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Nursing students must be able to function comfortably, confidently, and competently within the culture of nursing when they graduate. Although different models of clinical teaching are used to acculturate undergraduate nursing students to their professional practice roles, it is not known to what extent acculturation is affected by these models. The two-fold purpose of this study was to compare self-perceptions as insiders of students involved in preceptored and instructor led clinical experiences and to identify factors contributing to students self-perceptions as insiders. Using a non-equivalent group's prepost- test design, 38 undergraduate students, participated either in traditional instructor led practicums or summer externships. In addition to a background questionnaire, students completed an investigator generated perceptions of self in the clinical practice culture scale prior to, and at the end of, their clinical experiences. Findings revealed that both groups of students demonstrated significant changes in their self-perceptions as insiders as a result of their clinical experiences but there was no significant interaction effect of clinical teaching model and time on students' insider self-perceptions. Students identified multiple factors that influenced their insider perceptions. Implications of these finding are discussed. [ABSTRACT FROM AUTHOR]

Aim. To describe the findings from a qualitative study exploring acute care nurses' experiences with patient falls. Background. Patient falls continue to be a problem in acute care settings for nurses at the point of care. Despite the growing body of knowledge related to risk factors and interventions for fall prevention, minimal attention has been given to nurses' perspectives of patient falls. Design. A qualitative descriptive design was used. Method. Focus group discussions were conducted with nurses working on a cross-section of inpatient acute care settings. Audio-taped sessions were transcribed and analysed thematically. Results. Nurses described their experience of falls as 'knowing the patient as safe', an ongoing affirmation that the patient was free from harm. In this focused, narrowly defined and highly specific knowing, nurses employed the key strategies of assessment, monitoring and communicating. Variable conditions influenced whether these strategies were effective in giving nurses the knowledge they needed to keep the patient safe. When strategies failed to provide nurses with knowledge of their patients as safe and patients fell, this created considerable stress for nurses and prompted them to use a range of coping strategies. Conclusion. Knowing the patient as safe has the potential to resolve the tension between patient safety and independence. The critical, often taken for granted, activities used by nurses in this knowing must be expanded to include the meaning falls have for patients and attend to factors beyond nurses control such as environmental redesign and staffing. Relevance to clinical practice. Nurses play an important role in fall prevention through knowing the patient as safe but must be supported through the use of a multi-faceted approach extending from the individual nurse to the institutional level. [ABSTRACT FROM AUTHOR]

The purpose of this multiphasic qualitative research study was to obtain an in-depth understanding of how students experience a non-terminal summer externship program. Baccalaureate and associate degree nursing students participated in the six-week externship developed through a partnership between a regional hospital and a school of nursing in the southeastern United States. Data were collected before, during, immediately following, and six months after the externship experience using a combination of focus groups and interviews with student-preceptor dyads. Interviews were transcribed verbatim and analyzed using constant comparative methodology. Findings from the study indicated that the core process characterizing the experience was 'empowered learning on the inside.' In contrast to traditional instructor-led experiences, students were positioned on the inside and acculturated to the world of nursing. As insiders, students related to others and experienced nursing in new ways. Implications of the findings for nursing education are addressed. [ABSTRACT FROM AUTHOR]

This article presents findings from part of a larger qualitative study designed to explore the concept of mobility within the context of concept development. Primary nurses and their elderly clients made up the two study samples. Data were collected through semistructured interviews and analyzed using thematic content-analysis techniques. In this article, only data from the client sample are reported. Findings suggested that the elderly clients defined mobility in terms of three interrelated dimensions: physical, cognitive, and social. From client descriptions of mobility, six qualities emerged: ease and freedom of movement, independence, automaticity, purposefulness, self-environmental awareness, and continuity. [ABSTRACT FROM AUTHOR]

This paper is part of a larger study to examine the concept of mobility from the perspectives of clients and nurses. It represents a beginning effort at clarifying, refining, and developing the concept for nursing practice as the current literature concentrates on immobility. The enquiry began with a theoretical phase during which attributes and characteristics of the concept were elicited. This was followed by a fieldwork phase to determine whether there was congruency between the theoretical formulations of the concept and empirical data. Primary nurses and their clients were interviewed and data were analyzed using content analysis. In this article, only data obtained from the nurse population are reported. Themes derived from the nurses' interviews are described and compared with the results of the theoretical phase. Findings revealed that there was a measure of support for the concept as defined in the theoretical phase but pointed to the need for more empirical work with different client populations across settings. [ABSTRACT FROM AUTHOR]

Nursing has been concerned primarily with the visible aspects of health promotion and has shown little regard for what is invisible. Yet the hidden ideology powerfully shapes current approaches to health promotion. This paper examines and makes visible the ideology of individual responsibility which is embedded in individualistic health promotion, the primary orientation to health promotion. Ways in which this ideology is perpetuated within nursing curricula are described. Concrete strategies are proposed that may be considered by nurse educators as they seek to prepare students in health promotion, with particular emphasis on strategies that highlight its ideological underpinnings. [ABSTRACT FROM AUTHOR]

In this paper, the authors present their analysis of the concept of mobility as a starting point for the development of relevant theory. Multiple uses of the concept are considered and provisional criteria identified. Case examples, together with antecedents and consequences, of the concept are presented. Finally, research questions that would form the basis of fieldwork have been generated. [ABSTRACT FROM AUTHOR]

