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People with aphasia can be marginalized by a communicatively inaccessible society. Compounding this problem, routinized exclusion from stroke research leads to bias in the evidence base and subsequent inequalities in service provision. Within the United Kingdom, the Clinical Research Network of the National Institute of Health identified this problem and funded a 6-month project in 2013-2014 that resulted in the creation of practical and freely available resources to equip researchers to engage more people with aphasia in research. Critical elements enabled authentic coconstruction of new knowledge regarding accessible research documentation, including the process structure, timescale, and crucially, the fundamental engagement of people with aphasia. Stages in this process included mapping existing resources; engaging with researchers and with people affected by aphasia; and developing a new set of resources comprising images, accessible text, and templates for research forms. These resulted in high-quality outputs, as indicated by preliminary feedback from the research community and people with aphasia.

This paper examines some of the implications of testing for statistical significance. After considering methodological issues raised by two examples from the literature, the paper proceeds to look in detail at a variety of misunderstandings attached to the reporting of "significant" results. It is concluded that significance testing is of limited utility and highly misleading. Implications of abandoning the significance test are considered. (JL)

While interest in the voice of children and young people has grown alongside concern for their rights and participation, for those excluded from mainstream education or with a label of behavioural, emotional and social difficulties, the issue of student voice takes on particular relevance. Yet the voices of these young people, and particularly girls, are often hidden and unheard both in education and educational research. Using digital visual and narrative methods we have been listening to girls excluded from mainstream education. They attend Kahlo School, a small special, girl-only secondary provision in the south of England, and our focus has been on gathering their views as stakeholders in the school and engaging them in curriculum and school development. In this paper, we reflect on the affordances of visual and digital methods and on how the girls perceive their educational inclusion and exclusion. We discuss the themes of space, identity, relationships and community that have emerged from analysis of the data, and conclude by outlining the importance of the core messages about belonging and not belonging that we heard in the girls' accounts.

In the UK, very few studies have engaged older people in two or more elements of the research process (design, conduct, dissemination). Although there is a body of work on educational gerontology, there are few publications that specifically focus on training older people as coresearchers. This paper reports upon the training program undertaken as part of the Rural North Wales Initiative for the Development of Support for Older People (RuralWIDe). The RuralWIDe training program was built upon principles of andragogy: the art and science of teaching adults. The trainers used lecturing; modeling (observation of another person conducting a task); and active participation (structured guidance, instructions or trial and error, during which the student discovers for him or herself how to perform the task) to teach older volunteers social gerontology, research methods, interview techniques, and data analysis. This paper describes the methods used in RuralWIDe and highlights instances when these were both effective and ineffective. It assesses the study against Rachal's (2002) criteria for andragogy (voluntary participation, adult status, collaboratively determine objectives, performance-based assessment of achievement, measuring satisfaction, appropriate adult learning environment, and technical issues), and it describes when pedagogical assumptions were made by the research team. (Contains 2 tables.)

Developing, implementing and evaluating programmes of intervention for children and young people on the autistic spectrum are challenging endeavours. In this paper, we adopt a critical approach to research in this area, and attempt to offer an alternative perspective for understanding and interpreting empirical evaluations. We outline and discuss theoretical, methodological and practical issues and limitations associated with the current research body, and provide illustrative examples of gaps in the current literature.

The latest UK White Paper has once again focused attention on the quality of learning, teaching and professional development in higher education. Underpinning the discussion is the premise that teaching excellence and professional development are essential for all academics, in particular new lecturers, which are firmly positioned within the framework of quality enhancement. The research reported in this article focuses on new lecturers' constructs of teaching, learning and research as identified by Kelly's personal construct theory. The elicited constructs are considered with respect to the changing demands and expectations made of new lecturers within the higher education community and the implications these may have for higher education.

Sport and exercise psychology research appearing in Research Quarterly for Exercise and Sport (RQES) over the past 75 years can be characterized by re-emerging themes--hot topics in the 1930s remain hot topics now. Re-emerging themes include sportsmanship/moral development, social development/significant others, self-perceptions, attitudes/motivation, modeling/observational learning, emotion/arousal/anxiety, competition/achievement orientations, and gender roles. Although research paradigms and methodologies have changed, these topics have endured. This article has also identified dominant emergent themes appearing in RQES over the last 25 years: measurement development and validation; physical activity adoption and adherence; and multidisciplinary approaches to psychological issues. Given the many specialty journals and trends toward integrating models and methods from multiple disciplines, the authors suggest that RQES adopt a multidisciplinary focus for research in the field of kinesiology.

Two key issues thrown up by the 1999 introduction of the National Minimum Wage (NMW) in the United Kingdom are its likely impact on employers' training practices in low paying sectors of the economy and the implications for skills. Based on a study of the hospitality industry, this article assesses the limited significance of the differential, "subminimum" NMW rates as devices for promoting skills development and considers the absence of any direct impact on training practices of the statutory floor of wages in general. The weaknesses of a policy framework dominated by a supply-side ethos in which the importance of incentives for employers to provide training and employment opportunities is prioritised, rather than one in which an opportunity is taken to use the NMW as part of a wider strategy to generate greater demand for skills in low-paying industries are attested.

