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Background: Depression and panic disorders have high prevalence rates in primary care. Given the crucial role of general practitioners in diagnosing and treating mental disorders, the two-arm cluster-randomized, controlled PREMA trial was designed. PREMA was aimed at investigating a new intervention combining cognitive behavioral therapy, case management and eHealth components for patients with depression and/or panic disorder with or without agoraphobia in primary care practices in Germany. This qualitative study, embedded in the PREMA trial, explores primary healthcare professionals' lived experiences in using the new treatment program. Using a qualitative design, we conducted eleven interviews with general practitioners and medical assistants from Hesse, Germany, between July 2021 and March 2022. For both groups we relied on a semi-structured interview guide covering the following subjects: study procedures, implementation, practicality, and individual components of the treatment program. Interviews were audio-recorded, transcribed verbatim and analyzed by two researchers using content analysis. A deductive-inductive approach was used for the analysis according to Kuckartz. Results: We narratively summarized the facilitators and barriers from two different stakeholders across five key themes regarding experiences of feasibility and practicability of the new treatment program: study instruction materials, individual components of the treatment program, practicality, target population, and benefits of the treatment program. Facilitators to become familiar with the study include study instruction materials that are easy to understand and not too complex, considering the limited time resources available; barriers included text-heavy instruction materials, lack of collegial exchange, and issues especially with digital materials also involved access and log-in difficulties on the online platform. Facilitators for using the treatment program include the combination of face-to-face consultations and the use of an online platform, enabling a structured approach and regularity; barriers included patients feeling unsupported in performing anxiety exercises independently at home. For practicality, the professional skills of medical assistants and their central role as points of contact for patients facilitated the implementation; barriers included time-intensive organization and planning of monitoring phone calls and consultations. Regarding the target population, general practitioners and medical assistants state that the treatment program would be most appropriate for patients with mild to moderate depression and for those waiting for psychotherapeutic treatment; it would be less suitable for older patients, and those with negative attitudes towards technological tools. For benefits of the program, facilitating factors included free and low-threshold access to the online platform and strengthening the relationship between medical assistants and patients; barriers included a preference for in-person conversations and the inability of some people to use online applications. Conclusions: The complexity of the new treatment program and the associated high workload underline the need for further adjustments to the treatment approach. Team-based care and the expanded responsibilities of medical assistants demonstrated promising results. Trial registration: The study was registered in the German Clinical Trials Register (DRKS00016622) on February 22, 2019. [ABSTRACT FROM AUTHOR]

Background: Young adults represent a third of the United Kingdom prison population and are at risk of poor health outcomes, including drug and alcohol misuse, self-harm and suicide. Court diversion interventions aim to reduce the negative consequences of criminal sanctions and address the root causes of offending. However, evidence of their effectiveness has not yet been established. The Gateway programme, issued as a conditional caution, aimed to improve the life chances of young adults committing low-level offences. Participants agreed not to reoffend during the 16-week caution and, following a needs assessment, received individual support from a Gateway navigator and attended two workshops encouraging analysis of own behaviour and its consequences. Objective: To evaluate the effectiveness and cost-effectiveness of Gateway in relation to health and well-being of participants compared to usual process (court summons or a different conditional caution). Design, setting and participants: Pragmatic, multisite, parallel-group, superiority randomised controlled trial with two 6-month internal pilots and a target sample size of 334. Randomisation between Gateway and usual process was on a 1 : 1 basis. Four Hampshire Constabulary sites recruited 18- to 24-year-old residents of Hampshire and Isle of Wight who were questioned for an eligible low-level offence. Semistructured interviews were also held with a sample of Gateway programme participants, staff and police study recruiters. Main outcome measures: Primary outcome was the Warwick-Edinburgh Mental Wellbeing Scale score at 12 months. Secondary outcomes included health status, alcohol and drug use, recidivism and resource use. Results: Recruitment commenced in October 2019 and the trial stopped in April 2021. A total of 191 participants were recruited, with 109 randomised to Gateway and 82 to usual process. Due to an initial overestimation of potentially eligible young people and low retention rates, recruitment targets were adjusted, and a range of mitigating measures introduced. Although recruitment broadly met study progression criteria [35/50 (70%) Pilot 1: 64/74 (86%) Pilot 2], retention was low throughout (overall: data collected at week 4 was 50%: at week 16 it was 50%: 1-year 37%). Low retention was multifactorial, with one of the main barriers being difficulties contacting participants. It was therefore not possible to complete the randomised controlled trial or the health economics analyses. Qualitative interviews held with 58 individuals yielded rare insights into the benefits and limitations of this type of intervention, as well as barriers and facilitators in relation to recruitment in this setting. Limitations: Despite close collaboration with the police to address recruitment and consent issues, expansion of the inclusion criteria and recruitment area and introducing other measures, the researchers were unable to collect sufficient data within an acceptable timeframe. Conclusions: The Gateway study was a unique endeavour to gather evidence for a potentially life-changing intervention for an underserved population. The experience gained indicates that randomised controlled trials of interventions, with a health-related outcome, are possible in this setting but point towards the need for conservative recruitment and retention estimates in this target population. Other study designs should be considered. The qualitative evaluation provided a range of valuable lessons for those seeking to design similar interventions or conduct research in similar settings. Study registration: This study is registered as ISRCTN11888938. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 16/122/20) and is published in full in Public Health Research; Vol. 12, No. 7. See the NIHR Funding and Awards website for further award information. Plain language summary: Young adults who commit low-level offences often have many health and social needs, making them vulnerable to physical and mental health problems. The Gateway programme was a conditional caution developed to address the underlying causes of low-level offending in young people aged 18–24 years and hence improve their life chances. In Gateway, a mentor assessed the young person's needs and supported them, signposting to healthcare, housing or other services as required. The young people also participated in two workshops, analysing the causes and consequences of their behaviour. To find out if Gateway improved health and reoffending rates, a group of those who received a Gateway conditional caution were compared with a group of those receiving a court summons or a different conditional caution. Of the 191 participants recruited to the study, 109 were randomised to Gateway and 82 to the usual process. However, the researchers had significant difficulties getting hold of the study participants on the phone and they were unable to collect enough information from them to be able to say whether Gateway worked. The researchers introduced various changes to overcome this, but in the end had to stop the study early. As part of the study, the researchers interviewed 28 Gateway programme participants, 17 Gateway project staff and 13 police officers and staff who had been recruiting into the study. From the interviews the study discovered the perceived benefits of Gateway, how programmes like this could be improved and which factors helped or got in the way of doing research in the police setting. The Gateway study aimed to provide evidence for a potentially life-changing intervention for vulnerable young adults. Although it proved impossible to complete the study, the lessons learnt from running it should help colleagues design similar programmes or plan research studies with similar populations or in similar settings. Scientific summary: Background: Young adults represent a third of the United Kingdom (UK) prison population and are at risk of poor health outcomes including drug and alcohol misuse, self-harm and suicide. Those aged between 18 and 24, who have been questioned as suspects in relation to a low-level offence, may need to attend court and, if convicted, face penalties such as imprisonment. However, other means aimed at preventing young adults from reoffending exist. Court diversion interventions aim to reduce the negative consequences of some types of criminal sanctions and focus resources on addressing the root causes of offending. Although diversions are widely used in the UK, evidence of their effectiveness in terms of health outcomes has not yet been established using robust research methods. Hampshire Constabulary (HC), working with local charities, developed the Gateway programme, an out-of-court disposal aimed at improving the life chances of young adults. Objectives: The aim of this study was to evaluate the effectiveness and cost-effectiveness of the Gateway programme issued as a conditional caution (intervention) compared to usual process (court appearance or a different conditional caution). The study objectives were to: Examine the effectiveness of the Gateway intervention on: (1) health and well-being including alcohol and substance use, (2) access to and use of health and social services and (3) quality of life, among young adult offenders. Explore the views and experiences of victims. Assess the quantity and quality of the Gateway intervention as delivered in the study and the generalisability of the findings. Identify and measure relevant consequences, both cost and benefits, of the Gateway intervention compared with usual process. Examine the effectiveness of the Gateway intervention on recidivism. Methods: Design: The study undertook a pragmatic, superiority RCT with two 6-month internal pilot phases and qualitative evaluation: an economic evaluation was planned. Participants were randomised using a 1 : 1 allocation ratio to either the Gateway conditional caution (intervention) or disposal as usual to a court summons or a different conditional caution to Gateway (usual process). The qualitative evaluation aimed to capture the experiences and perceptions of the impact of the intervention on participants, the police, victims and those delivering the intervention. Participants, setting and recruitment: Eligible participants were those aged 18–24 who had committed low-level offences and resided within Hampshire and Isle of Wight (IoW) area. Participants were recruited by Police investigators during processing for an offence. Potential participants were offered a chance by the police to receive the Gateway caution, and those interested were invited to take part in the study. Police officers obtained Stage 1 consent and carried out an eligibility check, after which those eligible were automatically randomised to receive either a Gateway caution or follow the usual process, such as court appearance or a different conditional caution. Qualitative interviews were undertaken with trial participants, police officers and those delivering the intervention. Sample size: There is no widely accepted and established minimal clinically significant difference for the primary outcome, Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). A change of three or more points is likely to be important to individuals. There is also variation in the standard deviation (SD) of the WEMWBS with estimates ranging from 6 to 10.8 with the pooled estimate of 10 across all studies. Assuming 90% power, 5% 2-sided statistical significance, mean difference of 4 points on WEMWBS and a SD of 10, 266 participants were required. Conservatively, assuming a 20% attrition rate, the study aimed to recruit and randomise 334 participants. Interventions: The Gateway programme, issued as a conditional caution, required participants to undertake a health and social care needs assessment, attend workshops encouraging analysis of their behaviour and its consequences, and agree not to reoffend during the 16-week caution. Usual process was disposal to a court summons or an alternative conditional caution. Outcomes: The primary outcome measure was the WEMWBS. Participants self-reported WEMWBS at 4-weeks, 16-weeks and 1-year post-randomisation. Secondary outcomes were health status [Short Form 12 questionnaire (SF-12)]; alcohol [Alcohol Use Disorders Identification Test (AUDIT)] and drug [Adolescent Drug Involvement Scale (ADIS)] use; type and frequency of reoffending (police data); and health and social care resource use (self-reported). Statistical methods: The original plan, pre-specified in version 1.0 of the SAP , was to carry out a repeated measures, mixed-effects linear regression model with the WEMWBS score at 4-weeks, 16-weeks and 1-year post-randomisation as the dependent variable, adjusting for treatment group, time, group by time interaction, total number of records management system incidents and police national computer convictions 1-year prerandomisation, age at randomisation, Index of Multiple Deprivation quintile at randomisation, pandemic time period and standard of usual process available as fixed effects. Recruiting site was to be adjusted for as a random effect. However, due to the study closing early because of issues with retaining participants, a descriptive analysis was undertaken with no formal hypothesis testing. All outcomes were summarised descriptively by a randomised treatment group. Qualitative evaluation: A qualitative evaluation was conducted to assess the implementation of the Gateway programme, including any related issues and observed benefits to the clients. Focusing on implementation, mechanisms and context, the research questions were: How is Gateway being implemented? What are the barriers to the implementation and effects of the Gateway programme? What are the mechanisms through which the intervention brings about change? How do different delivery methods (face-to-face/virtual/telephone) influence the above questions? We conducted qualitative interviews and focus groups with a range of stakeholders across three time periods during the implementation of the Gateway programme. Economic evaluation: A formal health economic analysis was not feasible. Health economic data are summarised descriptively with the trial data. Results: Randomised controlled trial: We recruited 191 participants; 109 were randomised to Gateway and 82 to usual process. Although recruitment rates were within acceptable limits, the number of participants providing data [94 (32%) at week 4; 95 (34%) at week 16; 43 (28%) at 1-year] was insufficient to undertake any formal hypothesis testing and the trial was closed early. The groups were generally well balanced in terms of characteristics and percentage providing data, but more of those providing valid data had a previous conviction than those who did not provide data. Similar percentages from each arm provided data with those attending interviews completing all sections. Telephone interviews were acceptable to those willing to share an active telephone number. Rates for those who were non-contactable were similar between the groups at all three time points. Eighty-one of the 101 allocated to Gateway complied with the intervention. Reasons for non-compliance were reoffending and non-attendance at the LINX workshops. Qualitative evaluation: Across 3 time points, 69 in-depth interviews were conducted with: 28 young people, 25 Gateway staff, 13 police recruiters and 3 focus groups with navigators. The researchers were unable to pursue interviews with victims as there were few offences with a victim. Our findings showed that, following engagement with the Gateway programme, young people reported being better able to make decisions after engagement with the LINX workshops, while navigators played a significant role in enabling compliance and change among young people. The role of the navigator was akin to that of the mentor, providing practical support towards improved health including, for example, making and attending doctors' appointments with clients, as well as offering a listening role. Young people felt that, for them, the wider determinants (or 'areas') addressed with navigators, such as access to employment or improved health, were of greater importance than a reduction in reoffending. There was a polarity of needs among young people, which meant that all stakeholders valued the ability to tailor and adapt the programme to individual client's needs, also giving clients a sense of agency and control over their lives. The independence of the Gateway intervention team, from the police, was highly valued by young people. Factors related to communication were a concern for all, particular at the point of recruitment (by police) and between multiple delivery agencies. Discussion: The problems encountered throughout this trial and the researchers' endeavours to overcome these problems provide valuable insights for colleagues seeking to design similar interventions and/or conduct studies with vulnerable populations in the police setting. Co-production is essential for studies in the police setting. By working in close collaboration with HC , and their two project dedicated officers, the researchers were able to make pragmatic adjustments to the study design as issues arose. However, training an entire police force is fraught with difficulty even when supported by senior officers; competing interests precluded mandatory training for research purposes. The use of a two-stage consent process and a web-based eligibility and randomisation tool facilitate recruitment in the police setting, but frequent, regular need to use is required to maintain the study profile. Young people who have committed an offence are known to be a difficult group to engage with generally, let alone in research. The study identified and tested implementation of different approaches to overcome this problem. Switching to telephone interviews produced a positive response. Persistence and engagement paid off, but the study was unable to solve the problem of inactive mobile telephone numbers; an issue shared by the navigators and police. Independence of those delivering the intervention is important as perceived links with the police caused some disengagement. The collected data provide valuable information on attrition rates for health studies. Interestingly, allocation did not appear to make any difference to participation. The study's qualitative evaluation highlighted the unmet health needs for this group of 18- to 24-year-olds, and the need to address the wider determinants of reoffending through individualised assessment. The Gateway programme was, however, developed for those with higher needs, which meant that flexibility and adaptability to suit individual needs was essential. It further highlighted the invaluable role of mentors in rehabilitative programmes such as Gateway. The study has demonstrated that it is possible to recruit and randomise to a RCT in the police setting. The data that the study presents should be used to inform the planning of future trials, including anticipated attrition rates, and setting conservative targets for retention as well as recruitment rates. Internal pilots should be long enough to confirm recruitment and data collection rates are achievable over an adequate follow-up period. Given the challenges encountered, alternative study designs should be considered for the evaluation of interventions with a health-related outcome. These include: cluster RCTs where processes at individual cluster sites could be simplified; post hoc cohort studies which may address non-response and attrition bias; and regression discontinuity design (RDD), a quasi-experimental approach at lower risk of bias which has the potential to equate to a RCT. Conclusions: This ambitious RCT and qualitative study provides information about an out-of-court intervention aimed at improving life chances, health and well-being and recidivism in young adults. Challenges encountered in participation and retention in this setting and the ways in which these may be addressed are described and will be useful in planning future research. Study registration: This study is registered as ISRCTN11888938. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 16/122/20) and is published in full in Public Health Research; Vol. 12, No. 7. See the NIHR Funding and Awards website for further award information. [ABSTRACT FROM AUTHOR]