There is increasing and widespread use of central line catheterization in clinical practice. Nevertheless, there is a growing awareness and concern about the escalating rate of infection related to central lines, especially in those patients receiving total parenteral nutrition. This paper reviews selected studies which have identified factors contributing to central line infection. Factors relating to all areas of catheter management, including insertion, maintenance and removal have been implicated in central line infections. Nurses who are involved to varying degrees in all phases of central line management, play an important role in infection control. An understanding of infection-related factors as the first step needed to effect changes in procedures and protocols in the care of patients with central lines. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to explore healthcare experiences of rural-living patients both with (attached) and without (unattached) a local primary care provider., Background: Primary care providers serve a gatekeeping role in the Canadian healthcare system as the first contact for receiving many health services. With the shortage of primary care providers, especially in rural areas, there is a need to explore attached and unattached patient experiences when accessing healthcare., Methods: A cross-sectional survey of rural patients both with (attached) and without (unattached) a primary care provider was conducted July-September 2022. An open-ended question gathered participants' thoughts and experiences with provider shortages., Findings: Overall, 523 (Mean age = 51 years, 75% female) rural British Columbia community members (306 attached; 217 unattached) completed the survey. Despite similar overall health, unattached patients received care less frequently overall compared to attached patients, including less frequent non-urgent and preventive care. The vast majority of attached patients sought care from a regular provider whereas unattached patients were more likely to use walk-in, emergency department, and urgent care and 29% did not seek care at all. Overall, 460 (88.0%) provided a response to the open-ended doctor shortage question. Similar themes were found among both attached and unattached participants and included: i) the ubiquity of the doctor shortage, ii) the precariousness or fluidity of attachment status, and iii) solutions and recommendations. Greater attention is needed on the negative and cyclical impacts provider shortages have for both attached and unattached patients alike.

This case study presents a process that was iteratively developed for clinical informaticians to identify, analyse, and respond to safety events related to health information technologies (HIT) in community care settings (This research was supported by the CIHR Health Systems Impact Fellowship Program. We would also like to thank Vancouver Coastal Health for their valuable contributions.). The goal was to build capacity within a clinical informatics team to integrate patient safety into their work and to help them recognize and respond to HIT-related safety events. The technology-related safety event analysis process that was ultimately developed included three key components: 1) an internal workflow to analyse voluntarily reported HIT-related safety events using a sociotechnical model, 2) safety huddles to amplify learnings from reviewed events, and 3) a cumulative analysis of all events over time to identify and respond to patterns. A systematic approach to quickly identify and understand HIT safety concerns enables informatics teams to proactively reduce risks and prevent harm.

This scoping review assesses the current knowledge on technology-related safety events in primary and community care settings, focusing on patient safety and harm. Utilizing Arksey and O'Malley's methodological framework, a comprehensive literature search was conducted across various databases, yielding 17 relevant articles. The review highlighted predominant safety event issues, such as technology limitations, incorrect data, and software malfunctions, and identified essential risk mitigation strategies. Consultation with healthcare leaders reinforced these findings and revealed additional organizational challenges, emphasizing the need for continuous monitoring, reporting, and analyzing of HIT-related safety concerns. The findings suggest that while safety events in non-acute settings share similarities with those in acute care, they require specific attention and further research.

Competing Interests: Declaration of competing interest None.