Describes a project to code complementation patterns of all verbs in the Collins COBUILD English language corpus, using simple notation based on words and word classes rather than traditional functional categories. This is the first pedagogic grammar to integrate syntax and lexis using corpus data. Explores the possibility of using a pattern grammar to analyze naturally-occurring discourse. (Author/MSE)

Cherlin argues that Gill's procedural criticisms of Cherlin's work are groundless, and underlying themes of both of Gill's articles do not guide public policy concerning children and families. Gill's response to Cherlin notes that anecdotal evidence shows that increased availability and social acceptability of divorce cause more marital problems. (JB)

Policy analysis is a two-stage process of (1) diagnosing the problem and (2) unraveling the parts in it played by the policy issue, environment, factors affecting implementation, and proposed alternatives. In higher education, this requires a thorough understanding of the unique higher education environment. (MSE)

Purpose: To explore how health professionals provide information to informal carers during inpatient stroke rehabilitation and whether these practices align with adult learning principles. Methods: Informal carers and survivors of stroke who had completed inpatient rehabilitation, and health professionals working in inpatient stroke rehabilitation were interviewed. Directed qualitative content analysis was conducted using an adult learning model, to determine how closely reported practices aligned to adult learning principles. Results: 14 carers, 6 survivors of stroke and 17 health professionals participated. Carers (79% female, 57% spouse/partner) reported having incomplete knowledge during rehabilitation, lacking information about mechanisms of stroke recovery, rehabilitation processes, long-term effects of stroke, and navigating post-discharge services. Health professionals supported carers to address their learning needs related to safety of caring for stroke survivors. Carers indicated they were responsible for their own non-safety related learning. Health professionals tended not to check carers' understanding of information provided nor offer learning opportunities beyond written or verbal information. Conclusions: Health professionals consistently provide certain information to carers during inpatient rehabilitation, but adult learning principles are not routinely applied when information is provided. Fostering adult learning among informal carers may improve preparedness of carers to support stroke survivors after discharge from inpatient rehabilitation. IMPLICATIONS FOR REHABILITATION: Carers reported often being in a state of shock in the early post-stroke period, and may need extra support to remember, understand, and apply information. Carers are often highly motivated to acquire immediate and relevant information tailored to their situation. Interactions between health professionals and carers are learning opportunities that can assist the carer to commence their unexpected and significant learning journey. Health professionals should apply adult learning principles when communicating with carers on all topics, not just topics important to the healthcare team such as patient safety and requirements for discharge. [ABSTRACT FROM AUTHOR]

Medically compromised people with anorexia nervosa are cared for in inpatient settings where clinicians closely monitor health and safety. Clinicians are in a position of power, with the capacity to impose mandated weight gain to achieve medical stabilisation. Consumers are in a vulnerable position, compelled to temporarily relinquish autonomy and to accept coercive practices that often diminish the quality of the therapeutic relationship. Clinicians' position of power in mental healthcare has a dual potential for both healing and harm, and limited attention has been given to consumers' views of clinicians' power. The aim of this qualitative descriptive study was to investigate the consumer perspective of clinicians' power in the inpatient care of anorexia nervosa, establishing insight into the beneficence and maleficence of the power asymmetry. Ten women with anorexia nervosa in the community participated in semi‐structured interviews online. The COREQ checklist was used to ensure accuracy and completeness of reporting. Thematic analysis revealed that abuses of power were common in the course of inpatient AN care, however life‐saving measures were regarded as defensible. The perception of clinicians' power was determined by the strength of interpersonal relationships and clinicians' clinical competence. To mitigate the potential for harmful experiences, clinicians' use of power must be exercised with close consideration for consumer perspectives, with the integration of person‐centred care and trauma‐informed care principles. [ABSTRACT FROM AUTHOR]

COVID-19 has affected healthcare in profound and unprecedented ways, distorting the experiences of patients and healthcare professionals (HCPs) alike. One area that has received little attention is how COVID-19 affected HCPs caring for dying patients. The goal of this study was to examine the experiences of HCPs working with dying patients during the COVID-19 pandemic. Between July 2020–July 2021, we recruited HCPs (N = 25) across Canada. We conducted semi-structured interviews, using a qualitative study design rooted in constructivist grounded theory methodology. The core themes identified were the impact of the pandemic on care utilization, the impact of infection control measures on provision of care, moral distress in the workplace, impact on psychological wellbeing, and adaptive strategies to help HCPs manage emotions and navigate pandemic imposed changes. This is the first Canadian study to qualitatively examine the experiences of HCPs providing care to dying patients during the COVID-19 pandemic. Implications include informing supportive strategies and shaping policies for HCPs providing palliative care. [ABSTRACT FROM AUTHOR]

Position statements from national organizations commonly vary in methodology for the evaluation of existing literature and the development of recommendations. Recent national recommendations have highlighted important components for evidence-based guidelines that can be feasibly incorporated in the creation of position statements and their resource documents. We describe the methodology developed to guide the creation of a compendium of 16 trauma-related position statements led by NAEMSP and partner organizations. Each position statement group developed trauma-related topic areas, primarily guided by the Population, Intervention, Comparison, and Outcome (PICO) framework. A structured literature search comprised of search terms aimed to identify relevant EMS and trauma-related scientific publications was performed for each topic area. Resource documents for each position statement included a description of the literature considered in forming recommendations, reported through evidence tables and a narrative description of the available literature. Where evidence was limited, consensus-based recommendations were developed using content experts and reviewed by the NAEMSP Standards and Clinical Practice Committee. We report a standardized methodology for literature review and development of recommendations as part of a compendium of trauma-related position statements from NAEMSP and partner organizations. This methodology can serve as a template for future position statements with ongoing refinement. [ABSTRACT FROM AUTHOR]

