (75%–65%), and all other reported breastfeeding concerns. Overall, participants reported the support group successfully addressed their concerns (92%, n = 89), provided adequate time for responses to their questions (87%, n = 87), and assisted them to achieve their breastfeeding goals (91%, n = 88). Over 90% of participants planned to exclusively breastfeed through 6 months. Conclusion: Hospital-based breastfeeding support groups can successfully address mothers' key breastfeeding concerns and support extended duration of breastfeeding. [ABSTRACT FROM AUTHOR]

Introduction: US workplace law requires employers to provide reasonable break time and space other than a bathroom for breastfeeding women to express their milk. However, this law does not include students in higher education institutions who choose to breastfeed, as students are typically not employed by their schools. The purpose of this report is to describe the joint efforts of faculty members and students to successfully operationalize a lactation room and develop college-specific lactation guidelines in a university in central Kentucky. Method: Students from a college of nursing (CON) participated in a survey (N = 135), of which 30% were parenting at that time (n = 41). Results: Responses from this subset were used to make the case to CON leadership and faculty to develop college-specific guidelines entitled, "Guidelines for Lactation Support," which was included in students' handbooks, and to the designated space for a lactation room in the CONbuilding. Discussion: The combined effort of faculty, administrators, and students was crucial to promotea breastfeeding-friendly environment in the CON. [ABSTRACT FROM AUTHOR]

Meritocratic beliefs continue to be widely accepted in the United States; nonetheless, upward mobility is out of reach for many American women due to pervasive barriers to accessing decent work. The present study aims to explore American women's work aspirations and beliefs in the American Dream (the premise that no matter where people come from, with hard work, they can achieve prosperity) in light of the gap between this notion and the social inequalities in their working lives. We conducted semistructured interviews with 17 American women from diverse racial, educational, and work backgrounds to examine these women's work aspirations and beliefs on the American Dream. Qualitative content analysis yielded 3 domains: (a) aspiring for work that fulfills essential human needs, (b) multilayered influences on women's work aspirations, and (c) making sense of work aspirations in relation to beliefs on the American Dream. Our findings highlight the importance of relationships and systemic factors in shaping women's work aspirations. In addition, women's beliefs on the American Dream reflect complex interactions between endorsing meritocratic beliefs and their personal experiences. Implications for counseling psychology theory, research, and practice are discussed. Public Significance Statement: This study shares voices of American women from diverse backgrounds by documenting women's work aspirations and beliefs in the American ethos of meritocracy in relation to their working lives. It provides insights on individual, interpersonal, and systemic factors that affect women's work-related experiences and aspirations. [ABSTRACT FROM AUTHOR]

Communication about organ donation at the time of imminent death is a meaningful, yet less understood, area of health communication. We employed a multiple goals framework to explore family normative perceptions of organ donation and the conversational goal tensions experienced during a family member's imminent death. Semi-structured interviews were conducted with 14 family members who refused to donate when approached by an organ procurement coordinator (OPC) upon the imminent death of a family member. Thematic analysis revealed that family members described their decisions to refuse donation as (a) last acts of love, (b) responses to unnecessary requests, and (c) consistent with the known beliefs of the patient. Participants described several goal tensions operating within the organ donation conversation itself, including (a) the management of frequent requests, (b) pressure to donate, and (c) enduring unwanted requests from the OPC. Communication goals frameworks offer practical insights for improving organ-related conversations. [ABSTRACT FROM AUTHOR]