Demand is emerging for personal health records (PHRs), a patient-centric digital tool for engaging in shared decision-making and healthcare data management. This study uses a RE-AIM framework to explore rural patients and providers' perceptions prior to and following implementation of a PHR. Health care providers and their patients were recruited from early-adopter patient medical home clinics and a local patient advisory group. Focus groups were used to explore patient and provider pre-implementation perceptions of PHRs and post-implementation provider perspectives. Patients were invited through participating clinics to use the PHR. An implementation process evaluation was conducted. Multiple methods and data sources were used and included pre-/post-intervention patient surveys, provider interviews, and PHR/EHR administrative data. Both patient and provider focus groups described PHRs as providing a comprehensive health story and enhanced communication. Patients prioritized collection of health promotion data while providers endorsed health-related, clinical data. Both groups expressed the need for managing expectations and setting boundaries on PHR use. The evaluation indicated Reach: 16% of targeted patients participated and an additional 127 patients used the PHR as a tool during the COVID-19 pandemic. Effectiveness: Patient satisfaction with use was neutral, with no significant changes to quality of life, self-efficacy, or patients' activation. Adoption: 44% of eligible clinics participated, primarily those operated publicly versus privately, in smaller communities, and farther from a regional hospital. Implementation: Despite system interoperability expectations, at time of roll out, information exchange standards had not been reached. Additional implementation complications arose from the onset of the pandemic. One clinic on-boarded additional patients resulting in a rapid spike in PHR use. Maintenance: All clinics discontinued PHR within the study period, citing several key barriers to use. RE-AIM offers a valuable process evaluation framework for a comprehensive depiction of impact, and how to drive future success. Interoperability, patient agency and control, and provider training and support are critical obstacles to overcome in PHR implementation., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Davis et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This systematic review evaluates the efficacy of self-care interventions for atrial fibrillation (AF), focusing on strategies for maintenance, monitoring, and management applied individually or in combination. Adhering to the 2020 PRISMA guidelines, the search strategy spanned literature from 2005 to 2023, utilizing keywords and subject headings for "atrial fibrillation" and "self-care" combined with the Boolean operator AND. The databases searched included Medline, Embase, and CINAHL. The initial search, conducted on February 17, 2021, and updated on May 16, 2023, identified 5160 articles, from which 2864 unique titles and abstracts were screened. After abstract screening, 163 articles were reviewed in full text, resulting in 27 articles being selected for data extraction; these studies comprised both observational and randomized controlled trial designs. A key finding in our analysis reveals that self-care interventions, whether singular, dual, or integrated across all three components, resulted in significant improvements across patient-reported, clinical, and healthcare utilization outcomes compared to usual care. Educational interventions, often supported by in-person sessions or telephone follow-ups, emerged as a crucial element of effective AF self-care. Additionally, the integration of mobile and web-based technologies alongside personalized education showed promise in enhancing outcomes, although their full potential remains underexplored. This review highlights the importance of incorporating comprehensive, theory-informed self-care interventions into routine clinical practice and underscores the need for ongoing innovation and the implementation of evidence-based strategies. The integration of education and technology in AF self-care aligns with the recommendations of leading health organizations, advocating for patient-centered, technology-enhanced approaches to meet the evolving needs of the AF population., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Equity-deserving groups face well-known health disparities that are exacerbated by rural residence. Health technologies have shown promise in reducing disparities among these groups, but there has been no comprehensive evidence synthesis of outcomes., Purpose: The purpose of this systematic review was to examine the patient, healthcare, and economic outcomes of health technology applications with rural living equity-deserving groups., Research Design: The databases searched included Medline and Embase. Articles were assessed for bias using the McGill mixed methods appraisal tool., Analysis: Data were synthesized narratively using a convergent integrated approach for qualitative and quantitative findings., Results: This evidence synthesis includes papers ( n = 21) that reported on health technologies targeting rural equity-deserving groups. Overall, patient outcomes - knowledge, self-efficacy, weight loss, and clinical indicators - improved. Healthcare access improved with greater convenience, flexibility, time and travel savings, though travel was still occasionally necessary. All studies reported satisfaction with health technologies. Technology challenges reported related to connectivity and infrastructure issues influencing appointment quality and modality options. While some studies reported additional costs, overall, studies indicated cost savings for patients., Conclusions: There is a paucity of research on health technologies targeting rural equity-deserving groups, and the available research has primarily focused on women. While current evidence was primarily of high quality, research is needed inclusive of equity-deserving groups and interventions co-designed with users that integrate culturally sensitive approaches. Review registered with Prospero ID = CRD42021285994., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: This study created personas using quantitative segmentation and knowledge user enhancement to inform intervention and service design for rural patients to encourage preventive care uptake., Methods: This study comprised a cross-sectional survey of rural unattached patients and a co-design workshop for persona development. Cross-sectional survey data were analyzed for meaningful subgroups based on quartiles of preventive care completion. These quartiles informed "relevant user segments" grouped according to demographics (age, sex), length of unattachment, percentage of up-to-date preventive activities, health care visit frequency, preventive priorities, communication confidence with providers, and chronic health conditions, which were then used in the workshop to build the final personas., Results: 207 responses informed persona user segments, and five health care providers and 13 patients attended the workshop. The resulting four personas, included John (not up-to-date on preventive care activities), Terrance (few up-to-date preventive care activities), George (moderately up-to-date preventive care activities), and Anne (mostly up-to-date preventive care activities)., Conclusion: Quantitative persona development with integrated knowledge user co-design/enhancement elevated and enriched final personas that achieved robust profiles for intervention design., Innovation: This project's use of a progressive methodology to build robust personas coupled with participant feedback on the co-design process offers a replicable approach for health researchers., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Our objectives were to measure long-term adherence to oral anticoagulants (OACs) in patients with atrial fibrillation (AF) and to identify patient factors associated with adherence. Using linked, population-based administrative data from British Columbia, Canada, an incident cohort of adults prescribed OACs for AF was identified. We calculated the proportion of days covered (PDC) as a time-dependent covariate for each 90-day window from OAC initiation until the end of follow-up. Associations between patient attributes and adherence were assessed using generalized mixed effect linear regression models. 30,264 patients were included. Mean PDC was 0.69 (SD 0.28) over a median follow-up of 6.7 years. 54% of patients were non-adherent (PDC < 0.8). After controlling for confounders, factors positively associated with adherence were number of drug class switches, history of stroke or transient ischemic attack, history of vascular disease, time since initiation, and age. Age > 75 years at initiation, polypharmacy (among VKA users only), and receiving DOAC (vs. VKA) were negatively associated with adherence. PDC decreased over time for VKA users and increased for DOAC users. Over half of AF patients studied were, on average, nonadherent to OAC therapy and missed 32% of their doses. Several patient factors were associated with higher or lower adherence, and adherence to VKA declined during therapy while DOAC adherence increased slightly over time. To min im ize the risk stroke, adherence-supporting interventions are needed for all patients with AF, particularly those aged > 75 years, those with prior stroke or vascular disease, VKA users with polypharmacy, and DOAC recipients., (© 2023. The Author(s).)