Abstract Background Depression and panic disorders have high prevalence rates in primary care. Given the crucial role of general practitioners in diagnosing and treating mental disorders, the two-arm cluster-randomized, controlled PREMA trial was designed. PREMA was aimed at investigating a new intervention combining cognitive behavioral therapy, case management and eHealth components for patients with depression and/or panic disorder with or without agoraphobia in primary care practices in Germany. This qualitative study, embedded in the PREMA trial, explores primary healthcare professionals’ lived experiences in using the new treatment program. Using a qualitative design, we conducted eleven interviews with general practitioners and medical assistants from Hesse, Germany, between July 2021 and March 2022. For both groups we relied on a semi-structured interview guide covering the following subjects: study procedures, implementation, practicality, and individual components of the treatment program. Interviews were audio-recorded, transcribed verbatim and analyzed by two researchers using content analysis. A deductive-inductive approach was used for the analysis according to Kuckartz. Results We narratively summarized the facilitators and barriers from two different stakeholders across five key themes regarding experiences of feasibility and practicability of the new treatment program: study instruction materials, individual components of the treatment program, practicality, target population, and benefits of the treatment program. Facilitators to become familiar with the study include study instruction materials that are easy to understand and not too complex, considering the limited time resources available; barriers included text-heavy instruction materials, lack of collegial exchange, and issues especially with digital materials also involved access and log-in difficulties on the online platform. Facilitators for using the treatment program include the combination of face-to-face consultations and the use of an online platform, enabling a structured approach and regularity; barriers included patients feeling unsupported in performing anxiety exercises independently at home. For practicality, the professional skills of medical assistants and their central role as points of contact for patients facilitated the implementation; barriers included time-intensive organization and planning of monitoring phone calls and consultations. Regarding the target population, general practitioners and medical assistants state that the treatment program would be most appropriate for patients with mild to moderate depression and for those waiting for psychotherapeutic treatment; it would be less suitable for older patients, and those with negative attitudes towards technological tools. For benefits of the program, facilitating factors included free and low-threshold access to the online platform and strengthening the relationship between medical assistants and patients; barriers included a preference for in-person conversations and the inability of some people to use online applications. Conclusions The complexity of the new treatment program and the associated high workload underline the need for further adjustments to the treatment approach. Team-based care and the expanded responsibilities of medical assistants demonstrated promising results. Trial registration The study was registered in the German Clinical Trials Register (DRKS00016622) on February 22, 2019.

Abstract Background The period between cancer diagnosis and surgery presents an opportunity for trials to assess the feasibility of behaviour change interventions. However, this can be a worrying time for patients and may hinder recruitment. We describe the perspectives of patients with excess weight awaiting colorectal cancer surgery about their recruitment into a randomised trial of a prehabilitation weight loss intervention. Methods We interviewed the first 26 participants from the 8 recruitment sites across England in the ‘CARE’ feasibility trial. Participants were randomised into either usual care (n = 13) or a low-energy nutritionally-replete total diet replacement programme with weekly remote behavioural support by a dietitian (n = 13). The semi-structured interviews occurred shortly after recruitment and the questions focused on participants’ recollections of being recruited into the trial. We analysed data rapidly and then used a mind-mapping technique to develop descriptive themes. Themes were agreed by all co-authors, including a person with lived-experience of colorectal surgery. Results Participants had a mean body mass index (± SD) of 38 kg/m2 (± 6), age of 50 years (± 12), and 42% were female. People who participated in the trial were motivated by the offer of structured weight loss support that could potentially help them improve their surgical outcomes. However, participants also had concerns around the potential unpalatability of the intervention diet and side effects. Positive attitudes of clinicians towards the trial facilitated recruitment but participants were disappointed when they were randomised to usual care due to clinical teams’ overemphasis on the benefits of losing weight. Conclusions Patients were motivated to take part by the prospect of improved surgical outcomes. However, the strong preference to be allocated to the intervention suggests that balanced communication of equipoise is crucial to minimise disappointment from randomisation to usual care and differential dropout from the trial. Clinical trial registration ISRCTN39207707, Registration date 13/03/2023.

Abstract A large number of tectonically mixed rock belts and complex tectonic zones are distributed in the southwestern part of China. In these areas, high geostress and tectonic stresses have caused some underground rock layers to be crushed and broken, eventually forming crushed rock zones. Which may undergo creep deformation under long-term loads. The manuscript is based on a typical crushed rock in the southwestern China. Firstly, the factors affecting creep deformation were analysed, and the response law of each influencing factor to rock creep is demonstrated. Then, the theory of uncorroborated measures and hierarchical analysis were used to systematically correlate the factors influencing creep. Thereby, a creep level qualitative evaluating model of crushed rock is established. Finally, this model was used to qualitatively evaluate the creep level of the crushed rock in the study area. It is concluded that the creep level qualitative evaluating of this crushed rock is rated as Class II, which is characterised by a low creep level and small creep deformations (0–10 mm). The research results can provide a reference for the creep analysis of crushed rock and provide a basis for the safe construction of engineering slopes.

Patient compliance in chronic illnesses is essential for disease management. This also applies to age-related macular degeneration (AMD), a chronic acquired retinal degeneration that needs constant monitoring and patient cooperation. Therefore, patients with AMD can benefit by being properly informed about their disease, regardless of the condition's stage. Information is essential in keeping them compliant with lifestyle changes, regular monitoring, and treatment. Large language models have shown potential in numerous fields, including medicine, with remarkable use cases. In this paper, we wanted to assess the capacity of two large language models (LLMs), ChatGPT4 and PaLM2, to offer advice to questions frequently asked by patients with AMD. After searching on AMD-patient-dedicated websites for frequently asked questions, we curated and selected a number of 143 questions. The questions were then transformed into scenarios that were answered by ChatGPT4, PaLM2, and three ophthalmologists. Afterwards, the answers provided by the two LLMs to a set of 133 questions were evaluated by two ophthalmologists, who graded each answer on a five-point Likert scale. The models were evaluated based on six qualitative criteria: ( C 1 ) reflects clinical and scientific consensus, ( C 2 ) likelihood of possible harm, ( C 3 ) evidence of correct reasoning, ( C 4 ) evidence of correct comprehension, ( C 5 ) evidence of correct retrieval, and ( C 6 ) missing content. Out of 133 questions, ChatGPT4 received a score of five from both reviewers to 118 questions (88.72%) for C 1 , to 130 (97.74%) for C 2 , to 131 (98.50%) for C 3 , to 133 (100%) for C 4 , to 132 (99.25%) for C 5 , and to 122 (91.73%) for C 6 , while PaLM2 to 81 questions (60.90%) for C 1 , to 114 (85.71%) for C 2 , to 115 (86.47%) for C 3 , to 124 (93.23%) for C 4 , to 113 (84.97%) for C 5 , and to 93 (69.92%) for C 6 . Despite the overall high performance, there were answers that are incomplete or inaccurate, and the paper explores the type of errors produced by these LLMs. Our study reveals that ChatGPT4 and PaLM2 are valuable instruments for patient information and education; however, since there are still some limitations to these models, for proper information, they should be used in addition to the advice provided by the physicians. [ABSTRACT FROM AUTHOR]