Importance: Dimensional definitions of transdiagnostic mental health problems have been suggested as an alternative to categorical diagnoses, having the advantage of capturing heterogeneity within diagnostic categories and similarity across them and bridging more naturally psychological and neural substrates.Objective: To examine whether a self-reported compulsivity dimension has a stronger association with goal-directed and related higher-order cognitive deficits compared with a diagnosis of obsessive-compulsive disorder (OCD).Design, Setting, and Participants: In this cross-sectional study, patients with OCD and/or generalized anxiety disorder (GAD) from across the United States completed a telephone-based diagnostic interview by a trained rater, internet-based cognitive testing, and self-reported clinical assessments from October 8, 2015, to October 1, 2017. Follow-up data were collected to test for replicability.Main Outcomes and Measures: Performance was measured on a test of goal-directed planning and cognitive flexibility (Wisconsin Card Sorting Test [WCST]) and a test of abstract reasoning. Clinical variables included DSM-5 diagnosis of OCD and GAD and 3 psychiatric symptom dimensions (general distress, compulsivity, and obsessionality) derived from a factor analysis.Results: Of 285 individuals in the analysis (mean [SD] age, 32 [12] years; age range, 18-77 years; 219 [76.8%] female), 111 had OCD; 82, GAD; and 92, OCD and GAD. A diagnosis of OCD was not associated with goal-directed performance compared with GAD at baseline (β [SE], -0.02 [0.02]; P = .18). In contrast, a compulsivity dimension was negatively associated with goal-directed performance (β [SE], -0.05 [0.02]; P = .003). Results for abstract reasoning task and WCST mirrored this pattern; the compulsivity dimension was associated with abstract reasoning (β [SE], 2.99 [0.63]; P < .001) and several indicators of WCST performance (eg, categories completed: β [SE], -0.57 [0.09]; P < .001), whereas OCD diagnosis was not (abstract reasoning: β [SE], 0.39 [0.66]; P = .56; categories completed: β [SE], -0.09 [0.10]; P = .38). Other symptom dimensions relevant to OCD, obsessionality, and general distress had no reliable association with goal-directed performance, WCST, or abstract reasoning. Obsessionality had a positive association with requiring more trials to reach the first category on the WCST at baseline (β [SE], 2.92 [1.39]; P = .04), and general distress was associated with impaired goal-directed performance at baseline (β [SE],-0.04 [0.02]; P = .01). However, unlike the key results of this study, neither survived correction for multiple comparisons or was replicated at follow-up testing.Conclusions and Relevance: Deficits in goal-directed planning in OCD may be more strongly associated with a compulsivity dimension than with OCD diagnosis. This result may have implications for research assessing the association between brain mechanisms and clinical manifestations and for understanding the structure of mental illness. [ABSTRACT FROM AUTHOR]

Purpose: Community-based exercise can support long-term management of Parkinson's disease, although it is not known if personal goals are met in these programs. The objectives of this study were to: (1) examine the goals of community based exercise programs from the participant and instructor perspectives; (2) establish the extent to which these programs meet self-described exercise outcomes; and (3) explore participant and instructor perspectives on barriers to meeting exercise expectations. Materials and Methods: This study explores the experiences of people with Parkinson's disease participating in a structured exercise program at six community sites. A mixed-methods approach was used, including participant and instructor interviews, assessment of exercise intensity, and mapping of exercise dosage to participant goals. Twenty-four exercise participants provided interview, quality of life, and exercise intensity data. Results: Twenty-one participants exercised for primary management of their Parkinson's disease. None met the exercise dosage necessary to meet this primary objective, although 60% met exercise dosage required to prevent disuse deconditioning. Participants and instructors did not describe similar goals for the community-based exercise program. Conclusions: Community-based exercise programs could be optimized by better aligning participant goals and exercise intensity. [ABSTRACT FROM AUTHOR]

Aims: Individualized goals are the foundation for physical therapy services and outcomes. This research describes school-based physical therapists' (PTs) experiences and perceptions of how student goals impact services and outcomes. Methods: Twenty school-based PTs participated in one of five semi-structured focus groups on goal development and use. Therapists were recruited from 113 therapists who participated in a study of school-based physical therapy outcomes. Two researchers conducted thematic analysis of written transcriptions of audio recordings to identify qualitative themes; a third researcher reviewed the analysis. Results: Four themes emerged related to how goals impact services: (1) the nature of services, (2) intervention strategies, (3) teaming, and (4) flexibility of services. Three themes emerged related to how goals impact outcomes: (1) natural linkages among goals, services, and outcomes; (2) goals impact teaming to achieve outcomes; and (3) specifics of the goal matter. Therapists also reported a range of student and environmental factors that impact services and outcomes. Conclusions: Therapists perceive that goals influence services and outcomes in complex ways, especially due to the flexibility and individualization needed in school-based practice. This study helps school-based PTs understand and reflect on how individualized goals influence services and optimize student outcomes. [ABSTRACT FROM AUTHOR]