Background: Although intended to support improvement, the rapid adoption and evolution of technologies in health care can also bring about unintended consequences related to safety. In this project, an embedded researcher with expertise in patient safety and clinical education worked with a clinical informatics team to examine safety and harm related to health information technologies (HITs) in primary and community care settings. The clinical informatics team participated in learning activities around relevant topics (eg, human factors, high reliability organizations, and sociotechnical systems) and cocreated a process to address safety events related to technology (ie, safety huddles and sociotechnical analysis of safety events)., Objective: This study aimed to explore clinical informaticians' experiences of incorporating safety practices into their work., Methods: We used a qualitative descriptive design and conducted web-based focus groups with clinical informaticians. Thematic analysis was used to analyze the data., Results: A total of 10 informants participated. Barriers to addressing safety and harm in their context included limited prior knowledge of HIT safety, previous assumptions and perspectives, competing priorities and organizational barriers, difficulty with the reporting system and processes, and a limited number of reports for learning. Enablers to promoting safety and mitigating harm included participating in learning sessions, gaining experience analyzing reported events, participating in safety huddles, and role modeling and leadership from the embedded researcher. Individual outcomes included increased ownership and interest in HIT safety, the development of a sociotechnical systems perspective, thinking differently about safety, and increased consideration for user perspectives. Team outcomes included enhanced communication within the team, using safety events to inform future work and strategic planning, and an overall promotion of a culture of safety., Conclusions: As HITs are integrated into care delivery, it is important for clinical informaticians to recognize the risks related to safety. Experiential learning activities, including reviewing safety event reports and participating in safety huddles, were identified as particularly impactful. An HIT safety learning initiative is a feasible approach for clinical informaticians to become more knowledgeable and engaged in HIT safety issues in their work., (©Chantelle Recsky, Kathy L Rush, Maura MacPhee, Megan Stowe, Lorraine Blackburn, Allison Muniak, Leanne M Currie. Originally published in JMIR Formative Research (https://formative.jmir.org), 05.02.2024.)

Background: A number of real-world digital literacy training programs exist to support engagement with mobile devices, but these have been understudied., Objective: The purpose of this study was to examine the effectiveness and program acceptability of a digital skills training program among middle-aged and older adults (aged ≥50 years) and to gather participants' recommendations for lifelong digital skills promotion., Methods: The Gluu Essentials digital skills training program includes learning resources to support tablet use. Through pre-post surveys, this study assessed mobile device proficiency, confidence in going online and in avoiding frauds and scams, the frequency of engaging in online activities, program engagement, acceptability, and suggestions for continued support., Results: A total of 270 middle-aged and older adults completed baseline surveys. Of these 270 participants, 145 (53.7%) completed follow-up surveys. Our findings indicate that mobile device proficiency increased (P<.001), whereas confidence was unchanged. Participants also reported going online more frequently to shop (P=.01) and access government services (P=.02) at follow-up. Program engagement varied considerably, but program acceptability was high. Participants' recommendations included the need for providing ongoing programs for support and training because technology constantly changes, reducing costs for technology and internet access, and keeping learning resources simple and easy to access., Conclusions: The Gluu Essentials digital skills training program increased mobile device proficiency and frequency of web-based activities (shopping and accessing government services) among middle-aged and older adults., (©Cherisse L Seaton, Kathy L Rush, Eric Ping Hung Li, Mohammad Khalad Hasan, Linda Fawcus. Originally published in JMIR Aging (https://aging.jmir.org), 10.11.2023.)