Background: Peritonitis is the main treatment‐related complication of peritoneal dialysis and a primary concern for patients and their relatives. Therefore, understanding their perceptions of peritonitis is important. Objectives: To explore patients' and relatives' perceptions of peritoneal dialysis‐associated peritonitis risk, prevention measures and experiences of diagnosis, and experience of perceived stigma. Design: A sequential mixed methods study design was used, including a questionnaire and semi‐structured interviews. Participants: Patients using peritoneal dialysis and relatives (n = 75) from six National Health Service organisations from the United Kingdom. Measurements: A structured questionnaire was administered with patients and relatives (n = 75) using peritoneal dialysis; data were analysed using descriptive statistics. Thirty questionnaire respondents were then purposively sampled and interviewed in‐depth; data were analysed thematically. Data were collected 2017−2018. Ethical and governance approvals were gained. Results: Qualitative and quantitative analyses were integrated and three themes presented: •Perceptions of risk: participants assessed their risk of developing peritonitis and possible implications on their health and relatives. Participants felt greatly responsible for preventing infection.•Preventing peritonitis: participants reported similar and some differing measures to minimise their risk of developing peritonitis. Participants wanted to be seen as "clean".•Diagnosis of peritonitis: peritonitis diagnosis was embarrassing and stigmatising for many individuals. This was influenced by the response of healthcare professionals and the cause of peritonitis. Conclusions: It is important that healthcare professionals are aware of how responsible patients and relatives feel about preventing peritonitis, the emotional effect of this responsibility and crucially the impact this may have on seeking help. [ABSTRACT FROM AUTHOR]

Introduction. Advanced and extended primary health care practice roles have been developed in Aotearoa New Zealand (NZ) for dietetics, nursing, pharmacy, and physiotherapy professions. Advanced musculoskeletal physiotherapy roles in primary health care could address escalating health care costs, challenges to workforce sustainability and inefficient primary/secondary care interfaces. Little is known about how stakeholders perceive the recently introduced Advanced Practice Physiotherapist (APP) scope of practice. Aim. This study aimed to explore health professionals' perceptions of the APP scope of practice in NZ and how APPs could influence physiotherapy service delivery for people with musculoskeletal conditions in primary health care. Methods. Qualitative, face-to-face, semi-structured interviews were conducted with 15 participants including physiotherapists, general practitioners, medical specialists and Accident Compensation Corporation case managers. Inductive interpretive analysis was undertaken. Results. Five themes were identified: perceptions of current musculoskeletal management in primary health care; lack of a career pathway; ways in which APPs might facilitate change and what their role would be; characteristics of an APP; and the implementation of the APP role into practice. Discussion. Stakeholders were supportive of the APP scope of practice and thought it has the potential to improve patient pathways, health care delivery and health outcomes for those with musculoskeletal conditions. Stakeholders also thought it would fill an important gap in the physiotherapy clinical career pathway. Successful implementation will require assessment of applicants' personal attributes as well as clinical experience and academic qualifications to ensure all stakeholders have confidence to engage with the service, clear communication, active promotion and specific funding. [ABSTRACT FROM AUTHOR]

Introduction. Community-based primary care physiotherapy has developed through private practice, fee-for-service model in Aotearoa New Zealand where independent businesses operate in competition. Aim. We aimed to explore how the private practice model of physiotherapy impacts patient care, physiotherapists, and professional behaviour. Methods. Six physiotherapists managing musculoskeletal conditions in a primary care private practice in Aotearoa New Zealand were recruited using maximum variation purposive sampling. In-depth individual face-toface semi-structured interviews were audio-recorded, transcribed verbatim, and analysed using Interpretive Description. Inductive data analysis synthesised and contextualised data, creating a thematic framework that developed across interviews. Results. All physiotherapy participants discussed concerns about culture and professionalism in private practice physiotherapy despite not being asked about these. Three themes were identified. 'Competitive business model and lack of collaboration' - participants thought that competition between practices resulted in a lack of trust, collegiality, and collaboration, and pressure on clinicians to maintain income. '(Un)professional behaviour' - participants thought that physiotherapists were defensive and averse to scrutiny, resulting in reluctance to admit when they needed help, or to undertake peer review or seek second opinions. 'Lack of support and mentoring' - the professional culture in private practice was perceived to reduce support and mentoring, with negative impacts that affected physiotherapists at all stages of career. Conclusion. This exploratory qualitative study suggests that competition dominates communication and collaboration in private practice physiotherapy and may have wider implications for professionalism and the quality of patient care. Competitive business models and an aversion to scrutiny may reduce collegial interaction and professional behaviour. [ABSTRACT FROM AUTHOR]

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In the most comprehensive population surveys, mental health is only broadly captured through questionnaires asking about "mentally unhealthy days" or feelings of "sadness." Further, population mental health estimates are predominantly consolidated to yearly estimates at the state level, which is considerably coarser than the best estimates of physical health. Through the large-scale analysis of social media, robust estimation of population mental health is feasible at finer resolutions. In this study, we created a pipeline that used ~1 billion Tweets from 2 million geo-located users to estimate mental health levels and changes for depression and anxiety, the two leading mental health conditions. Language-based mental health assessments (LBMHAs) had substantially higher levels of reliability across space and time than available survey measures. This work presents reliable assessments of depression and anxiety down to the county-weeks level. Where surveys were available, we found moderate to strong associations between the LBMHAs and survey scores for multiple levels of granularity, from the national level down to weekly county measurements (fixed effects β = 0.34 to 1.82; p < 0.001). LBMHAs demonstrated temporal validity, showing clear absolute increases after a list of major societal events (+23% absolute change for depression assessments). LBMHAs showed improved external validity, evidenced by stronger correlations with measures of health and socioeconomic status than population surveys. This study shows that the careful aggregation of social media data yields spatiotemporal estimates of population mental health that exceed the granularity achievable by existing population surveys, and does so with generally greater reliability and validity. [ABSTRACT FROM AUTHOR]