To understand the perspectives of physiotherapists on the contribution of students to the delivery of health services during clinical placements. Focus groups with a semi-structured interview guide were completed separately with new graduate physiotherapists reflecting on their student experience and experienced physiotherapists from five Queensland public health-sector hospitals. Interviews were transcribed verbatim in preparation for thematic analysis. Interview manuscripts were read independently and initially coding completed. Codes were compared and further refinement of themes occurred. Themes were reviewed by two investigators. There were 38 new graduate participants across nine focus groups and 35 experienced physiotherapists across six focus groups who participated in this study. Students participate in a range of activities during clinical placements some of which contribute to delivery of health services and others which support student learning. Three major themes were identified: 1) tangible student contribution; 2) non-tangible student contribution; and 3) factors that influence the student contribution. Overwhelmingly, both new graduate and experienced physiotherapists felt that students do contribute to the delivery of health services however careful consideration of a variety of factors is necessary to maximize the student contribution. [ABSTRACT FROM AUTHOR]

Background: The existing research in this field indicates that there has been insufficient investigation into the life experiences of sixth-grade teachers and students concerning the qualitative values of mathematics lessons. Furthermore, there is a noticeable gap in the development of a scale for assessing teaching skills in the qualitative evaluation of mathematics lessons. This highlights the need for comprehensive studies that explore the lived experiences of both teachers and students in the context of qualitative values within mathematics education, along with the design of an effective scale to assess teaching skills in the qualitative evaluation of mathematics lessons. Aims: The purpose of this research was to investigate the lived experiences of sixth grade teachers and students of the qualitative value of math lessons. Methods: The current research was applied in terms of purpose and qualitative in terms of method and based on phenomenological strategy. The participants of this research were sixth grade teachers and students who were selected by purposive sampling. The tool used in this research was a semistructured interview. In order to analyze the data, the coding method was used. Results: the results showed that the interviewees suffered from disadvantages such as lack of belief in qualitative evaluation, teachers' lack of knowledge about the philosophy of qualitative evaluation, the spirit of evaluation not being governed, and the inability of students to measure by themselves., the growth of teachers in the evaluation system has been mentioned a little. Also, teachers suffer from harms such as the reduction of healthy competition, children's insensitivity to lessons, low motivation, and lack of proper infrastructure, carelessness, students not studying, lack of enthusiasm and attractiveness in teachers, and the inability to cover weaknesses in evaluation. Qualitatively pointed out. Conclusion: The aim of the current research was to investigate the lived experiences of sixth grade teachers and students of the qualitative evaluation of mathematics lessons, to design a scale of teacher skills in the qualitative evaluation of mathematics lessons. The results of data analysis showed that from the teachers' point of view, 23 main categories and 60 sub-categories, and from the students' point of view, 21 main categories and 42 sub-categories were identified as necessary factors and components and obstacles and challenges for the implementation of qualitative evaluation. [ABSTRACT FROM AUTHOR]

The increase in elderly population is emerging as a serious social issue. The coronavirus pandemic has increased the number of elderly people suffering from depression and loneliness owing to the lack of face-to-face activities. In this study, we developed an integrated system for the human-care robot service, considering cognitive and emotional support for elderly people, and verified its stability and usefulness in the real world. We recruited 40 elderly people for an apartment testbed environment experiment and two elderly people living alone for a long time participated in the experiment at their homes. Quantitative experimental results were analyzed by comparing service success rates and user satisfaction in two different test environments to verify the stability of the service. Qualitative evaluations were also conducted through surveys and interviews to assess the usefulness of the service. [ABSTRACT FROM AUTHOR]

This paper describes how mixed methods can improve the value and policy relevance of impact evaluations, paying particular attention to how mixed methods can be used to address external validity and generalization issues. We briefly review the literature on the rationales for using mixed methods; provide documentation of the extent to which mixed methods have been used in impact evaluations in recent years; describe how we developed a list of recent impact evaluations using mixed methods and the process used to conduct full-text reviews of these articles; summarize the findings from our analysis of the articles; discuss three exemplars of using mixed methods in impact evaluations; and discuss how mixed methods have been used for studying and improving external validity and potential improvements that could be made in this area. We find that mixed methods are rarely used in impact evaluations, and we believe that increased use of mixed methods would be useful because they can reinforce findings from the quantitative analysis (triangulation), and they can also help us understand the mechanism by which programs have their impacts and the reasons why programs fail. [ABSTRACT FROM AUTHOR]

The Clinician Scholars Program (CSP) was designed to expand the HIV care workforce by improving the clinical capacity of clinicians in underserved areas. This evaluation assessed program participants' long-term practice changes and system changes. The year-long program combined mentoring, training, and on-site clinical observation. Qualitative interviews (N = 46) were conducted with Scholars at least 2 years following CSP, supplemented by a 2023 survey. Multiple coders analyzed transcripts using open coding. Thematic analysis explored practice changes and efforts to move patients along the HIV care continuum. Findings indicate positive long-term impacts of CSP regarding the HIV care continuum and care system engagement. Over 90% of Scholars remained working in HIV care, with 75% maintaining or increasing patient loads and 72% making changes to their clinical practice. This training model appears to enhance care along the HIV care continuum and may be adaptable to other contexts that address complex chronic conditions. [ABSTRACT FROM AUTHOR]

Background: The UK Diabetes Remission Clinical Trial (DiRECT) study was replicated in an Australian primary care setting. This qualitative study aimed to explore and understand the perceptions and experiences of both participants and healthcare professionals (HCPs) involved in the DiRECT‐Australia Type 2 Diabetes Remission Service. Methods: All participants and HCPs delivering the service were invited to participate in semi‐structured interviews via online videoconferencing. The interview guides explored perceptions and experiences in DiRECT‐Australia, covering aspects such as barriers and facilitators to recruitment and participation, motivations and challenges across service phases, adequacy of support provided and the overall acceptability of the service. All interviews were audio‐recorded, transcribed verbatim and analysed using thematic analysis. Results: Eight DiRECT‐Australia participants and six HCPs (three general practitioners, two practice nurses and one dietitian) participated. Four overarching themes were identified: (1) Enablers and barriers to recruitment and continuous participation in DiRECT‐Australia; (2) Motivators and overcoming barriers across the total diet replacement, food reintroduction and weight maintenance phases; (3) Importance of participant‐HCP interactions and continuous support; (4) Acceptance and long‐term need for DiRECT‐Australia. Adherence to total diet replacement was less challenging than anticipated by participants. Transitioning to the food reintroduction phase was difficult but overcome through HCP support. DiRECT‐Australia was well accepted by both participants and HCPs, and participants expressed willingness to continue with the service, if provided on a long‐term basis. Conclusions: Both participants and HCPs were highly interested in the new diabetes remission service set up in an Australian primary care setting. The acceptability of DiRECT‐Australia was underscored by participants emphasising the effectiveness of the service in achieving significant weight loss and diabetes remission. There is a need for long‐term and wider implementation of the service to ensure that anyone with recent onset type 2 diabetes is offered the best possible chance to achieve remission. [ABSTRACT FROM AUTHOR]

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To contribute to healthcare improvements, qualitative health research must adapt to the demanding pace of constantly changing healthcare practices and policies. To meet this challenge, researchers need methods for rigorous and rapid data analysis. This article introduces the Rapid Group Analysis Process (Rap-GAP), a new approach for rapid qualitative data analysis. This method is more efficient than other rapid qualitative analysis methods. It allows for the direct involvement of diverse participants in the analysis process, including patients or healthcare decision-makers with limited qualitative research experience, while keeping the analysis grounded in the primary data (e.g., transcripts). These attributes make Rap-GAP a unique and valuable alternative to traditional qualitative analysis. This article describes the 5-step Rap-GAP process and 3 case studies that demonstrate how to use the method and adapt it for different analytical goals. Future research will evaluate and describe the outcomes of Rap-GAP compared to traditional qualitative analysis. [ABSTRACT FROM AUTHOR]

This mixed methods study had two aims: (1) to examine the effectiveness of a jail diversion program in reducing recidivism and promoting educational and employment outcomes; and (2) to qualitatively explore mechanisms through which the program was effective. Participants were 17 individuals arrested for drug offenses who participated in an intensive, law enforcement‐based jail diversion program, and 17 individuals in a comparison group. Arrests were extracted from police records, and education and employment were extracted from program data. Four intervention participants completed qualitative interviews. Arrest rates in the intervention group decreased significantly postintervention, and arrest rates in the intervention group were numerically lower than those in the comparison group. Participants experienced significant increases in employment and driver's license status. Participants also identified mechanisms through which the program was effective. This jail diversion program shows promise in reducing recidivism and promoting adaptive functioning. Jail diversion programs that include mentorship, peer support, and removal of barriers to success may be particularly effective. [ABSTRACT FROM AUTHOR]

Virtual community-based programming for people with disabilities has become a popular method for advocating for health promotion, specifically exercise, for people with disabilities (PWD). Using theoretical frameworks to better understand the perspective of PWD who participate in virtual exercise programs allows strategies of implementation following completion of virtual exercise programs. The objective of this study was to examine the effect adherence had on perceptions, experiences, and post-program exercise maintenance in participants with disabilities. Eight qualitative interviews were conducted in highly adherent participants using the Social Cognitive Theory (SCT). Interviews were recorded on Zoom, transcribed using Microsoft 365, and analyzed using NVivo software. Data were analyzed by the primary author and an independent coder to increase rigor and reduce bias. Thirty-five unique codes were generated from transcribed interviews. Member-checking was employed to increase internal validity; 100% of participants agreed with the findings. Results demonstrate an overall positive experience in the virtual exercise program, noting specific facilitators (i.e., knowledgeable instructor, program provided equipment, etc.) and barriers (i.e., limited physical space at home to exercise, other participant's attitudes, etc.) of participating. Impressionably, 100% of participants maintained exercise following their time within the virtual exercise program.