Background: Patients with atrial fibrillation (AF) have significantly lower health-related quality of life (HRQoL) compared to the general population and patients with other heart diseases. The research emphasis on the influence of AF symptoms on HRQoL overshadows the role of individual characteristics. To address this gap, this study's purpose was to test an incremental predictive model for AF-related HRQoL following an adapted HRQoL conceptual model that incorporates both symptoms and individual characteristics., Methods: Patients attending an AF specialty clinic were invited to complete an online survey. Hierarchical regression analyses were conducted to examine whether individual characteristics (overall mental health, perceived stress, sex, age, AF knowledge, household and recreational physical activity) incremented prediction of HRQoL and AF treatment satisfaction beyond AF symptom recency and overall health., Results: Of 196 participants (mean age 65.3 years), 63% were male and 90% were Caucasian. Most reported 'excellent' or 'good' overall and mental health, had high overall AF knowledge scores, had low perceived stress scores, and had high household and recreation physical activity. The mean overall AF Effect On Quality-Of-Life Questionnaire (AFEQT) and AF treatment satisfaction scores were 70.62 and 73.84, respectively. Recency of AF symptoms and overall health accounted for 29.6% of the variance in overall HRQoL and 20.2% of the variance in AF treatment satisfaction. Individual characteristics explained an additional 13.6% of the variance in overall HRQoL and 7.6% of the variance in AF treatment satisfaction. Perceived stress and household physical activity were the largest contributors to overall HRQoL, whereas age and AF knowledge made significant contributions to AF treatment satisfaction., Conclusions: Along with AF symptoms and overall health, individual characteristics are important predictors of HRQoL and AF treatment satisfaction in AF patients. In particular, perceived stress and household physical activity could further be targeted as potential areas to improve HRQoL., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: JGA reports grants from Medtronic and the Heart and Stroke Foundation of Canada during the conduct of this study; personal fees from Medtronic and Biosense Webster Inc, outside the submitted study. This does not alter our adherence to PLOS ONE policies on sharing data and materials. The other authors have no conflicts to declare., (Copyright: © 2023 Rush et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The adoption of technology in health care settings is often touted as an opportunity to improve patient safety. While some adverse events can be reduced by health information technologies, technology has also been implicated in or attributed to safety events. To date, most studies on this topic have focused on acute care settings., Objectives: To describe voluntarily reported safety events that involved health information technology in community and primary care settings in a large Canadian health care organization., Methods: Two years of safety events involving health information technology (2016-2018) were extracted from an online voluntary safety event reporting system. Events from primary and community care settings were categorized according to clinical setting, type of event, and level of harm. The Sittig and Singh sociotechnical system model was then used to identify the most prominent sociotechnical dimensions of each event., Results: Of 104 reported events, most ( n  = 85, 82%) indicated the event resulted in no harm. Public health had the highest number of reports ( n  = 45, 43%), whereas home health had the fewest ( n  = 7, 7%). Of the 182 sociotechnical concepts identified, many events ( n  = 61, 59%) mapped to more than one dimension. Personnel ( n  = 48, 46%), Workflow and Communication ( n  = 37, 36%), and Content ( n  = 30, 29%) were the most common. Personnel and Content together was the most common combination of dimensions., Conclusion: Most reported events featured both technical and social dimensions, suggesting that the nature of these events is multifaceted. Leveraging existing safety event reporting systems to screen for safety events involving health information technology, and applying a sociotechnical analytic framework can aid health organizations in identifying, responding to, and learning from reported events., Competing Interests: None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Objective : Self-care is essential to improving heart failure patient outcomes. However, the knowledge and behaviours necessary for self-care decision making, such as symptom perception and management, are complex and require patient education. The objective of this study was to test the feasibility, acceptability, and potential effectiveness of a web-based, gamified heart failure patient education solution, Heart Self-Care Patient Education (HeartSCaPE), that used narrative and virtual reward gamification techniques. Materials and Methods: This mixed-methods study used a pre-post-test design with an embedded explanatory qualitative phase. Patients completed the Self-Care of Heart Failure Index, that measured self-care behaviour change and the Dutch Heart Failure Knowledge Scale, used to measure heart failure knowledge. Usability measures of HeartSCaPE were tracked using Google Analytics and the System Usability Scale. Results: Nineteen patients completed the study, with a subset of six participating in semi-structured interviews. We found increases in HF knowledge despite high baseline knowledge scores. Post-intervention self-reported HF self-care behaviours ( maintenance, management and confidence ), as measured by the Self-Care of Heart Failure Index, were also improved. Knowledge and self-care scores were not correlated. Participants also scored HeartSCaPE as highly usable. In interviews, participants described valuing the opportunity to practice self-care decision-making. There were mixed opinions regarding the use of virtual rewards. Conclusion: We found that a gamified web-based solution that uses narrative and reward-based gamification techniques has the potential to improve HF patient knowledge and self-care. Further research is needed to confirm the study's clinical benefits and address technology literacy inequities.

Background: Growing evidence indicates that chronic high-intensity endurance exercise predisposes male, middle-aged athletes to increased risk of atrial fibrillation (AF). The aetiology of AF in endurance athletes is multifactorial and remains incompletely understood. Despite their unique training demands, AF care in athletes remains largely based on evidence derived from the general population. Understanding the experiences of athletes with AF provides a necessary foundation for addressing challenges in managing their condition and identifying gaps in care., Aim: The purpose of this interpretive descriptive qualitative study was to describe the experiences and perspectives of endurance athletes living with AF., Method: Masters athletes diagnosed with AF and aged between 35 and 60 years were recruited internationally through cardiology practices and social media. Ten middle-aged, male endurance athletes with AF and >1,500 lifetime training hours participated in individual, semi-structured interviews. Data were analysed using inductive thematic analysis., Results: Three key themes were constructed: (1) tensions with training, (2) tensions with treatment plans, and (3) tensions with clinicians. Participants experienced a wide range of symptoms from AF that significantly affected their ability to train, and reacted negatively to medical treatment strategies that affected their exercise capacity and training performance. Athletes experienced tensions with providers who failed to acknowledge their athletic needs., Conclusions: Our results highlight the unique difficulties that male athletes with AF face in navigating between training and their disease, treatment, and clinicians. Shared decision-making between the athlete and provider is likely necessary for effective management of athletic AF., Competing Interests: Conflicts of Interest There are no conflicts of interest to disclose., (Copyright © 2023 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)

Background: The purpose of this study was to design, usability test, and explore the feasibility of a web-based educational platform/intervention for patients with atrial fibrillation (AF) as part of their virtual AF care., Methods: Participants were patients attending a specialized AF clinic. The multiple mixed-methods design included website design, think-aloud usability test, 1-month unstructured pre-testing analysis using Google Analytics, follow-up interviews, and a non-randomized one-group feasibility test using pre/post online surveys and Google Analytics., Results: Usability testing participants ( n = 2) guided adjustments for improving navigation. Pre-testing participants' ( n = 9) website activity averaged four sessions (SD = 2.6) at 10 (SD 8) minutes per session during a 1-month study period. In the feasibility test, 30 patients referred to AF specialty clinic care completed the baseline survey, and 20 of these completed the 6-month follow-up survey. A total of 19 patients accessed the website over the 6 months, and all 30 participants were sent email prompts containing information from the website. Health-related quality of life, treatment satisfaction, household activity, and AF knowledge scores were higher at follow-up than baseline. There was an overall downward trend in self-reported healthcare utilization at follow-up., Conclusions: Access to a credible education website for patients with AF has great potential to complement virtual and hybrid models of care.