Complex trauma can have a significant negative impact on the developing brain and occupational performance of children and adolescents. This study explored current practice in occupational therapy in complex trauma utilizing interviews and interpretive descriptive analysis. Nine experienced occupational therapists identified functional concerns that were mapped onto the International Classification of Functioning, Disability and Health framework. Findings indicated the importance of caregiver involvement in treatment, interventions to address bottom-up processes, advanced training, and being connected with other therapists who serve this population. Given the range of interventions with this complex population, occupational therapists have a unique opportunity to contribute to this emerging area of practice. [ABSTRACT FROM AUTHOR]

Background Middle-aged and older adults requiring skilled home healthcare ('home health') services following hospital discharge are at high risk of experiencing suboptimal outcomes. Information management (IM) needed to organise and communicate care plans is critical to ensure safety. Little is known about IM during this transition. Objectives (1) Describe the current IM process (activity goals, subactivities, information required, information sources/targets and modes of communication) from home health providers' perspectives and (2) Identify IMrelated process failures. Methods Multisite qualitative study. We performed semistructured interviews and direct observations with 33 home health administrative staff, 46 home health providers, 60 middle-aged and older adults, and 40 informal caregivers during the preadmission process and initial home visit. Data were analysed to generate themes and information flow diagrams. Results We identified four IM goals during the preadmission process: prepare referral document and inform agency; verify insurance; contact adult and review case to schedule visit. We identified four IM goals during the initial home visit: assess appropriateness and obtain consent; manage expectations; ensure safety and develop contingency plans. We identified IM-related process failures associated with each goal: home health providers and adults with too much information (information overload); home health providers without complete information (information underload); home health coordinators needing information from many places (information scatter); adults' and informal caregivers' mismatched expectations regarding home health services (information conflict) and home health providers encountering inaccurate information (erroneous information). Conclusions IM for hospital-to-home health transitions is complex, yet key for patient safety. Organisational infrastructure is needed to support IM. Future clinical workflows and health information technology should be designed to mitigate IM-related process failures to facilitate safer hospital-to-home health transitions. [ABSTRACT FROM AUTHOR]

OBJECTIVE. Occupational engagement is the foundation of occupational therapy. We identified perspectives of 18 occupational therapy practitioners on integrating occupation-based interventions during postacute care (PAC) rehabilitation for persons with hip fracture to identify occupational therapy's distinct contribution. METHOD. We conducted six focus groups derived from a purposive national sample of occupational therapy practitioners (N 5 18). A secondary analysis was conducted to analyze the transcripts for major subthemes around occupation-based interventions. RESULTS. Three major themes arose from practitioners' perspectives regarding the role of occupation in rehabilitation: (1) conducting an occupational profile, (2) integrating occupation-based intervention in the facility, and (3) identifying goals for occupational engagement after discharge. Challenges and strategies for integrating occupation-based interventions were also identified. CONCLUSION. Identifying practitioners' perspectives on integrating occupation into rehabilitation may inform strategies to facilitate occupation-based interventions in PAC and define occupational therapy's role in this setting. [ABSTRACT FROM AUTHOR]