Background: Over the past two decades, Canadian provinces and territories have introduced a series of primary care reforms in an attempt to improve access to and quality of primary care services, resulting in diverse organizational structures and practice models. We examine the impact of these reforms on family physicians' (FPs) ability to adapt their roles during the COVID-19 pandemic, including the provision of routine primary care. Methods: As part of a larger case study, we conducted semi-structured qualitative interviews with FPs in four Canadian regions: British Columbia, Newfoundland and Labrador, Nova Scotia, and Ontario. During the interviews, participants were asked about their personal and practice characteristics, the pandemic-related roles they performed over different stages of the pandemic, the facilitators and barriers they experienced in performing these roles, and potential roles FPs could have filled. Interviews were transcribed and a thematic analysis approach was applied to identify recurring themes in the data. Results: Sixty-eight FPs completed an interview across the four regions. Participants described five areas of primary care reform that impacted their ability to operate and provide care during the pandemic: funding models, electronic medical records (EMRs), integration with regional entities, interdisciplinary teams, and practice size. FPs in alternate funding models experienced fewer financial constraints than those in fee-for-service practices. EMR access enhanced FPs' ability to deliver virtual care, integration with regional entities improved access to personal protective equipment and technological support, and team-based models facilitated the implementation of infection prevention and control protocols. Lastly, larger group practices had capacity to ensure adequate staffing and cover additional costs, allowing FPs more time to devote to patient care. Conclusions: Recent primary care system reforms implemented in Canada enhanced FPs' ability to adapt to the uncertain and evolving environment of providing primary care during the pandemic. Our study highlights the importance of ongoing primary care reforms to enhance pandemic preparedness and advocates for further expansion of these reforms. [ABSTRACT FROM AUTHOR]

Anorexia nervosa has a high mortality rate and is often treated in the inpatient setting, where close monitoring and medical support are available. Consistent with objective biomedical benchmarks, conventional inpatient treatment is often focussed on weight gain. Consumers report that clinicians provide care focussed on weight and physical restoration without adequate consideration of their full spectrum of needs. The aim of this study was to explore consumers' perspectives of the biomedical focus on weight gain in the inpatient care of anorexia nervosa. This study employed a qualitative approach, involving semistructured interviews, and participants were recruited from relevant social media communities. This study was ethically approved by a university ethics committee and the COREQ checklist ensured ethical reporting. Ten women participated in interviews. Participants reported that the biomedical imperative of weight gain is focussed on at the exclusion of other relevant determinants of well‐being, and the narrow focus on weight gain does not suitably prepare consumers for discharge. The conflict between clinicians' biomedical focus and consumers' broader unmet needs leads to harmful interpersonal dynamics and feelings of invalidation. The inpatient care of anorexia nervosa needs to develop beyond biomedically driven objectives and incorporate the merits of an approach that substantively integrates person‐centred care, therapeutic relationships and trauma‐informed principles. [ABSTRACT FROM AUTHOR]

Background: Stigma perceived by persons affected with Coronavirus disease 2019 (COVID-19) and their family members has been reported in the literature. This study aimed to evaluate COVID-19-related public stigma in detail in a regional area of Punjab, North India. Materials and Methods: It was a cross-sectional, hospital-based, descriptive study. Four hundred and eighty-eight participants were recruited and administered Explanatory Model Interview Catalogue-Stigma Scale to measure public stigma against COVID-19. The data were analyzed using Mann--Whitney test and Spearman correlation coefficient. Results: >78.68% participants believed that people in their community avoided a person affected by COVID-19, 76.6% believed that COVID-19 caused problems for family. More than 70% participants responded that people refused to visit the home of an affected person and it created difficulties for an affected person to find work. Nearly 70% responded that people dislike buying food from an affected person. 60% participants responded that sufferers would have concerns related to disclosure of illness. On the positive side, majority participants responded that COVID-19 would not lead to difficulties in finding match for the sufferer's marriage (57.8%) or relative's marriage (80.3%) or would not lead to problems in ongoing marriage (61.7%). Nearly 60% also responded that people would not think less of themselves if a family member had COVID-19 and it would not cause shame and embarrassment in community (58.8%). Conclusion: Public stigma for COVID-19 was high in some forms (avoidance, disclosure concerns, difficulty in finding work, etc.) and low in some other forms (like marriage-related issues, shame, and embarrassment in community). [ABSTRACT FROM AUTHOR]

Objective: To explore the impact of a 2-day, in-person interprofessional palliative care course for staff working in long-term care (LTC) homes. Methods: A qualitative descriptive study design was employed. LTC staff who had participated in Pallium Canada's Learning Essential Approaches to Palliative Care LTC Course in Ontario, Canada between 2017 and 2019 were approached. Semi-structured interviews were conducted, using an online videoconferencing platform in mid-2021 in Ontario, Canada. These were done online, recorded, and transcribed. Data were coded inductively. Results: Ten persons were interviewed: four registered practical nurses, three registered nurses, one nurse practitioner, and two physicians. Some held leadership roles. Participants described ongoing impact on themselves and their ability to provide end-of-life (EOL) care (micro-level), their services and institutions (meso-level), and their healthcare systems (macro-level). At a micro-level, participants described increased knowledge and confidence to support residents and families, and increased work fulfillment. At the meso-level, their teams gained increased collective knowledge and greater interprofessional collaboration to provide palliative care. At the macro level, some participants connected with other LTC homes and external stakeholders to improve palliative care across the sector. Training provided much-needed preparedness to respond to the impact of the COVID-19 pandemic, including undertaking advance care planning and EOL conversations. The pandemic caused staff burnout and shortages, creating challenges to applying course learnings. Significance of results: The impact of palliative care training had ripple effects several years after completing the training, and equipped staff with key skills to provide care during the COVID-19 pandemic. Palliative care education of staff remains a critical element of an overall strategy to improve the integration of palliative care in LTC. [ABSTRACT FROM AUTHOR]