Background: Telehealth can optimize access to specialty care for patients with atrial fibrillation (AF). Virtual AF care, however, may not fit with the complex needs of patients with AF., Objective: This study aims to explore the correlation among attitudes toward health care technologies, self-efficacy, and telehealth satisfaction as part of the future planning of virtual AF clinic care., Methods: Patients with AF older than 18 years from an urban-based, highly specialized AF clinic who had an upcoming telehealth visit were invited to participate in a web-based survey. The survey asked about demographic characteristics; use of technology; general, computer, and health care technology self-efficacy (HTSE) and health care technology attitudes, using a validated 30-item tool; and telehealth satisfaction questionnaire using a validated 14-item questionnaire. Data were analyzed with descriptive statistics, correlational analyses, and linear regression modeling., Results: Participants (n=195 of 579 invited, for a 34% response rate) were primarily older, male, and White, had postsecondary schooling or more, and had high self-reported overall and mental health ratings. A variety of technologies were used in their daily lives and for health care, with the majority of technologies comprising desktop and laptop computers, smartphones, and tablets. Self-efficacy and telehealth satisfaction questionnaire scores were high overall, with male participants having higher general self-efficacy, computer self-efficacy, HTSE, and technology attitude scores. After controlling for age and sex, only HTSE was significantly related to individuals' attitudes toward health care technology. Both general self-efficacy and attitude toward health care technology were positively related to telehealth satisfaction., Conclusions: Consistent with a previous study, only HTSE significantly influenced attitudes toward health care technology. This finding confirms that, in this regard, self-efficacy is not a general perception but is domain specific. Considering participants' predominant use of the telephone for virtual care, it follows that general self-efficacy and attitude toward health care technology were significant contributors to telehealth satisfaction. Given our patients' frequent use of technology and high computer self-efficacy and HTSE scores, the use of video for telehealth appointments could be supported., (©Kathy L Rush, Lindsay Burton, Cherisse L Seaton, Peter Loewen, Brian P O'Connor, Lana Moroz, Kendra Corman, Mindy A Smith, Jason G Andrade. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 14.09.2023.)

Background: Examining characteristics of patients with atrial fibrillation (AF) has the potential to help in identifying groups of patients who might benefit from different management approaches., Methods: Secondary analysis of online survey data was combined with clinic referral data abstraction from 196 patients with AF attending an AF specialty clinic. Cluster analyses were performed to identify distinct, homogeneous clusters of AF patients defined by 11 relevant variables: CHA 2 DS 2 -VASc score, age, AF symptoms, overall health, mental health, AF knowledge, perceived stress, household and recreation activity, overall AF quality of life, and AF symptom treatment satisfaction. Follow-up analyses examined differences between the cluster groups in additional clinical variables., Results: Evidence emerged for both 2- and 4-cluster solutions. The 2-cluster solution involved a contrast between patients who were doing well on all variables (n = 129; 66%) vs those doing less well (n = 67; 34%). The 4-cluster solution provided a closer-up view of the data, showing that the group doing less well was split into 3 meaningfully different subgroups of patients who were managing in different ways. The final 4 clusters produced were as follows: (i) doing well; (ii) stressed and discontented; (iii) struggling and dissatisfied; and (iv) satisfied and complacent., Conclusions: Patients with AF can be accurately classified into distinct, natural groupings that vary in clinically important ways. Among the patients who were not managing well with AF, we found 3 distinct subgroups of patients who may benefit from tailored approaches to AF management and support. The tailoring of treatment approaches to specific personal and/or behavioural patterns, alongside clinical patterns, holds potential to improve patient outcomes (eg, treatment satisfaction)., (© 2023 The Authors.)