Background Young adults represent a third of the United Kingdom prison population and are at risk of poor health outcomes, including drug and alcohol misuse, self-harm and suicide. Court diversion interventions aim to reduce the negative consequences of criminal sanctions and address the root causes of offending. However, evidence of their effectiveness has not yet been established. The Gateway programme, issued as a conditional caution, aimed to improve the life chances of young adults committing low-level offences. Participants agreed not to reoffend during the 16-week caution and, following a needs assessment, received individual support from a Gateway navigator and attended two workshops encouraging analysis of own behaviour and its consequences. Objective To evaluate the effectiveness and cost-effectiveness of Gateway in relation to health and well-being of participants compared to usual process (court summons or a different conditional caution). Design, setting and participants Pragmatic, multisite, parallel-group, superiority randomised controlled trial with two 6-month internal pilots and a target sample size of 334. Randomisation between Gateway and usual process was on a 1 : 1 basis. Four Hampshire Constabulary sites recruited 18- to 24-year-old residents of Hampshire and Isle of Wight who were questioned for an eligible low-level offence. Semistructured interviews were also held with a sample of Gateway programme participants, staff and police study recruiters. Main outcome measures Primary outcome was the Warwick-Edinburgh Mental Wellbeing Scale score at 12 months. Secondary outcomes included health status, alcohol and drug use, recidivism and resource use. Results Recruitment commenced in October 2019 and the trial stopped in April 2021. A total of 191 participants were recruited, with 109 randomised to Gateway and 82 to usual process. Due to an initial overestimation of potentially eligible young people and low retention rates, recruitment targets were adjusted, and a range of mitigating measures introduced. Although recruitment broadly met study progression criteria [35/50 (70%) Pilot 1: 64/74 (86%) Pilot 2], retention was low throughout (overall: data collected at week 4 was 50%: at week 16 it was 50%: 1-year 37%). Low retention was multifactorial, with one of the main barriers being difficulties contacting participants. It was therefore not possible to complete the randomised controlled trial or the health economics analyses. Qualitative interviews held with 58 individuals yielded rare insights into the benefits and limitations of this type of intervention, as well as barriers and facilitators in relation to recruitment in this setting. Limitations Despite close collaboration with the police to address recruitment and consent issues, expansion of the inclusion criteria and recruitment area and introducing other measures, the researchers were unable to collect sufficient data within an acceptable timeframe. Conclusions The Gateway study was a unique endeavour to gather evidence for a potentially life-changing intervention for an underserved population. The experience gained indicates that randomised controlled trials of interventions, with a health-related outcome, are possible in this setting but point towards the need for conservative recruitment and retention estimates in this target population. Other study designs should be considered. The qualitative evaluation provided a range of valuable lessons for those seeking to design similar interventions or conduct research in similar settings. Study registration This study is registered as ISRCTN11888938. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 16/122/20) and is published in full in Public Health Research; Vol. 12, No. 7. See the NIHR Funding and Awards website for further award information. Plain language summary Young adults who commit low-level offences often have many health and social needs, making them vulnerable to physical and mental health problems. The Gateway programme was a conditional caution developed to address the underlying causes of low-level offending in young people aged 18–24 years and hence improve their life chances. In Gateway, a mentor assessed the young person’s needs and supported them, signposting to healthcare, housing or other services as required. The young people also participated in two workshops, analysing the causes and consequences of their behaviour. To find out if Gateway improved health and reoffending rates, a group of those who received a Gateway conditional caution were compared with a group of those receiving a court summons or a different conditional caution. Of the 191 participants recruited to the study, 109 were randomised to Gateway and 82 to the usual process. However, the researchers had significant difficulties getting hold of the study participants on the phone and they were unable to collect enough information from them to be able to say whether Gateway worked. The researchers introduced various changes to overcome this, but in the end had to stop the study early. As part of the study, the researchers interviewed 28 Gateway programme participants, 17 Gateway project staff and 13 police officers and staff who had been recruiting into the study. From the interviews the study discovered the perceived benefits of Gateway, how programmes like this could be improved and which factors helped or got in the way of doing research in the police setting. The Gateway study aimed to provide evidence for a potentially life-changing intervention for vulnerable young adults. Although it proved impossible to complete the study, the lessons learnt from running it should help colleagues design similar programmes or plan research studies with similar populations or in similar settings. Scientific summary Background Young adults represent a third of the United Kingdom (UK) prison population and are at risk of poor health outcomes including drug and alcohol misuse, self-harm and suicide. Those aged between 18 and 24, who have been questioned as suspects in relation to a low-level offence, may need to attend court and, if convicted, face penalties such as imprisonment. However, other means aimed at preventing young adults from reoffending exist. Court diversion interventions aim to reduce the negative consequences of some types of criminal sanctions and focus resources on addressing the root causes of offending. Although diversions are widely used in the UK, evidence of their effectiveness in terms of health outcomes has not yet been established using robust research methods. Hampshire Constabulary (HC), working with local charities, developed the Gateway programme, an out-of-court disposal aimed at improving the life chances of young adults. Objectives The aim of this study was to evaluate the effectiveness and cost-effectiveness of the Gateway programme issued as a conditional caution (intervention) compared to usual process (court appearance or a different conditional caution). The study objectives were to: Examine the effectiveness of the Gateway intervention on: (1) health and well-being including alcohol and substance use, (2) access to and use of health and social services and (3) quality of life, among young adult offenders. Explore the views and experiences of victims. Assess the quantity and quality of the Gateway intervention as delivered in the study and the generalisability of the findings. Identify and measure relevant consequences, both cost and benefits, of the Gateway intervention compared with usual process. Examine the effectiveness of the Gateway intervention on recidivism. Methods Design The study undertook a pragmatic, superiority RCT with two 6-month internal pilot phases and qualitative evaluation: an economic evaluation was planned. Participants were randomised using a 1 : 1 allocation ratio to either the Gateway conditional caution (intervention) or disposal as usual to a court summons or a different conditional caution to Gateway (usual process). The qualitative evaluation aimed to capture the experiences and perceptions of the impact of the intervention on participants, the police, victims and those delivering the intervention. Participants, setting and recruitment Eligible participants were those aged 18–24 who had committed low-level offences and resided within Hampshire and Isle of Wight (IoW) area. Participants were recruited by Police investigators during processing for an offence. Potential participants were offered a chance by the police to receive the Gateway caution, and those interested were invited to take part in the study. Police officers obtained Stage 1 consent and carried out an eligibility check, after which those eligible were automatically randomised to receive either a Gateway caution or follow the usual process, such as court appearance or a different conditional caution. Qualitative interviews were undertaken with trial participants, police officers and those delivering the intervention. Sample size There is no widely accepted and established minimal clinically significant difference for the primary outcome, Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). A change of three or more points is likely to be important to individuals. There is also variation in the standard deviation (SD) of the WEMWBS with estimates ranging from 6 to 10.8 with the pooled estimate of 10 across all studies. Assuming 90% power, 5% 2-sided statistical significance, mean difference of 4 points on WEMWBS and a SD of 10, 266 participants were required. Conservatively, assuming a 20% attrition rate, the study aimed to recruit and randomise 334 participants. Interventions The Gateway programme, issued as a conditional caution, required participants to undertake a health and social care needs assessment, attend workshops encouraging analysis of their behaviour and its consequences, and agree not to reoffend during the 16-week caution. Usual process was disposal to a court summons or an alternative conditional caution. Outcomes The primary outcome measure was the WEMWBS. Participants self-reported WEMWBS at 4-weeks, 16-weeks and 1-year post-randomisation. Secondary outcomes were health status [Short Form 12 questionnaire (SF-12)]; alcohol [Alcohol Use Disorders Identification Test (AUDIT)] and drug [Adolescent Drug Involvement Scale (ADIS)] use; type and frequency of reoffending (police data); and health and social care resource use (self-reported). Statistical methods The original plan, pre-specified in version 1.0 of the SAP, was to carry out a repeated measures, mixed-effects linear regression model with the WEMWBS score at 4-weeks, 16-weeks and 1-year post-randomisation as the dependent variable, adjusting for treatment group, time, group by time interaction, total number of records management system incidents and police national computer convictions 1-year prerandomisation, age at randomisation, Index of Multiple Deprivation quintile at randomisation, pandemic time period and standard of usual process available as fixed effects. Recruiting site was to be adjusted for as a random effect. However, due to the study closing early because of issues with retaining participants, a descriptive analysis was undertaken with no formal hypothesis testing. All outcomes were summarised descriptively by a randomised treatment group. Qualitative evaluation A qualitative evaluation was conducted to assess the implementation of the Gateway programme, including any related issues and observed benefits to the clients. Focusing on implementation, mechanisms and context, the research questions were: How is Gateway being implemented? What are the barriers to the implementation and effects of the Gateway programme? What are the mechanisms through which the intervention brings about change? How do different delivery methods (face-to-face/virtual/telephone) influence the above questions? We conducted qualitative interviews and focus groups with a range of stakeholders across three time periods during the implementation of the Gateway programme. Economic evaluation A formal health economic analysis was not feasible. Health economic data are summarised descriptively with the trial data. Results Randomised controlled trial We recruited 191 participants; 109 were randomised to Gateway and 82 to usual process. Although recruitment rates were within acceptable limits, the number of participants providing data [94 (32%) at week 4; 95 (34%) at week 16; 43 (28%) at 1-year] was insufficient to undertake any formal hypothesis testing and the trial was closed early. The groups were generally well balanced in terms of characteristics and percentage providing data, but more of those providing valid data had a previous conviction than those who did not provide data. Similar percentages from each arm provided data with those attending interviews completing all sections. Telephone interviews were acceptable to those willing to share an active telephone number. Rates for those who were non-contactable were similar between the groups at all three time points. Eighty-one of the 101 allocated to Gateway complied with the intervention. Reasons for non-compliance were reoffending and non-attendance at the LINX workshops. Qualitative evaluation Across 3 time points, 69 in-depth interviews were conducted with: 28 young people, 25 Gateway staff, 13 police recruiters and 3 focus groups with navigators. The researchers were unable to pursue interviews with victims as there were few offences with a victim. Our findings showed that, following engagement with the Gateway programme, young people reported being better able to make decisions after engagement with the LINX workshops, while navigators played a significant role in enabling compliance and change among young people. The role of the navigator was akin to that of the mentor, providing practical support towards improved health including, for example, making and attending doctors’ appointments with clients, as well as offering a listening role. Young people felt that, for them, the wider determinants (or ‘areas’) addressed with navigators, such as access to employment or improved health, were of greater importance than a reduction in reoffending. There was a polarity of needs among young people, which meant that all stakeholders valued the ability to tailor and adapt the programme to individual client’s needs, also giving clients a sense of agency and control over their lives. The independence of the Gateway intervention team, from the police, was highly valued by young people. Factors related to communication were a concern for all, particular at the point of recruitment (by police) and between multiple delivery agencies. Discussion The problems encountered throughout this trial and the researchers’ endeavours to overcome these problems provide valuable insights for colleagues seeking to design similar interventions and/or conduct studies with vulnerable populations in the police setting. Co-production is essential for studies in the police setting. By working in close collaboration with HC, and their two project dedicated officers, the researchers were able to make pragmatic adjustments to the study design as issues arose. However, training an entire police force is fraught with difficulty even when supported by senior officers; competing interests precluded mandatory training for research purposes. The use of a two-stage consent process and a web-based eligibility and randomisation tool facilitate recruitment in the police setting, but frequent, regular need to use is required to maintain the study profile. Young people who have committed an offence are known to be a difficult group to engage with generally, let alone in research. The study identified and tested implementation of different approaches to overcome this problem. Switching to telephone interviews produced a positive response. Persistence and engagement paid off, but the study was unable to solve the problem of inactive mobile telephone numbers; an issue shared by the navigators and police. Independence of those delivering the intervention is important as perceived links with the police caused some disengagement. The collected data provide valuable information on attrition rates for health studies. Interestingly, allocation did not appear to make any difference to participation. The study’s qualitative evaluation highlighted the unmet health needs for this group of 18- to 24-year-olds, and the need to address the wider determinants of reoffending through individualised assessment. The Gateway programme was, however, developed for those with higher needs, which meant that flexibility and adaptability to suit individual needs was essential. It further highlighted the invaluable role of mentors in rehabilitative programmes such as Gateway. The study has demonstrated that it is possible to recruit and randomise to a RCT in the police setting. The data that the study presents should be used to inform the planning of future trials, including anticipated attrition rates, and setting conservative targets for retention as well as recruitment rates. Internal pilots should be long enough to confirm recruitment and data collection rates are achievable over an adequate follow-up period. Given the challenges encountered, alternative study designs should be considered for the evaluation of interventions with a health-related outcome. These include: cluster RCTs where processes at individual cluster sites could be simplified; post hoc cohort studies which may address non-response and attrition bias; and regression discontinuity design (RDD), a quasi-experimental approach at lower risk of bias which has the potential to equate to a RCT. Conclusions This ambitious RCT and qualitative study provides information about an out-of-court intervention aimed at improving life chances, health and well-being and recidivism in young adults. Challenges encountered in participation and retention in this setting and the ways in which these may be addressed are described and will be useful in planning future research. Study registration This study is registered as ISRCTN11888938. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 16/122/20) and is published in full in Public Health Research; Vol. 12, No. 7. See the NIHR Funding and Awards website for further award information.