Evaluating the experiences of persons with spinal cord injury (PwSCI) regarding their transitions in care and changes in health, function, and quality of life is complex, fragmented, and involves multiple tools and measures. A staged protocol was implemented with PwSCI and relevant expert stakeholders initially exploring and selecting existing measures or tools through a modified Delphi process, followed by choosing one of two options. The options were to either support the use of the 10 selected tools from the Delphi method or to co-develop one unique condensed tool with relevant measures to evaluate all four domains. The stakeholders chose to co-develop one tool to be used by persons with SCI to monitor their transition experiences across settings and care providers. This includes any issues with care or support they needed to address at the time of discharge from acute care or rehabilitation and in the community at 3, 6, and 12 months or longer post-discharge. Once developed, the tool was made available online for the final stage of the protocol, which proposes that the tool be reliability tested prior to its launch, followed by validation testing by PwSCI. [ABSTRACT FROM AUTHOR]

Strenuous exercise is synonymous with disturbing gastrointestinal integrity and function, subsequently prompting systemic immune responses and exercise-associated gastrointestinal symptoms, a condition established as "exercise-induced gastrointestinal syndrome." When exercise stress and aligned exacerbation factors (i.e., extrinsic and intrinsic) are of substantial magnitude, these exercise-associated gastrointestinal perturbations can cause performance decrements and health implications of clinical significance. This potentially explains the exponential growth in exploratory, mechanistic, and interventional research in exercise gastroenterology to understand, accurately measure and interpret, and prevent or attenuate the performance debilitating and health consequences of exercise-induced gastrointestinal syndrome. Considering the recent advancement in exercise gastroenterology research, it has been highlighted that published literature in the area is consistently affected by substantial experimental limitations that may affect the accuracy of translating study outcomes into practical application/s and/or design of future research. This perspective methodological review attempts to highlight these concerns and provides guidance to improve the validity, reliability, and robustness of the next generation of exercise gastroenterology research. These methodological concerns include participant screening and description, exertional and exertional heat stress load, dietary control, hydration status, food and fluid provisions, circadian variation, biological sex differences, comprehensive assessment of established markers of exercise-induced gastrointestinal syndrome, validity of gastrointestinal symptoms assessment tool, and data reporting and presentation. Standardized experimental procedures are needed for the accurate interpretation of research findings, avoiding misinterpreted (e.g., pathological relevance of response magnitude) and overstated conclusions (e.g., clinical and practical relevance of intervention research outcomes), which will support more accurate translation into safe practice guidelines. [ABSTRACT FROM AUTHOR]