Heart failure is a complex, chronic disease that requires self-care to manage, and patients need support and education to perform adequate self-care. Although electronic health interventions to support behavior change and self-care in cardiovascular disease are gaining traction, there is little engaging online education specifically designed for heart failure patients. This paper describes the design and development of a heart failure self-care patient education Web site that integrated gamification, meaning the use of game design elements in a non-game context. We sought feedback on the Web site from a group of heart failure clinicians in a focus group using a semi-structured interview guide, and data were analyzed thematically. Clinician input during the design phase touched on themes such as patients' decision-making in heart failure and older adults' adoption of technology. Clinicians recommended that a narrative gamification technique should reflect real-life dilemmas patients encounter in their self-care. Clinicians also discussed the need to carefully plan reward-based gamification techniques to avoid unintended effects. Overall, a gamified Web site has the potential to support heart failure self-care, but efforts are needed to address the disparity of those with limited computer literacy or access., Competing Interests: Alexandra Lukey received the CIHR Canada Graduate Scholarships – master's program scholarship in support of this project. For the remaining authors, no conflicts of interest are declared., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: This is a study protocol to co-create with knowledge users a core outcome set focused on middle-aged and older adults (40 years+) for use in social prescribing research., Methods: We will follow the Core Outcome Measures in Effectiveness Trials (COMET) guide and use modified Delphi methods, including collating outcomes reported in social prescribing publications, online surveys, and discussion with our team to finalize the core outcome set. We intentionally center this work on people who deliver and receive social prescribing and include methods to evaluate collaboration. Our three-part process includes: (1) identifying published systematic reviews on social prescribing for adults to extract reported outcomes; and (2) up to three rounds of online surveys to rate the importance of outcomes for social prescribing. For this part, we will invite people (n = 240) who represent the population experienced in social prescribing, including researchers, members of social prescribing organizations, and people who receive social prescribing and their caregivers. Finally, we will (3) convene a virtual team meeting to discuss and rank the findings and finalize the core outcome set and our knowledge mobilization plan., Conclusion: To our knowledge, this is the first study designed to use a modified Delphi method to co-create core outcomes for social prescribing. Development of a core outcome set contributes to improved knowledge synthesis via consistency in measures and terminology. We aim to develop guidance for future research, and specifically on the use of core outcomes for social prescribing at the person/patient, provider, program, and societal-level., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Esfandiari et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: Social prescribing is a complex care model, which aims to address unmet non-medical needs and connect people to community resources. The purpose of this systematic review was to synthesize available evidence from qualitative methods (e.g. interviews or focus groups) on experience, outcomes, and processes for social prescribing and older adults (from the person or provider level)., Study Design: This was a systematic review using the Joanna Brigg's meta-aggregative approach., Methods: We searched multiple online databases for peer-reviewed studies, which included older adults aged ≥60 years (group mean age) and social prescribing experience, outcomes, or processes. We included all qualitative or mixed methods designs from all years and languages. Date of the last primary search was March 24, 2022. Two authors used online software to conduct the screening independently and then decided on the final list of included studies via notes and online discussion., Results: We screened 376 citations (after duplicates) and included eight publications. There were 197 older adult participants (59% women), and many people were living with chronic health conditions. Few details were provided for participants' ethnicity, education, and related factors. We created five synthesized findings related to (1) the approach of social prescribing; implementation factors such as (2) relationships, (3) behavior change strategies, and (4) the environment; and (5) older adults' perceived health and psychosocial outcomes., Conclusions: Despite the limited number of available studies, data provide an overview of people and processes involved with social prescribing, identified research and practice gaps, and possible next steps for implementing and evaluating social prescribing for older adults in primary care., (Copyright © 2023 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Background: In-person health care has been the standard model of care delivery for patients with atrial fibrillation (AF). Despite the growing use of remote technology, virtual health care has received limited formal study in populations with AF. Understanding the virtual care experiences of patients in specialized AF clinics is essential to inform future planning of AF clinic care., Objective: This qualitative descriptive study aimed to understand patients' virtual AF clinic care experiences during the COVID-19 pandemic., Methods: Participants were recruited from a pool of patients who were receiving care from an AF clinic and who were enrolled in a larger survey study. A total of 8 virtual focus groups (n=30) were conducted in 2 waves between March 2021 and May 2021. Facilitators used a semistructured discussion guide to ask participants questions about their experiences of virtual care and the perceived quality of virtual care and technology support. Three team members initially open coded group data to create a preliminary coding framework. As the analysis progressed, with subsequent focus groups, the code clusters were refined., Results: The participants were primarily male (21/30, 70%), aged ≥65 years (20/30, 67%), and college graduates (22/30, 73%). Patients found virtual care to be highly beneficial. Central to their experiences of virtual care was its fit or lack of fit with their health needs, which was integrally connected to communication effectiveness and their preferred virtual care future. Practical benefits included flexibility, convenience, and time and cost savings of virtual care. Virtual care fit occurred for small, quick, and mundane issues (eg, medication refills) but was suboptimal for new and more complex issues that patients thought warranted an in-person visit. Fit often reflected the effectiveness of communication between patient and provider and that of in-clinic follow-up. There was near-complete agreement among participants on the acceptability of virtual communication with their providers in addressing their needs, but this depended on adequate reciprocal communication. Without the benefit of in-person physical assessments, patients were uncertain and lacked confidence in communicating the needed, correct, and comprehensive information. Finally, participants described concerns related to ongoing virtual care with recommendations for their preferred future using a hybrid model of care and integrating patient-reported data (ie, blood pressure measurements) in virtual care delivery., Conclusions: Virtual care from a specialty AF clinic provides practical benefits for patients, but they must be weighed against the need for virtual care's fit with patients' needs and problems. The stability and complexity of patients' health needs, their management, and their perceptions of communication effectiveness with providers and clinics must be considered in decisions about appointment modality. Patients' recommendations for future virtual care through use of hybrid models together with systems for data sharing have the potential to optimize fit., (©Kathy L Rush, Lindsay Burton, Peter Loewen, Ryan Wilson, Sarah Singh, Lana Moroz, Jason G Andrade. Originally published in JMIR Cardio (https://cardio.jmir.org), 30.01.2023.)

Objectives: The purpose of this study was to understand the mental health experiences of adults 50 years of age and older living in a rural community in British Columbia., Methods: This study used critical social theory and interpretive description. Purposive sampling was used to recruit 8 adults aged 50 years and older. Participants used digital cameras and spent up to five weeks taking photos of representations of their life as an older adult with a mental health concern in a rural community. Semi-structured interviews were used to explore participants' reasons for taking various photos, unveiling their experiences. Constant comparison was used to analyze the data., Results: Four key themes were identified: mental wellbeing (hope, spirituality, and gratitude; nature and losses); stigma; services and supports; and environment., Conclusion: There is a significant need for more health care providers for rural older adults' mental health. Additionally, there is a need for integrated services and peer-led supports to address the needs of this population.