Background There is a policy drive in NHS maternity services to improve open disclosure with harmed families and limited information on how better practice can be achieved. Objectives To identify critical factors for improving open disclosure from the perspectives of families, doctors, midwives and services and to produce actionable evidence for service improvement. Design A three-phased, qualitative study using realist methodology. Phase 1: two literature reviews: scoping review of post-2013 NHS policy and realist synthesis of initial programme theories for improvement; an interview study with national stakeholders in NHS maternity safety and families. Phase 2: in-depth ethnographic case studies within three NHS maternity services in England. Phase 3: interpretive forums with study participants. A patient and public involvement strategy underpinned all study phases. Setting National recruitment (study phases 1 and 3); three English maternity services (study phase 2). Participants We completed n = 142 interviews, including 27 with families; 93 hours of ethnographic observations, including 52 service and family meetings over 9 months; and interpretive forums with approximately 69 people, including 11 families. Results The policy review identified a shift from viewing injured families as passive recipients to active contributors of post-incident learning, but a lack of actionable guidance for improving family involvement. The realist synthesis found weak evidence of the effectiveness of open disclosure interventions in the international maternity literature, but some improvements with organisation-wide interventions. Recent evidence was predominantly from the United Kingdom. The research identified and explored five key mechanisms for open disclosure: meaningful acknowledgement of harm; involvement of those affected in reviews/investigations; support for families’ own sense-making; psychological safely of skilled clinicians (doctors and midwives); and knowing that improvements to care have happened. The need for each family to make sense of the incident in their own terms is noted. The selective initiatives of some clinicians to be more open with some families is identified. The challenges of an adversarial medicolegal landscape and limited support for meeting incentivised targets is evidenced. Limitations Research was conducted after the pandemic, with exceptional pressure on services. Case-study ethnography was of three higher performing services: generalisation from case-study findings is limited. No observations of Health Safety Investigation Branch investigations were possible without researcher access. Family recruitment did not reflect population diversity with limited representation of non-white families, families with disabilities and other socially marginalised groups and disadvantaged groups. Conclusions We identify the need for service-wide systems to ensure that injured families are positioned at the centre of post-incident events, ensure appropriate training and post-incident care of clinicians, and foster ongoing engagement with families beyond the individual efforts made by some clinicians for some families. The need for legislative revisions to promote openness with families across NHS organisations, and wider changes in organisational family engagement practices, is indicated. Examination of how far the study’s findings apply to different English maternity services, and a wider rethinking of how family diversity can be encouraged in maternity services research. Study registration This study is registered as PROSPERO CRD42020164061. The study has been assessed following RAMESES realist guidelines. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research Programme (NIHR award ref: 17/99/85) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 22. See the NIHR Funding and Awards website for further award information. Plain language summary This study describes the experiences of families and healthcare professionals involved in incidents in NHS maternity care. The incidents caused harm-like injury or death to the baby or woman. We wanted to know whether services involved families in investigations and reviews and how this was done, what worked well, what did not work well and why. To do this, we first looked at what had already been written about ‘open disclosure’ or OD. Open disclosure is when the NHS admits to families that the care they provided has directly caused harm. After open disclosure occurs, families should be involved in making sure that the NHS learns so it can deliver better care for families in the future. In our reading, we found that families want a meaningful apology, to be involved in reviews or investigations, to know what happened to their loved one, to be cared for by knowledgeable doctors and midwives who are supported in providing open disclosure and to know things have changed because of what happened. Recommendations for involving families in open disclosure have improved, but there is still work to be done to make sure families are involved. Next, we talked to over 100 healthcare professionals involved in government policy for open disclosure in maternity services and 27 families who experienced harm. We spent 9 months observing the work of clinicians at three maternity services to watch open disclosure. We shared early findings with families, doctors, midwives and managers, and included their views. We found that services need to provide dedicated time, education and emotional support for staff who provide open disclosure. Services need to ensure that families have ongoing support and better communication about incidents. Finally, families must be involved in the review process if they want to be with their experiences reflected in reports and kept informed of ongoing improvements. Scientific summary Background A range of interventions have been introduced in the UK NHS to improve post-incident communication and support of injured families. However, there is limited evidence on the progress of this work and how improvements in open disclosure (OD) are to be embedded. Study aims and objectives The aim was to identify the critical, underlying factors for improving the incidence and quality of post-incident communication with families in NHS maternity services. This required examination of what is necessary and required in different contexts for OD processes and practices to be strengthened for families, doctors and midwives (henceforth clinicians) and service managers. Following a realist evaluation approach, the study objectives were to: establish initial hypotheses to focus investigation of OD improvements in NHS maternity services in England examine the scope of OD in NHS maternity services from the perspectives of regional and national stakeholders refine our initial hypotheses in relation to the analysis of regional and national stakeholder perspectives conduct an in-depth study of OD improvement within services verify data interpretation and study output development with different stakeholders (families, clinicians, service managers and national policy-makers). Overview of methods A qualitative study using realist evaluation methodology to evaluate the progress of OD in English NHS maternity services was conducted (May 2019–March 2022) in three sequential study phases (SPs). Realist approaches are theory-driven and designed for investigation of complex social interventions. They consider if and how an intervention works in different circumstances from the perspectives of different people. Initial hypotheses, developed from the use of a realist evaluation conceptual tool [context–mechanism–outcome (C–M–O) configurations], are developed from literature synthesis and ‘tested’ by primary research to identify potential causal relationships that explain how an intervention works. A Project Advisory Group (PAG), including families, participated in study decisions, from initial theory development, case-study sampling, data collection and interpretation of study findings against a background of rapid policy change. Primary data collection was from November 2019 to January 2022. A patient involvement and public engagement strategy sought to maximise family involvement in all stages of the study cycle. Study phase1a: literature review A scoping review examined recent (2014–22) policy recommendations for family engagement improvements in NHS maternity services. Documents were identified through database searching and included if they were related to safety, incidents, harm, reviews and investigations in maternity care. Academic papers; essays; conference abstractions, papers and presentations; and research studies were excluded. The realist synthesis of primary evidence of the progress of interventions for strengthening OD in international maternity settings included 38 documents appraised for relevance and rigour. Documents were from key database searches, included all English language sources (post 2000), without predetermined exclusion criteria for research methods. Only primary research evidence or evidence synthesis was included. Programme theories were developed with our PAG for testing during later SPs. Study phase 1b: national and regional stakeholder interview study National and regional stakeholders (n = 44), and families (n = 23), were interviewed following a topic guide developed from our literature synthesis. Families included in the study have histories of significant injury, including the stillbirth, death or serious injury of their baby and/or themselves (dating from 2007 to 2021). Study phase 2: ethnographic case studies Three maternity services in two Trusts were identified for in-depth ethnographic research by purposive sampling, based on their capacity to accommodate research immediately following the coronavirus disease 2019 (COVID-19) pandemic, and evidence of their positive deviance in improvement work on openness identified from public data sets. Across these services, we conducted: staff interviews (n = 75) and three return staff interviews, family interviews (n = 4), observations of staff and family meetings (n = 52) and observations of informal unit and office activities (all observations totalled 93 hours, with 30 hours of in-person observations). Families recruited from the case-study services had histories of significant injury dating from 2018 to 2020. We also collected and analysed locally available documentation relating to candour and being open. Study phase 3: interpretation We conducted five interpretive forums to inform the interpretation of findings. These were a forum with project advisors (n = 14), including families (n = 6), a family forum with several SP1b study participants (n = 5) and three service case-study forums, comprised of clinical and service managers and clinicians. Total forum participation was approximately n = 65. All data were managed using NVivo 20 (QSR International, Warrington, UK) and analysed concurrently by two researchers using a retroductive approach. This technique involved the ongoing examination and theorisation of findings to identify causal explanations for how, for whom, and in what ways OD might be improved. We used the five programme theories identified from the realist review to organise the analysis and reporting of our stakeholder interview and ethnographic case-study findings. Findings from our forums are included in the synthesis and discussion of findings. Results Literature reviews Our scoping review of policy documents (n = 39) identified a shift from a paternalistic view of injured families as passive recipients of care to active contributors in reviews, investigations, learning and quality improvement. Two overlapping policy trajectories were identified: one related to the Duty of Candour (DoC) and one related to maternity safety more widely. Seven themes were identified: building trust in organisations; improving systems of care and ensuring accountability; improving the safety of maternity care and saying sorry; shifting to individualised, relational care; enhancing communication; conceptualising families as active partners rather than passive recipients; and enabling families to guide the process. Although the progression of how family involvement is discussed and considered in policy is moving in a positive direction, we note the opportunity for future, specific, actionable recommendations to ensure these ideals translate into practice. In the realist synthesis, documents (n = 39) were appraised for ‘fitness-for-purpose’, that together documented primary evidence of 21 OD improvement interventions from which we identified 5 initial programme theories. Interventions documented were predominantly from USA, Australasia, and, more recently, UK sources. We identified limited evidence of the effectiveness of interventions documented. We found a difference between interventions that were adjuncts to more general safety improvement projects, and organisation-wide interventions focused on post-incident communication and care of injured families. Identified programme theories were: receiving a meaningful acknowledgement of the harm that has happened, being involved during the review/investigation process, making sense of what happened, receiving care from clinicians who are skilled and feel psychologically safe during post-incident communication and knowing that things have changed because of what has happened. Findings by programme theory Receiving a meaningful acknowledgement of the harm that has happened National stakeholders described factors that prevented or slowed improvements in initial post-incident communication and ongoing care of injured families. These were: the risks of litigation and reputational damage which may be associated with an apology and the obligation to be candid. This was particularly challenging when the extent or circumstances of injury were uncertain. Variation in the confidence and willingness of clinicians to undertake initial and ongoing disclosure with families was noted across the case studies. Alongside general medicolegal and ethical challenges to disclosure improvements, wider erosion of compassionate disclosure with families in relation to the escalation of organisational compliance in maternity safety initiatives was noted by stakeholders. Interviews with families on their post-incident experiences (2007–11) highlighted an ongoing lack of compassionate care and of prompt disclosure in many services. Many families distrusted post-incident communication, suspecting that information was being withheld. In the case-study services, the main concern for OD leads was the recovery of family trust in the service. Here, the tension between disclosure as a mandated directive and as ongoing communication was notable, with lack of investment and organisational support for the latter. A significant context of OD work was the churn of work schedules and the speed of family transfers. This complicated efforts to develop consistency of communication and care across initial, mandated and ongoing post-incident meetings, particularly where the uniqueness and flux in the needs of harmed families were paramount and families were already distrustful. These conditions led to a situation where OD was sustained as an individual and selective initiative conducted by some clinicians with some families. Being involved during the review/investigation process We examined experiences of the implementation of family engagement through the Perinatal Mortality Review Tool (PMRT) and independent Health Safety Investigation Branch (HSIB) reviews/investigations from national, in-depth, case-study perspectives. We found PMRT implementation sometimes lacked relational care for families. Additionally, families were sometimes suspicious of the independence of external incident reviews. The case-study services reported inadequacies in family inclusion, with limited proactive approaches to family involvement. A range of family involvement approaches and rationales for involvement were found across and within the case-study services, with an emphasis on families as contributing value to organisational learning for safety improvement. The tension felt by clinicians between sharing uncertain knowledge of an incident with a family and sustaining OD is identified, as is the tension between the different goals of families and services, with the former desiring answers about their case and the latter seeking system-based learning for ongoing safety improvement. Making sense of what happened We explore the practices of knowledge construction in incidents and the management of this knowledge from the perspectives of national stakeholders, staff and families. The impact of widespread organisational defensiveness over documentation sent to families, along with confusion over the purpose of reports, generated distrust. Nationally, the poor quality or inaccuracies in clinical records exacerbated differences between service and family perspectives. In the crafting of reports, during ongoing family debriefings on report findings and through informal avenues and networks, the support for families to make sense of what happened could sometimes be recovered. However, we identify the privilege and capacity required for families to gather information and garner personal networks and expertise independently of services for this to take place. Receiving care from clinicians who are skilled and feel psychologically safe during post-incident communication We identified a national underinvestment in the training of clinicians in the care of injured families and in specialist OD skills. Interviews with junior clinicians, including Band 5/6 midwives; obstetric trainees and clinical fellows, highlighted the importance of early, non-judgemental, post-incident support for junior staff. The ongoing impact of avoidable harm on clinicians is examined, along with the impact of the limited involvement of staff in Trust-level investigation and review processes. We mapped the organisation and reported use of post-incident staff support for the three case-study services and found that debriefs, organised within a few weeks of the incident, and opportunities for meeting with families were most valued by staff. Services designed or commissioned by organisations without consultation with front-line staff themselves were underused and there was also a tendency for expert clinicians to see OD work as a personal rather than a professional or service imperative. Knowing that things have changed because of what has happened The importance for injured families and staff involved in an incident to see learning and service change following an incident was clear in national and case-study findings. Demonstrating that changes were in progress was key to a service demonstrating trustworthiness to the injured family. Some injured families felt a personal responsibility to ensure that change was secured. However, in most cases, services did not maintain contact with families after their review or investigation debriefs. For some clinical leads, there was a tension between ‘quick wins’ and protracted, significant, service investment. For wider staff groups, there was a lack of effective service-level communication strategies for updating on learning and change from incidents. Embedded, ongoing multidisciplinary team meetings, where non-judgemental discussion of incidents and their effects could take place, were identified as important for establishing a wider culture of openness. The extent and tone of clinical governance (CG) outreach to front-line staff were also significant in shaping staff attitudes and behaviours towards incidents and harmed families. Discussion Realist analysis identified the significant factors and contexts that impacted efforts to strengthen OD in maternity care. We explored several layers of context influencing the progress of this work. Nationally, we identified an ongoing tension between policy prompting OD and a medicolegal context where this openness continued to place clinicians and services at reputational or legal risk. Trust-level clinical leadership and the maturation of related service approaches (notably, family and patient involvement expertise and access to post-pregnancy support pathways) played a significant role in supporting OD. For families, variations in post-incident communication and care depended on two main factors: first, the assignment of an incident to one or more national maternity safety improvement programmes that entailed particular expectations of, and processes for, family involvement, and second, the capacity of a family to proactively seek out explanations and to foster relationships for personalised support from some clinicians. In the case-study services, where some harmed families were proactive in demanding a hearing and ongoing care, and where individual clinicians reached personal judgements on a family’s entitlement to this, examples of improved OD were observed. Overall, variations in post-incident communication and support for families were explained by a lack of service investment and by individual differences in attitudes to risk and family entitlement from clinicians. Conclusions This study is the first to establish a national overview and in-depth analysis of the progress of interventions intended to support OD with families. It provides an evidence base of experiences of harmed families (incidents ranging from 2007 to 2021) and of clinicians and managers working in this field (2020–1). There are growing calls for service-level improvements in responsiveness to the experiences and needs of families post incident as well as to their calls for greater openness. However, we find that without dedicated investment in and focus on the post-incident care of families and the emotional and organisational demands of this work on clinicians; without an understanding of these needs by external agencies incentivising improvement; and without national revision in the medicolegal landscape where this work happens, candour about harm in health care will continue to divide the interests of families, staff and services. Research gaps and recommendations Research was conducted immediately after the COVID-19 pandemic, with services under considerable strain. Three high-performing services were recruited for the observational research; therefore, generalisation from findings is limited. Access to observe external (HSIB) investigations was not possible. Despite ongoing revisions to the patient and public involvement (PPI) strategy, families often marginalised by maternity services remain under-represented in this study. A multi-methods study across English maternity services to establish the validity of findings and family recruitment strategies ensuring diversity are recommended for the future. Study registration This study is registered as PROSPERO CRD42020164061. The study has been assessed following RAMESES realist guidelines. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research Programme (NIHR award ref: 17/99/85) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 22. See the NIHR Funding and Awards website for further award information.