This study investigated co-constructed research poetry as a way to understand the lived experiences of people affected by rarer dementia and as a means to use poetry to convey those experiences to healthcare professionals. Using mixed methods, 71 people living with rarer dementia and care-partners (stakeholders) contributed to co-constructing 27 poems with professional poets; stakeholders' verbatim words were analysed with descriptive qualitative analysis. Stakeholders were also surveyed and interviewed about their participation. Healthcare professionals (n = 93) were surveyed to elicit their responses to learning through poetry and its acceptability as a learning tool. Poems conveyed a shared narrative of different aspects of lived experience, often owing to atypical symptoms, misunderstandings by professionals, lack of support pathways, and a continuous struggle to adapt. Stakeholder surveys indicated it was a valuable experience to both co-create and respond to the poems, whilst group interviews revealed people's experiences of the research poetry were characterised by reflection on lived experience, curiosity and exploration. Healthcare professionals' responses reinforced poetry's capacity to stimulate cognitive and affective learning specific to rare dementia support and prompt both empathy and critical thinking in practice. As the largest poetry-based study that we are aware of, this novel accessible approach of creating group poems yielded substantial information about the experiences and needs of those affected by rarer dementia and how poetry can contribute to healthcare education and training. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to assess the suitability of an online education package to prepare health professionals to use a new paediatric early warning system. Design: Quasi‐experimental mixed methods using co‐production. Methods: Participants completed the Package and participated in up to four clinical scenarios. Data were collected using self‐report surveys, and during clinical scenarios; escalation of care, documentation, family involvement, communication handovers were assessed, and recorded debriefings were thematically analysed. Data were integrated using tabulated joint displays. Results: Eleven nurses and three doctors were recruited from three mixed adult and paediatric hospitals. Following completion of the Package and clinical scenarios 13/14 (93%) participants agreed preparedness and confidence to use the ESCALATION System had increased. For 53% handovers, the communication framework was followed, for 79% charts, documentation was complete. Participants engaged with the parent (actor) for 97% scenario interactions. The Package was effective and participation in clinical scenarios appeared to enhance learning. Patient or public contribution: Consumers participated in the steering group overseeing the study and in the expert panel who reviewed the education package and clinical scenarios. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to coproduce a smart-phone application for digital falls reporting in people with Parkinson disease (PD) and to determine usability using an explanatory mixed-methods approach. Methods This study was undertaken in 3 phases. Phase 1 was the development phase, in which people with PD were recruited as co-researchers to the project. The researchers, alongside a project advisory group, coproduced the app over 6 months. Phase 2 was the implementation phase, in which 15 people with PD were invited to test the usability of the app. Phase 3 was the evaluation phase, in which usability was assessed using the systems usability scale by 2 focus groups with 10 people with PD from phase 2. Results A prototype was successfully developed by researchers and the project advisory group. The usability of the app was determined as good (75.8%) by people with PD when rating using the systems usability scale. Two focus groups (n = 5 per group) identified themes of 1) usability, 2) enhancing and understanding management of falls, and 3) recommendations and future developments. Conclusions A successful prototype of the iFall app was developed and deemed easy to use by people with PD. The iFall app has potential use as a self-management tool for people with PD alongside integration into clinical care and research studies. Impact This is the first digital outcome tool to offer reporting of falls and near-miss fall events. The app may benefit people with PD by supporting self-management, aiding clinical decisions in practice, and providing an accurate and reliable outcome measure for future research. Lay Summary A smartphone application designed in collaboration with people who have PD to record their falls was acceptable and easy to use by people with PD. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to share the learning concerning how services and the paid carers working in them can support people living with dementia (PLWD) and their unpaid carers to overcome social isolation. This learning comes from the key findings from a Social Return on Investment (SROI) evaluation of a Shared Lives (SL) Day support service, known as TRIO. Design/methodology/approach: SROI is a form of cost-benefit analysis that captures and monetises stakeholder outcomes. The SROI evaluation included a rapid evidence review, an interview study and a questionnaire study. The learning shared is drawn from the interview and questionnaire data that explored the reported outcomes relating to social connection, which included data related to participating in meaningful activities, confidence and independence. Findings: PLWD who accessed the SL Day support service experienced better social connection, a sense of control over their activities (including their social activities) and community presence. A key foundation of these outcomes was the meaningful relationship that developed between the PLWD, their unpaid carer and the paid carer. Research limitations/implications: This evaluation was a pilot study with a small, albeit representative sample size. Practical implications: The learning suggests feasible and effective ways for paid carers to support the social connection of PLWD and their unpaid carers with their wider community. Originality/value: There has been little exploration of how community-based short breaks (like SL Day support) can enhance social connection. The authors drew on a social relational model lens to illustrate how this service type had supported successful outcomes of community and social inclusion for PLWD. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Introduction: Health numeracy (numerical literacy) refers to an individual's ability to use numerical information to make effective health decisions. Numeracy is fundamental in the role of a health care provider, forming the basis of evidence-based medicine and effective patient-provider communication. Despite a high level of education, many health care providers struggle with numeracy. Numeracy is often integrated into training curricula; however, teaching modality, competencies covered, learner satisfaction, and effectiveness of these educational interventions varies. Method: A scoping review was conducted to explore and summarize what is known about numeracy skills education programs for health care providers. A comprehensive literature search was conducted from January 2010 to April 2021 in 10 databases. Controlled vocabulary terms and text words were used. The search was restricted to human studies, adults, and the English language. Articles were included if they were related to numeracy education for health care providers or trainees and provided details regarding methods, evaluation, and results. Results: The literature search retrieved 31,611 results and 71 met the inclusion criteria. Most interventions were conducted in a university setting, and targeted nursing students, medical students, resident physicians, and pharmacy students. Common numeracy concepts included statistics/biostatistics, medication calculations, evidence-based medicine, research methodology, and epidemiology. A variety of teaching modalities were used, which most often combined active approaches (eg, workshops, laboratories, small-group exercises, and discussion boards) with passive approaches (eg, traditional lectures and didactic teaching). Measured outcomes included knowledge and skills, self-efficacy, attitudes, and engagement. Discussion: Although efforts have been made to incorporate numeracy into training curricula, greater emphasis should be placed on developing strong numeracy skills in health care providers, particularly given the role numerical information plays in clinical decision making, evidence-based practices, and patient-provider communication. [ABSTRACT FROM AUTHOR]

Long-term limitations in social participation are common after stroke. Whether these can be attenuated through a tele-rehabilitation approach is unknown. We were particularly interested in examining transfer of learning effects which could result in broader improvements in social participation. We adapted a strategy training rehabilitation approach (tele-CO-OP) for remote delivery. Participants with chronic stroke were randomized to receive the intervention (EXPT) or to a wait list (Control). Feasibility and acceptability were measured via attendance scores, satisfaction with the training and therapist evaluation of engagement with the training. The primary outcome measure was the Canadian Occupational Performance Measure (COPM), a standardized semi-structured interview which elicits difficulties in day-to-day life. Seventeen participants were randomized. Tele-CO-OP was found to be feasible and acceptable: participants reported high satisfaction and engagement, and missed few sessions. Large effect sizes for transfer of learning effects were observed in favor of receiving tele-CO-OP vs being waitlisted. Significant benefits were also conferred to the Control group following receipt of tele-CO-OP. The intervention also appeared to improve mood. This exploratory study demonstrates the feasibility and acceptability of tele-CO-OP and provides preliminary evidence for transfer of learning effects to untrained everyday social participation activities. Trial registration number: NCT02724813 Stroke results in long-term limitations in social participation. The Cognitive Orientation to daily Occupational Performance (CO-OP) Approach provides a potential avenue for ameliorating these limitations. This pilot randomized controlled trial demonstrated that it is feasible to deliver tele-CO-OP and that positive benefits may accrue to those receiving the intervention for both trained and untrained activities. Tele-CO-OP is a promising intervention for addressing long-term participation limitations in individuals with chronic stroke. [ABSTRACT FROM AUTHOR]