Context: Although recommendations are for goals of care (GoC) conversations to happen early and often, their timing and content over the disease course remain unclear.Objectives: To describe perceptions of the timing and content of GoC conversations among oncologists and patients with advanced cancer.Methods: Semi-structured interviews with oncologists and patients at four hospitals in New York and Connecticut. We analyzed data using interpretive description.Results: Oncologists (n = 21) were 67% male, averaged 46 years old (range 34-68 years), and had a mean 20 years (range 8-42 years) in practice. Advanced cancer patients (n = 39) were 59% female with a mean age of 58 years (range 26-88 years). Oncologists and patients viewed GoC conversations along an initial, intermediate, and final continuum. Oncologists reported having initial GoC conversations to build rapport, provide disease information, and clarify and consider treatment intent and options. Intermediate conversations focused on changes in treatment and side effects. Final conversations occurred when patients were hospice-eligible and covered the shift to comfort care, a treatment summary, and advance directives. Timing and content were influenced by cancer type, disease status, and emotional state. Patients supported beginning GoC conversations early, but had different preferences for content of initial conversations. Some wanted complete information; others found this overwhelming. Patients felt intermediate GoC conversations should occur at decision points with time for processing. Content of intermediate and final conversations was dependent on patients' prognosis, questions, and treatment decisions.Conclusion: Although GoC conversations should follow individual patient preferences, our findings offer structure for their timing and content. [ABSTRACT FROM AUTHOR]

Purpose: To outline the development, implementation, and evaluation of a multistrategy intervention to promote active transportation, on a large university campus.Design: Single group pilot study.Setting: A large university in the Northeastern United States.Participants: University students (n = 563), faculty and staff (employees, n = 999) were included in the study.Intervention: The Active Lions campaign aimed to increase active transportation to campus for all students and employees. The campaign targeted active transport participation through the development of a smartphone application and the implementation of supporting social marketing and social media components.Measures: Component-specific measures included app user statistics, social media engagement, and reach of social marketing strategies. Overall evaluation included cross-sectional online surveys preintervention and postintervention of student and employee travel patterns and campaign awareness.Analysis: Number of active trips to campus were summed, and the percentage of trips as active was calculated. T tests compared the differences in outcomes from preintervention to postintervention.Results: Students had a higher percentage of active trips postintervention (64.2%) than preintervention (49.2%; t = 3.32, P = .001), although there were no differences for employees (7.9% and 8.91%). Greater awareness of Active Lions was associated with greater active travel.Conclusion: This multistrategy approach to increase active transportation on a college campus provided insight on the process of developing and implementing a campaign with the potential for impacting health behaviors among campus members. [ABSTRACT FROM AUTHOR]

Home care agencies are initiating "patient health goal elicitation" activities as part of home care admission planning. We categorized elicited goals and identified "clinically informative" goals at a home care agency. We examined patient goals that admitting clinicians documented in the point-of-care electronic health record; conducted content analysis on patient goal data to develop a coding scheme; grouped goal themes into codes; assigned codes to each goal; and identified goals that were in the patient voice. Of the 1,763 patient records, 16% lacked a goal; only 15 goals were in a patient's voice. Nurse and physician experts identified 12 of the 20 codes as clinically important accounting for 82% of goal occurrences. The most frequent goal documented was safety/falls (23%). Training and consistent communication of the intent and operationalization of patient goal elicitation may address the absence of patient voice and the less than universal recording of home care patient's goals. [ABSTRACT FROM AUTHOR]

Purpose of Study: Dementia affects more than 5 million Americans, and is a leading cause of death. Family members of nursing home (NH) residents with advanced dementia report difficulty making decisions about care toward the end of life. As part of a randomized trial testing an intervention to improve decision making, this qualitative study aimed to understand how family decision makers experienced goal-based decision making in advance of the death of their relative. Design and Methods: This qualitative study was conducted as part of the goals of care clinical trial. Study participants ( n = 16) were family decision makers in North Carolina whose relative with advanced dementia died after participating in the goals of care intervention. Semi-structured interviews were analyzed using a qualitative description approach. Results: Family members' experience of decision making and death differed based on the presence or absence of trusting relationships with NH staff. Family members who reported trust described a positive end-of-life experience and less need for prescribed goals of care discussions. In the absence of trust, family members reported that goals of care discussions were ignored by staff or created confusion. Implications: Among family members of persons who recently died from dementia in NHs, expressions of trust in staff were strongly related to perceptions of decision making about goals of care. Although goals of care discussions may potentially promote communication to earn trust, the presence of pre-existing trust ultimately influenced the decision making and end-of-life experiences of residents and families. [ABSTRACT FROM AUTHOR]