Abstract Background The BETTER intervention is an effective comprehensive evidence-based program for chronic disease prevention and screening (CDPS) delivered by trained prevention practitioners (PPs), a new role in primary care. An adapted program, BETTER HEALTH, delivered by public health nurses as PPs for community residents in low income neighbourhoods, was recently shown to be effective in improving CDPS actions. To obtain a nuanced understanding about the CDPS needs of community residents and how the BETTER HEALTH intervention was perceived by residents, we studied how the intervention was adapted to a public health setting then conducted a post-visit qualitative evaluation by community residents through focus groups and interviews. Methods We first used the ADAPT-ITT model to adapt BETTER for a public health setting in Ontario, Canada. For the post-PP visit qualitative evaluation, we asked community residents who had received a PP visit, about steps they had taken to improve their physical and mental health and the BETTER HEALTH intervention. For both phases, we conducted focus groups and interviews; transcripts were analyzed using the constant comparative method. Results Thirty-eight community residents participated in either adaptation (n = 14, 64% female; average age 54 y) or evaluation (n = 24, 83% female; average age 60 y) phases. In both adaptation and evaluation, residents described significant challenges including poverty, social isolation, and daily stress, making chronic disease prevention a lower priority. Adaptation results indicated that residents valued learning about CDPS and would attend a confidential visit with a public health nurse who was viewed as trustworthy. Despite challenges, many recipients of BETTER HEALTH perceived they had achieved at least one personal CDPS goal post PP visit. Residents described key relational aspects of the visit including feeling valued, listened to and being understood by the PP. The PPs also provided practical suggestions to overcome barriers to meeting prevention goals. Conclusions Residents living in low income neighbourhoods faced daily stress that reduced their capacity to make preventive lifestyle changes. Key adapted features of BETTER HEALTH such as public health nurses as PPs were highly supported by residents. The intervention was perceived valuable for the community by providing access to disease prevention. Trial registration #NCT03052959, 10/02/2017.

Copyright of Journal of Exact Sciences is the property of Master Editora and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The BETTER intervention is an effective comprehensive evidence-based program for chronic disease prevention and screening (CDPS) delivered by trained prevention practitioners (PPs), a new role in primary care. An adapted program, BETTER HEALTH, delivered by public health nurses as PPs for community residents in low income neighbourhoods, was recently shown to be effective in improving CDPS actions. To obtain a nuanced understanding about the CDPS needs of community residents and how the BETTER HEALTH intervention was perceived by residents, we studied how the intervention was adapted to a public health setting then conducted a post-visit qualitative evaluation by community residents through focus groups and interviews. Methods: We first used the ADAPT-ITT model to adapt BETTER for a public health setting in Ontario, Canada. For the post-PP visit qualitative evaluation, we asked community residents who had received a PP visit, about steps they had taken to improve their physical and mental health and the BETTER HEALTH intervention. For both phases, we conducted focus groups and interviews; transcripts were analyzed using the constant comparative method. Results: Thirty-eight community residents participated in either adaptation (n = 14, 64% female; average age 54 y) or evaluation (n = 24, 83% female; average age 60 y) phases. In both adaptation and evaluation, residents described significant challenges including poverty, social isolation, and daily stress, making chronic disease prevention a lower priority. Adaptation results indicated that residents valued learning about CDPS and would attend a confidential visit with a public health nurse who was viewed as trustworthy. Despite challenges, many recipients of BETTER HEALTH perceived they had achieved at least one personal CDPS goal post PP visit. Residents described key relational aspects of the visit including feeling valued, listened to and being understood by the PP. The PPs also provided practical suggestions to overcome barriers to meeting prevention goals. Conclusions: Residents living in low income neighbourhoods faced daily stress that reduced their capacity to make preventive lifestyle changes. Key adapted features of BETTER HEALTH such as public health nurses as PPs were highly supported by residents. The intervention was perceived valuable for the community by providing access to disease prevention. Trial registration: #NCT03052959, 10/02/2017. [ABSTRACT FROM AUTHOR]

This work addresses the importance of food and nutrition in promoting the health of the elderly population, with a specific focus on the qualitative evaluation of menus provided by a social solidarity institution in Portugal. The aim of this study is to conduct a qualitative evaluation of menus furnished by a social solidarity institution situated in the northern region of Portugal in order to prevent and/or treat malnutrition in the elderly. The methodology involves the evaluation of four weekly menus, totaling 28 complete daily menus for the elderly, using the "Avaliação Qualitativa de Ementas Destinadas a Idosos" (AQEDI) tool. This assessment tool comprises six domains: general items, soup, protein suppliers, carbohydrate suppliers, vegetable suppliers, and dessert, each consisting of various parameters. The findings reveal that all menus were classified as "acceptable," with percentages ranging from 60.73% to 68.84%, and suggest that there exists room for improvement. This study emphasizes the necessity for coordinated efforts within the institution to enhance menu planning, taking into account both nutritional guidelines and sensory aspects of food. Effective coordination within the institution is crucial for maintaining positive aspects and rectifying inadequacies in menu planning. [ABSTRACT FROM AUTHOR]

Objective: We devised a new dynamic assessment of the supraspinatus (DAS) using ultrasonography. The objectives of this study are as follows: 1. to verify the moving distance of the supraspinatus using ultrasonography in the cadaveric shoulders; 2. to evaluate the reliability of DAS in patients with rotator cuff tear (RCT) and investigate the correlation between DAS and magnetic resonance imaging (MRI) assessments. Methods: In Part 1, the supraspinatus in both shoulders of one cadaveric specimen was pulled laterally by 5 mm and 10 mm. In the ultrasonographic movie of the supraspinatus, the moving distances of a placed marker and a representative speckle which was visually identified as a high-intensity dot with the longest track were measured. In Part 2, among 62 RCT shoulders we verified the interrater agreement of DAS and correlation between DAS and MRI findings of RCT size and muscle atrophy. Results: In Part 1, during the supraspinatus traction, the moving distances of the marker and speckle were almost same; 1.07–2.68 mm and 1.60–2.67 mm, respectively (the pulled distance was 5 mm), 3.95–5.35 mm and 3.59–5.60 mm (the pulled distance was 10 mm). In Part 2, DAS showed a high interrater agreement of 0.74 in the kappa coefficients. DAS showed no correlations with tear size and atrophy, respectively (Spearman's rank correlation coefficient (ρ): 0.14 (p = 0.35) and 0.13 (p = 0.29)). Conclusion: DAS can reliably demonstrate dynamic aspects of the supraspinatus in RCT patients, which have been lacked in static imaging assessments as MRI.