Background: Parastomal hernias are a common consequence of stoma surgery and can occur in up to 50% of patients. They are mangaged either conservatively, through support hosiery, or surgically. A patient feasibility study called the Hernia Active Living Trial (HALT) was designed to examine if a clinical pilates-based exercise programme offers an alternative approach to managing a parastomal hernia or bulge. Method: Adults with an ileostomy or colostomy who perceived they had a bulge around their stoma were included in the study. The intervention included up to 12 online sessions of an exercise booklet and videos with an exercise specialist. Interviews were conducted to explore participants' experiences of the intervention. The interview data were analysed systematically and thematically. Participants were also asked to complete patient diaries every week. Results: Twelve of the 13 participants who completed the intervention agreed to be interviewed. Following analysis, three main themes emerged including managing a hernia/bulge, benefits and barriers. Participants talked about the benefits of this programme including: reduction of the size of their hernia, increased abdominal control, body confidence and posture, as well as increased physical activity levels. The barriers described were generally overcome allowing participants to engage in what was perceived to be a positive and potentially life-changing experience. Conclusions: A clinical pilates-based exercise programme for people with a parastomal hernia can bring both direct and indirect improvements to a patient's hernia management, sense of wellbeing and day-to-day life. Individuals with a hernia should be informed about the need for, and value of, exercise to strengthen core muscles, as part of their non-surgical options for self-management. [ABSTRACT FROM AUTHOR]

Purpose: The screening process for social determinants of health (SDoH) includes questions regarding life circumstances and barriers to accessing health care. For patients, these questions may be intrusive, biased, and potentially risky. This article describes human-centered design methods to engage birthing parents and health care team members around SDoH screening and referral in maternity care. Methods: Three phases of qualitative research with birthing parents, health care teams, and hospital administrators were conducted in the United States. Shadowing, interviews, focus groups, and participatory workshops addressed the explicit and tacit concerns of the stakeholders regarding SDoH during maternity care. Results: Birthing parents wanted to be informed of the purpose of the clinic collecting SDoH information and how this information is used. Health care teams want to feel they are providing reliable and quality resources to their patients. They would like greater transparency that administrators are acting on SDoH data and the information is reaching people that can assist patients. Conclusion: As clinics implement patient-centered strategies for addressing SDoH in maternity care, it is important to include patients' perspectives. This human-centered design approach advances understanding of knowledge and emotional needs around SDoH and offers insights to meaningful engagement around sensitive health data. [ABSTRACT FROM AUTHOR]

The production of data and numbers has become the key mechanism of both knowing and governing global public policy. And yet, processes of quantification are inherently paradoxical: from expectations of technocratic rationality and political usability of producing 'global' numbers that count for 'local' politics and needs to practical limitation of measurement and the necessity to work with 'good enough' data. This begs a question – how do these competing epistemic, political and value orders manifest themselves through the work that experts do? In this article, we explore the problem by focussing on reflexivity as a way for experts (primarily those working in key International Organisations) to make sense of and tame the tensions inherent in their work. Through rich qualitative exploration of over 80 semi-structured interviews with experts working in the areas of poverty, education and statistical capacity development, we contribute to debates in the social studies of quantification by arguing that reflexivity is not just a mental process that experts engage in but rather an important resource allowing them to make sense of the contradictions inherent in their work and to mobilise political and ethical considerations in the technocratic process of producing numbers. We identify three types of reflexivity: (1) epistemic reflexivity – regarding the quality of data and its epistemic status as reflecting the reality; (2) care-ful reflexivity – regarding values embedded in data and the duty of care to the populations affected by the measurement and (3) instrumental reflexivity – regarding political rationality and necessary trade-off required to realise political goals. Overall, the article argues that reflexivity becomes an increasingly central expert practice, allowing the transformation of the process of quantification into one of qualification enabling them to attach political attributes and values to data and measurement. [ABSTRACT FROM AUTHOR]

We describe racially discordant oncology encounters involving EOL decision-making. Fifty-eight provider interviews were content analyzed using the tenets of problematic integration theory. We found EOL discussions between non-Black providers and their Black patients were often complex and anxiety-inducing. That anxiety consisted of (1) ontological uncertainty in which providers characterized the nature of Black patients as distrustful, especially in the context of clinical trials; (2) ontological and epistemological uncertainty in which provider intercultural incompetency and perceived lack of patient health literacy were normalized and intertwined with provider assumptions about patients' religion and support systems; (3) epistemological uncertainty as ambivalence in which providers' feelings conflicted when deciding whether to speak with family members they perceived as lacking health literacy; (4) divergence in which the provider advised palliative care while the family desired surgery or cancer-directed medical treatment; and (5) impossibility when an ontological uncertainty stance of Black distrust was seen as natural by providers and therefore impossible to change. Some communication strategies used were indirect stereotyping, negotiating, asking a series of value questions, blame-guilt framing, and avoidance. We concluded that provider perceptions of Black distrust, religion, and social support influenced their ability to communicate effectively with patients. [ABSTRACT FROM AUTHOR]