Abstract The South African National Department of Health developed a quality improvement (QI) programme to reduce maternal and neonatal mortality and still births. The programme was implemented between 2018 and 2022 in 21 purposively selected public health facilities. We conducted a process evaluation to describe the characteristics and skills of the QI team leaders of well-performing teams. The evaluation was conducted in 15 of the 21 facilities. Facilities were purposively selected and comprised semi-structured interviews with leaders at three time points; reviewing of QI documentation; and 37 intermittently conducted semi-structured interviews with the QI advisors, being QI technical experts who supported the teams. These interviews focused on participants’ experiences and perceptions of how the teams performed, and performance barriers and enablers. Thematic data analysis was conducted using Atlas.ti. Variation in team performance was associated with leaders’ attributes and skills. However, the COVID-19 pandemic also affected team functioning. Well-performing teams had leaders who effectively navigated COVID-19 and other challenges, who embraced QI and had sound QI skills. These leaders cultivated trust by taking responsibility for failures, correcting members’ mistakes in encouraging ways, and setting high standards of care. Moreover, they promoted programme ownership among members by delegating tasks. Given the critical role leaders play in team performance and thus in the outcomes of QI programmes, efforts should focus on leader selection, training, and support.

Background: Chronic obstructive pulmonary disease (COPD) is a common condition that causes irreversible airway obstruction. Fatigue and exertional dyspnoea, for example, have a detrimental impact on the patient's daily life. Current research has revealed the need to empower the patient, which can result in not only educated and effective decision-making, but also a considerable improvement in patient satisfaction and treatment compliance. The current study aimed to investigate the perspectives and requirements of people living with COPD to possibly explore new ways to manage their disease. Methods: Adults with COPD from 8 European countries were interviewed by human factor experts to evaluate their disease journey through the gathering of information on the age, performance, length, and impact of diagnosis, symptoms progression, and family and friends' reactions. The assessment of present symptoms, services, and challenges was performed through a 90-min semi-structured interview. To identify possible unmet needs of participants, a generic thematic method was used to explore patterns, themes, linkages, and sequences within the data collected. Flow charts and diagrams were created to communicate the primary findings. Following analysis, the data was consolidated into cohesive insights and conversation themes relevant to determining the patient's unmet needs. Results: The 62, who voluntarily accepted to be interviewed, were patients (61% females, aged 32–70 years) with a COPD diagnosis for at least 6 months with stable symptoms of different severity. The main challenges expressed by the patients were the impact on their lifestyle, reduced physical activity, and issues with their mobility. About one-fourth had challenges with their symptoms or medication including difficulty in breathing. Beyond finding a cure for COPD was the primary goal for patients, their main needs were to receive adequate information on the disease and treatments, and to have adequate support to improve physical activity and mobility, helpful both for patients and their families. Conclusions: These results could aid in the creation of new ideas and concepts to improve our patient's quality of life, encouraging a holistic approach to people living with COPD and reinforcing the commitment to understanding their needs. [ABSTRACT FROM AUTHOR]

Student success has multiple meanings; however, the quantitative bias prevalent in the northwest American and Western Canadian postsecondary education sector restricts how student success is defined and measured. Standardised measures of student success assume that the student experience is homogeneous and risk the implementation of policies and programmes based on insufficient information. Findings from several small student focus groups suggest that unless new evaluation approaches are adopted, it is unlikely postsecondary institutions will generate the knowledge and wisdom needed to serve the goals of a diverse array of students. This article presents findings from three small student focus groups (n = 14), in an attempt to understand how students themselves define student success and how it should be measured. The results contributed to the development of five principles for culturally responsive postsecondary performance measurement that include participatory, emergent and appreciative processes and qualitative evaluation methodologies. [ABSTRACT FROM AUTHOR]

Internationally, lead agencies and consumer movements emphasise the need for high-level research participation in mental health. However, evidence suggests that people with lived experience tend to be recruited as subjects rather than as active agents in research, or are consulted in tokenistic ways. Although participatory research has the potential to rectify epistemic disparities, few studies have grappled with how to move from exclusion and tokenism to high-level research participation. This paper describes a qualitative co-evaluation of a co-produced model of research partnership, Raising the Bar, which involved deliberate establishment and facilitation of six participatory research teams, comprising 28 lived experience and 'conventional' mental health researchers. Findings indicate that the theoretical elements of the model set the bar high from the outset, supporting research teams to address inconsistencies in knowledge about participation. It also provided researchers with the competencies and resources to undertake participatory research in egalitarian team structures, and to negotiate new forms of non-traditional research outputs - thereby challenging whom research might be for and how it might be made accessible. Finally, the model shifted collective meanings about research, lending credibility to participatory practices, which came to be seen as essential for meeting the needs of affected communities. Nonetheless, systemic barriers to participatory research remain, and need to be recognised and acted upon to promote a culture that supports high-level research participation. [ABSTRACT FROM AUTHOR]

Peer research has the potential to increase community engagement in research and improve understanding of the data co-produced. However, there is a dearth of research on how to effectively conduct peer research with parents. The current study aimed to collect the views and experiences of parents who were peer researchers in the evaluation of a parenting support intervention. Four parents participated in semi-structured interviews. Data were analysed via thematic analysis. Results indicated that peer research tasks were perceived as becoming easier with practice. Benefits of peer research included increased awareness of the organisation's work, enjoyment of the process, exposure to learning new things, and continued networks among peer researchers. Facilitating factors for peer research included availability and accessibility of the organisation's support, and opportunities for knowledge and information sharing among peer researchers. Main challenges experienced related to the training provided, previous experience in qualitative research, coding difficulties, and procedures regarding the organisation of the peer research process. Parents also shared ways of improving the peer research process in the future regarding structures to support the coordinating researcher and continued involvement of the same pool of peer researchers, given the acquired experience. Studying the peer research process has the potential to increase the understanding of peer researchers' needs, preferences, and resources, and to inform research aimed at supporting families. [ABSTRACT FROM AUTHOR]

We examined interprofessional working in a newly implemented parent-infant mental health service team supporting families experiencing bonding and attachment difficulties. The aim was to identify forms of interprofessional work undertaken, barriers and facilitators of this work, and families' and healthcare professionals' perceptions of it. Semi-structured interviews were carried out with 21 stakeholders (5 parents, 4 team clinicians, 9 service referrers, 3 service commissioners) and were analyzed thematically. Interprofessional activities identified included building the service team's cohesion and shared practice, building partner networks, interagency communication, coordination of roles, and raising awareness of infant mental health and parent-infant relationship needs. Enablers and barriers to interprofessional working were broadly consistent with findings from previous studies of related services, but with additional emphasis on consultative work as an enabler. Healthcare professionals reported benefiting from the case consultations and training on infant mental health provided by the service team. Parents reported that good interprofessional working enhanced satisfaction and engagement with the service. Findings indicate the centrality of interprofessional working for parent-infant mental health teams, with implications for future service implementation, service development, and understanding of mechanisms by which such services may influence family outcomes. [ABSTRACT FROM AUTHOR]

Background: Family members of critically ill patients often experience anxiety when their relatives are transferred from ICU to another level of care. ICU liaison nurse (ICULN) visits have been associated with improved support for patients, their families and nursing staff but has not been extensively studied in the non‐English speaking setting. Yet, cross‐country variations such as how hospital care is delivered and by who means that innovations such as the ICULN may not be able to be simply transferred to other contexts and may not have similar outcomes. Aim: The aim of this study was to investigate family member's experiences with and evaluation of ICULN support service in one Swedish ICU. Study Design: A qualitative evaluation study was undertaken, recruiting family members of former ICU patients. Audio‐taped in‐depth interviews were conducted. Data were analysed by content analysis. Findings: Fifteen family members were interviewed. Two categories: Minds the gap between intensive care and the next care level and providing stability in an uncertain situation were identified. The ICULN supported the family members both directly, when the ICULNs listened to their questions and met their needs, and indirectly, when the ICULNs took responsibility for the patients and their physical and psychological conditions and wellbeing. Conclusion: Families valued and were satisfied with the ICULN service but also gave suggestions to improve the service in this particular hospital context. Relevance to Clinical Practice: The study showed that an ICULN support service met several needs of family members and therefore was a beneficial way to support patients and family members in the transition from the ICU to the ward. [ABSTRACT FROM AUTHOR]

Abstract Background The National Health Service Diabetes Prevention Programme (NHS DPP) was commissioned by NHS England in 2016 and rolled out in three ‘waves’ across the whole of England. It aims to help people with raised blood glucose levels reduce their risk of developing type 2 diabetes through behaviour change techniques (e.g., weight loss, dietary changes and exercise). An independent, longitudinal, mixed methods evaluation of the NHS DPP was undertaken. We report the findings from the implementation work package: a qualitative interview study with designated local leads, responsible for the local commissioning and implementation of the programme. The aim of the study was to explore how local implementation processes were enacted and adapted over time. Methods We conducted a telephone interview study across two time-points. Twenty-four semi-structured interviews with local leads across 19 sampled case sites were undertaken between October 2019 and January 2020 and 13 interviews with local leads across 13 sampled case sites were conducted between July 2020 and August 2020. Interviews aimed to reflect on the experience of implementation and explore how things changed over time. Results We identified four overarching themes to show how implementation was locally enacted and adapted across the sampled case sites: 1. Adapting to provider change; 2. Identification and referral; 3. Enhancing uptake in underserved populations; and 4. Digital and remote service options. Conclusion This paper reports how designated local leads, responsible for local implementation of the NHS DPP, adapted implementation efforts over the course of a changing national diabetes prevention programme, including how local leads adapted implementation during the COVID-19 pandemic. This paper highlights three main factors that influence implementation: the importance of facilitation, the ability (or not) to tailor interventions to local needs and the role of context in implementation.

Patient compliance in chronic illnesses is essential for disease management. This also applies to age-related macular degeneration (AMD), a chronic acquired retinal degeneration that needs constant monitoring and patient cooperation. Therefore, patients with AMD can benefit by being properly informed about their disease, regardless of the condition’s stage. Information is essential in keeping them compliant with lifestyle changes, regular monitoring, and treatment. Large language models have shown potential in numerous fields, including medicine, with remarkable use cases. In this paper, we wanted to assess the capacity of two large language models (LLMs), ChatGPT4 and PaLM2, to offer advice to questions frequently asked by patients with AMD. After searching on AMD-patient-dedicated websites for frequently asked questions, we curated and selected a number of 143 questions. The questions were then transformed into scenarios that were answered by ChatGPT4, PaLM2, and three ophthalmologists. Afterwards, the answers provided by the two LLMs to a set of 133 questions were evaluated by two ophthalmologists, who graded each answer on a five-point Likert scale. The models were evaluated based on six qualitative criteria: (C1) reflects clinical and scientific consensus, (C2) likelihood of possible harm, (C3) evidence of correct reasoning, (C4) evidence of correct comprehension, (C5) evidence of correct retrieval, and (C6) missing content. Out of 133 questions, ChatGPT4 received a score of five from both reviewers to 118 questions (88.72%) for C1, to 130 (97.74%) for C2, to 131 (98.50%) for C3, to 133 (100%) for C4, to 132 (99.25%) for C5, and to 122 (91.73%) for C6, while PaLM2 to 81 questions (60.90%) for C1, to 114 (85.71%) for C2, to 115 (86.47%) for C3, to 124 (93.23%) for C4, to 113 (84.97%) for C5, and to 93 (69.92%) for C6. Despite the overall high performance, there were answers that are incomplete or inaccurate, and the paper explores the type of errors produced by these LLMs. Our study reveals that ChatGPT4 and PaLM2 are valuable instruments for patient information and education; however, since there are still some limitations to these models, for proper information, they should be used in addition to the advice provided by the physicians.

External advisory committees (EACs) are critical peer-review meetings that drive improvement at Clinical and Translational Science Award Program Hubs. Despite their ubiquity, evaluations of EAC optimization and effective implementation remain scarce. We present a two-tiered approach to optimizing EAC meetings through (1) in-depth, topically focused “pre-review” meetings comprised of external topic experts and at least one standing “full-board” EAC member, followed by (2) a traditional “full-board” EAC meeting. This approach allowed pre-review discussion of program-focused topics and specific recommendations, later delivered to the full-board for review and direction. To evaluate this approach, we interviewed 18 people who planned, administered, or attended pre-review and/or full-board meetings, including internal Hub staff, external topic experts, and standing EAC members. Thematic analysis was used to explore planning, implementation, and value of our two-tiered approach versus the traditional single full-board approach. Interviewees preferred the two-tiered approach, noting benefits including additional time to reflect, shared identification of strengths and challenges, and discussion of solutions to share later with the full-board. Those who attended pre-review meetings described building “transformational,” rather than “transactional,” relationships with invitees through more discussion and inter-hub sharing. That increased sharing invited more exploration, discussion, and planning of next steps toward innovation.

The identification of economically disadvantaged students in colleges and universities is the primary link in the college and university financial aid system, and it is the prerequisite, foundation, and guarantee for the implementation of various national financial aid policies and measures. This paper takes the Q college student financial aid system as the research object and discusses the authenticity of the information, the standard qualitative and quantitative difficulty in the determination of the work of standardized operation, and other problems in the determination of the work in depth. By analyzing the operation level of the student financial aid system of the university and according to the existing problems of the current financial aid system, a multi-objective decision-making model is designed and optimized, and the qualitative evaluation in the fuzzy multi-objective decision-making method is used to consider multiple factors in the determination process, so as to ensure the accuracy and fairness of the financial aid. This paper proposes an optimization strategy for the student financial aid system in colleges and universities based on the model’s identification results. A questionnaire survey is re-conducted on Q colleges and universities that use the optimized student financial aid system. The results show that the optimized student financial aid system is more helpful for students’ academic lives.

BackgroundThere is growing demand for developmental and behavioral pediatric services including autism evaluation and care management. Clinician trainings have been found to result in an increase of knowledge and attitudes. This study utilizes Normalization Process theory (NPT) to evaluate a clinician training program and its effects on practice.MethodsThe year-long virtual training program about autism screening and care management included didactic portions and case presentations. Focus groups and interviews were conducted with primary care clinicians (n = 10) from community health centers (n = 6) across an urban area five months post-training. Transcripts were deductively coded using NPT to uncover barriers to implementation of autism screening and care, benefits of the training program, and areas for future training.ResultsParticipants were motivated by the benefits of expanding and improving support for autistic patients but noted this effort requires effective collaboration within a complex network of care providers including clinicians, insurance agencies, and therapy providers. Although there were support that participants could provide to families there were still barriers including availability of behavior therapy and insufficient staffing. Overall, participants positively viewed the training and reported implementing new strategies into practice.ConclusionDespite the small sample size, application of NPT allowed for assessment of both training delivery and implementation of strategies, and identification of recommendations for future training and practice sustainability. Follow-up focus groups explored participants' practice five months post-program. Variations in participants' baseline experience and context at follow-up to enable application of skills should be considered when using NPT to evaluate clinician trainings.

The qualitative evaluation of harvested raw logs and sawlogs is mainly based on the quantitative and qualitative evaluation of the visible macroscopic features of the wood. Modern methods allow for the analysis of whole logs by means of computed tomography. These devices can analyze the internal qualitative features of wood that are not visible on the external structures of the logs. The aim of this work was to evaluate the detection accuracy of a CT-scanning device intended for scanning logs on the internal qualitative features of wood using model trunks. Two logs of beech and oak with a length of 4 m were selected for the analysis, based on availability. Qualitative features were identified through computed tomography scanning, visually identified on cut sections, and then manually measured in accordance with applicable legislation. Relatively good agreement was demonstrated for the detected features in terms of identifying their location (dimension in millimeters from the end of the log). For this parameter, the average differences were 0.90% on the beech log and only 1.21% on the oak log. Relatively high accuracy was shown via CT detection of qualitative features in the beech section (with average differences in dimensions of only 3.5%). In the case of the oak log, the dimensions of the quality features were significantly overestimated. These results indicate that CT scanning technology may have a problem with some hardwood species. It was primarily developed for coniferous tree species, and software algorithms are, therefore, not yet fully adapted to the precise detection of the dimensions of individual quality features. Despite the detected differences, it was confirmed that the CT technology of scanning harvested wood can have a fundamental impact on optimization procedures in the recovery and processing of wood. Renting a scanning line for a certain capacity of wood volume appears to be a deployment option for forestry operations and smaller wood processing operations. Thus, this technology can become an important factor in improving the economic evaluation of the final production of wood. [ABSTRACT FROM AUTHOR]

Background: Using structured templates to guide providers in communicating key information in electronic referrals is an evidence-based practice for improving care quality. To facilitate referrals in Veterans Health Administration's (VA) Cerner Millennium electronic health record, VA and Cerner have created "Care Pathways"—templated electronic forms, capturing needed information and prompting ordering of appropriate pre-referral tests. Objective: To inform their iterative improvement, we sought to elicit experiences, perceptions, and recommendations regarding Care Pathways from frontline clinicians and staff in the first VA site to deploy Cerner Millennium. Design: Qualitative interviews, conducted 12–20 months after Cerner Millennium deployment. Participants: We conducted interviews with primary care providers, primary care registered nurses, and specialty providers requesting and/or receiving referrals. Approach: We used rapid qualitative analysis. Two researchers independently summarized interview transcripts with bullet points; summaries were merged by consensus. Constant comparison was used to sort bullet points into themes. A matrix was used to view bullet points by theme and participant. Results: Some interviewees liked aspects of the Care Pathways, expressing appreciation of their premise and logic. However, interviewees commonly expressed frustration with their poor usability across multiple attributes. Care Pathways were reported as being inefficient; lacking simplicity, naturalness, consistency, and effective use of language; imposing an unacceptable cognitive load; and not employing forgiveness and feedback for errors. Specialists reported not receiving the information needed for referral triaging. Conclusions: Cerner Millennium's Care Pathways, and their associated organizational policies and processes, need substantial revision across several usability attributes. Problems with design and technical limitations are compounding challenges in using standardized templates nationally, across VA sites having diverse organizational and contextual characteristics. VA is actively working to make improvements; however, significant additional investments are needed for Care Pathways to achieve their intended purpose of optimizing specialty care referrals for Veterans. [ABSTRACT FROM AUTHOR]

Copyright of Pedagogia Più Didattica is the property of Edizioni Centro Studi Erickson SpA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The National Health Service Diabetes Prevention Programme (NHS DPP) was commissioned by NHS England in 2016 and rolled out in three 'waves' across the whole of England. It aims to help people with raised blood glucose levels reduce their risk of developing type 2 diabetes through behaviour change techniques (e.g., weight loss, dietary changes and exercise). An independent, longitudinal, mixed methods evaluation of the NHS DPP was undertaken. We report the findings from the implementation work package: a qualitative interview study with designated local leads, responsible for the local commissioning and implementation of the programme. The aim of the study was to explore how local implementation processes were enacted and adapted over time. Methods: We conducted a telephone interview study across two time-points. Twenty-four semi-structured interviews with local leads across 19 sampled case sites were undertaken between October 2019 and January 2020 and 13 interviews with local leads across 13 sampled case sites were conducted between July 2020 and August 2020. Interviews aimed to reflect on the experience of implementation and explore how things changed over time. Results: We identified four overarching themes to show how implementation was locally enacted and adapted across the sampled case sites: 1. Adapting to provider change; 2. Identification and referral; 3. Enhancing uptake in underserved populations; and 4. Digital and remote service options. Conclusion: This paper reports how designated local leads, responsible for local implementation of the NHS DPP, adapted implementation efforts over the course of a changing national diabetes prevention programme, including how local leads adapted implementation during the COVID-19 pandemic. This paper highlights three main factors that influence implementation: the importance of facilitation, the ability (or not) to tailor interventions to local needs and the role of context in implementation. [ABSTRACT FROM AUTHOR]

This study explores the potential of the AI chatbot ChatGPT to supplement human-centered tasks such as qualitative research analysis. The study compares the emergent themes in human and AI-generated qualitative analyses of interviews with guaranteed income pilot recipients. The results reveal that there are similarities and differences between human and AI-generated analyses, with the human coders recognizing some themes that ChatGPT did not and vice versa. The study concludes that AI like ChatGPT provides a powerful tool to supplement complex human-centered tasks, and predicts that such tools will become an additional tool to facilitate research tasks. Future research could explore feeding raw interview transcripts into ChatGPT and incorporating AI-generated themes into triangulation discussions to help identify oversights, alternative frames, and personal biases. [ABSTRACT FROM AUTHOR]

Clinical faculty and preceptors are often asked to teach students and residents in the classroom and on practice‐based experiences. Many have some prior training in instructional methodologies (e.g., as part of a residency program teaching certificate or faculty development workshop) and may know that there are opportunities for scholarship around teaching and learning. However, they may be less certain of the distinctions between scholarly teaching, the scholarship of teaching and learning (SoTL), and educational research, and how these can contribute to their success. In addition, clinical faculty may struggle with where to start, how to find time, and how to conduct scholarship around teaching and learning. This article summarizes key concepts related to SoTL and provides guidance to clinician educators about best practices in SoTL. [ABSTRACT FROM AUTHOR]

Engaging in creative arts and heritage have both been shown to improve wellbeing. Aim: The aim of the current study was to explore veterans' experiences of attending the Creative Wellbeing Programme programme (CWP) in a military museum. Seven veterans who attended the CWP programme were invited to share their experiences through a qualitative, semi-structured interview. The interview explored experiences of engaging in this type of programme and the impact this had on them. The interview was transcribed, and a thematic analysis was conducted. Themes concerned three stages of involvement: Pre-programme, Programme experiences, and Post-programme. Pre-Programme themes concerned reasons for participation, pre-programmes feelings, hopes and expectations. Programme Experiences concerned general experiences, the role of social support, the role of the museum, and the art therapy process. Post-Programme themes concerned perceived outcomes. Overall, the museum created a relaxed and informal environment, and the familiar items in the museum stimulated the creative process. However, for some this led to disengagement due to fear that objects may prompt negative emotions. The findings suggest that engaging veterans in art therapy in a museum environment is beneficial. Future programmes should aim to focus on support post intervention. Implications: The study provides insight into the acceptability of art therapy within a military museum environment. It also adds to the growing international evidence concerning the role museums have in supporting mental health and wellbeing. This study aimed to explore the experiences of veterans who took part in a Creative Wellbeing Programme (CWP). This programme involved using art and discussion in a museum environment as a way of supporting veterans with potentially traumatic memories. The group environment facilitated connection and a sense of belonging through discussion of museum items. Seven veterans were interviewed via MS Teams about their experiences engaging in the programme, exploring potentially positive and negative aspects of participating. The transcripts were transcribed by MS Teams and anonymized before being analysed for potential themes. Themes were identified relating to pre-programme, during the programme and following the programme. Pre-programme themes were centred on the reasons veterans participated, and their hopes and expectations about the programme. Programme themes were the role of social support in the groups, the role of the museum, art therapy process. Post-programme themes centred on the outcomes veterans felt had resulted from taking part in the programme. Overall, the familiar items in the museum facilitated discussion and creativity despite some veterans feeling that the items prompted negative emotions. The study findings indicate the potential benefits of a museum group environment for veterans experiencing mental health difficulties. [ABSTRACT FROM AUTHOR]