Introduction: Despite widespread recognition that communicating unexpected news during obstetric ultrasound examinations is challenging, there is a dearth of research investigating how to teach evidence-based communication to sonographers. Communication Coaching is a supportive, positive method that has previously been associated with improvements in communication, patient satisfaction, and reduced burnout in clinicians. However, to date, no study has coached sonographers. This study explored stakeholders' views on a proposed Communication Coaching intervention and used these data to adapt the intervention for use with qualified obstetric sonographers. Methods: Semi-structured interviews were conducted with people who have a vested interest in unexpected news delivery and thematic analysis was conducted on the data. Eight sonographers, six people with lived experience of receiving unexpected news and six representatives from third-sector organisations who support expectant parents were recruited (18 women; 2 men, aged between 21 and 75 years). Results: Participants viewed the planned Communication Coaching intervention favourably and suggested adaptations. The two main themes were (1) the practicalities of coaching, and (2) content. The first theme had four subthemes: (a) brief and flexible structure, (b) online modality, (c) sensitive and positive coach and (d) organisational awareness. The second theme had three subthemes: (a) specific language and behaviour recommendations, (b) adaptable to different service-users and situations and (c) confer relevant emotional skills and techniques. Conclusions: Communication Coaching could be a feasible and acceptable intervention for qualified sonographers if specific, limited adaptations are made as recommended by the stakeholders. Further evaluation of the intervention in practice is necessary. [ABSTRACT FROM AUTHOR]

Objectives: Many older adults with multiple chronic conditions (MCC) frequently experience hospitalizations, functional limitations, and poor quality of life. Outcomes may be improved by promoting self-regulation, which may individuals respond to health threats and manage their health conditions. The aim of this study was to describe self-regulatory coping among older adults with MCC. Methods: A qualitative descriptive study using semi-structured interviews and content analysis and guided by the Common-Sense Self-Regulation Model. Seventeen community-dwelling older adults with two or more chronic conditions participated in our study. Results: Three themes were developed from the analysis: (1) "I don't think about it unless something happens": coping in the absence of a health event, (2) "doing what I am supposed to do" : coping during a health event, and (3) "How do I know if what I did works?": appraisal of coping success. Discussion: Self-regulatory coping was influenced by individual beliefs and experiences (illness representations), context, self-efficacy and availability of support and resources to cope with MCC. These findings suggest implications for clinical practice and future self-regulation interventions for older adults with MCC. [ABSTRACT FROM AUTHOR]

Introduction: A workplace‐based assessment (WBA) is a learning recording device that is widely used in medical education globally. Although entrenched in medical curricula, and despite a substantial body of literature exploring them, it is not yet fully understood how WBAs play out in practice. Adopting a constructivist standpoint, we examine these assessments, in the workplace, using principles based upon naturalist inquiry, drawing from a theoretical framework based on Goffman's dramaturgical analogy for the presentation of self, and using qualitative research methods to articulate what is happening as learners complete them. Methods: Learners were voluntarily recruited to participate in the study from a single teaching hospital. Data were generated, in‐situ, through observations with field notes and audiovisual recording of WBAs, along with accompanying interviews with learners. Results: Data from six learners was analysed to reveal a set of general principles—the WBA playbook. These four principles were tacit, unwritten, unofficial and learners applied them to complete their WBA proformas: (1) maintain the impression of progression, (2) manage the authenticity of the individual proforma, (3) avoid losing face with the assessor and (4) complete the proforma in an effort‐efficient way. By adhering to these principles, learners expressed their understanding of their social position in their world at that time the documents were created. Discussion: This paper recognises the value of the WBA as a lived experience, and of the WBA document as a social space, where learners engage in a social performance before the readers of the proforma. Such an interpretation better represents what happens as learners undergo and record WBAs in the real‐world, recognising WBAs as learner‐centred, learner‐driven, meaning‐making phenomena. In this way, as a record of interpretation and meanings, the subjective nature of the WBA process is a strength to be harnessed, rather than a weakness to be glossed over. As a learner‐centred, meaning‐making phenomenon, the authors use field‐based observations and interviews to argue that the subjective nature of workbased assessment is a strength to be harnessed, not a weakness to be glossed over. [ABSTRACT FROM AUTHOR]

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While the vast majority of farmworkers in California are Latinx, a small proportion of the farmworkers are Asian Indian who primarily speak Punjabi. To date, there are few COVID-19 resources developed that specifically target Punjabi-speaking farmworkers. This study examines the COVID-19 educational needs of Punjabi-speaking farmworkers in California and aims to inform future development of educational materials for Punjabi-speaking farmworkers. During early 2021, a two-phase qualitative study was conducted. In Phase 1, five key informant interviews were conducted using a semi-structured interview guide to assess the content, visual, and cultural relevance of current COVID-19 educational resources. Based on informant feedback, new agriculture-specific COVID-19 educational resources were developed in Punjabi. In Phase 2, three focus groups were conducted (in Fresno and Yuba Counties) with five participants in each group to evaluate the newly developed COVID-19 resources. Informant interviews showed that Punjabi-speaking farmworkers preferred printed handouts, videos, and radio messages to receive COVID-19 related information. Participants preferred 8–1/2"x11" sized printed handouts that were colorful and had culturally relevant photographs. Participant video preferences included live action videos that were short (1–3 mins) with characters representing the Punjabi community. A substantial majority of focus group participants approved the newly developed COVID-19 educational and safety resources. Current COVID-19 resources are not meeting the educational needs of Punjabi-speaking farmworkers. This community needs COVID-19 educational and safety materials that are culturally relevant and linguistically appropriate to be available in different formats: handouts, videos, and radio messages. [ABSTRACT FROM AUTHOR]