Background: Technology holds great potential for promoting health equity for rural populations, who have more chronic illnesses than their urban counterparts but less access to services. Yet, more participatory research approaches are needed to gather community-driven health technology solutions. The purpose was to collaboratively identify and prioritize action strategies for using technology to promote rural health equity through community stakeholder engagement., Methods: Concept mapping, a quantitative statistical technique, embedded within a qualitative approach, was used to identify and integrate technological solutions towards rural health equity from community stakeholders in three steps: (1) idea generation; (2) sorting and rating feasibility/importance and (3) group interpretation. Purposeful recruitment strategies were used to recruit key stakeholders and organizational representatives from targeted rural communities., Results: Overall, 34 rural community stakeholders from western Canada (76% female, mean age = 55.4 years) participated in the concept mapping process. In Step 1, 84 ideas were generated that were reduced to a pool of 30. Multidimensional scaling and cluster analysis resulted in a six-cluster map representing how technological solutions can contribute toward rural health equity. The clusters of ideas included technological solutions and applications, but also ideas to make health care more accessible regardless of location, training and support in the use of technology, ensuring digital tools are simplified for ease of use, technologies to support collaboration among healthcare professionals and ideas for overcoming challenges to data sharing across health systems/networks. Each cluster included ideas that were rated as equally important and feasible. Key themes included organizational and individual-level solutions and connecting patients to newly developed technologies., Conclusions: Overall, the grouping of solutions revealed that technological applications require not only access but also support and collaboration. Concept mapping is a tool that can engage rural community stakeholders in the identification of technological solutions for promoting rural health equity., Patient or Public Contribution: Rural community stakeholders were involved in the generation and interpretation of technological solutions towards rural health equity in a three-step process: (1) individual brainstorming of ideas, (2) sorting and rating all ideas generated and (3) collective interpretation and group consensus on final results., (© 2022 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Background and Objectives: Telehealth holds potential for inclusive and cost-saving health care; however, a better understanding of the use and acceptance of telehealth for health promotion among rural older adults is needed. This systematic review aimed to synthesize evidence for telehealth use among rural-living older adults and to explore cost-effectiveness for health systems and patients., Research Design and Methods: This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study designs reporting health promotion telehealth interventions with rural-living adults aged 55 and older were eligible for review. Following screening and inclusion, articles were quality-rated and ranked by level of evidence. Data extraction was guided by the Technology Acceptance Model and organized into outcomes related to ease of use, usefulness, intention to use, and usage behavior along with cost-effectiveness., Results: Of 2,247 articles screened, 42 were included. Positive findings for the usefulness of telehealth for promoting rural older adults' health were reported in 37 studies. Evidence for ease of use and usage behavior was mixed. Five studies examined intention to continue to use telehealth and in 4 of these, patients preferred telehealth. Telehealth was cost-effective for health care delivery (as a process) compared to face to face. However, findings were mixed for cost-effectiveness with both reports of savings (e.g., reduced travel) and increased costs (e.g., insurance)., Discussion and Implications: Telehealth was useful for promoting health among rural-living older adults. Technological supports are needed to improve telehealth ease of use and adherence. Cost-effectiveness of telehealth needs more study, particularly targeting older adults., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

People in rural and remote areas often experience greater vulnerability and higher health-related risks as a result of complex issues that include limited access to affordable health services and programs. During disruptive events, rural populations face unique barriers and challenges due to their remoteness and limited access to resources, including digital technologies. While social determinants of health have been highlighted as a tool to understand how health is impacted by various social factors, it is crucial to create a holistic framework to fully understand rural health equity. In this commentary, we propose an integrated framework that connects the social determinants of health (SDOH), the political determinants of health (PDOH), the commercial determinants of health (ComDOH), and the corporate determinants of health (CorpDOH) to address health inequity in rural and remote communities in Canada. The goal of this commentary is to situate these four determinants of health as key to inform policy-makers and practitioners for future development of rural health equity policies and programs in Canada., (© 2022. The Author(s).)

Background: To reduce person-to-person contact, the COVID-19 pandemic has driven a massive shift to virtual care. Defined as the use of technology (synchronous or asynchronous) to support communication between health care providers and patients, rural-urban differences in virtual care are relatively unexplored., Objective: The 2-fold purpose of this study was to examine rural and urban virtual care access, use, and satisfaction during the pandemic and to identify any unmet needs., Methods: This study was a cross-sectional online survey exploring virtual care among rural and urban adults in summer 2021 using a combination of fixed and open-ended response options. Quantitative data were analyzed using both descriptive and inferential statistics, and qualitative data were analyzed using inductive thematic content analysis., Results: Overall, 501 (373, 74.4% female; age range 19-86 years; 237, 47.3% rural-living) Western Canadians completed the survey. Virtual care use was high among both rural (171/237, 72.2%) and urban (188/264, 71.2%) participants, with over one-half (279/501, 55.7%) reporting having only started to use virtual care since the pandemic. The self-reported need for mental health programs and services increased during the pandemic, compared with prior for both rural and urban participants. Among virtual care users, interest in its continuation was high. Our analysis also shows that internet quality (all P<.05) and eHealth literacy (all P<.001) were positively associated with participants' perceptions of virtual care usefulness, ease of use, and satisfaction, with no rural-urban differences. Rural participants were less likely to have used video in communicating with doctors or health care providers, compared with urban participants (P<.001). When describing unmet needs, participants described a (1) lack of access to care, (2) limited health promotion and prevention options, and (3) lack of mental health service options., Conclusions: The increased demand for and use of virtual care may reflect increased availability and a lack of alternatives due to limited in-person services during the COVID-19 pandemic, so a balance between virtual care and in-person care is important to consider postpandemic. Further, ensuring availability of high-speed internet and education to support patients will be important for providing accessible and effective virtual care, especially for rural residents., (©Kathy L Rush, Cherisse L Seaton, Kendra Corman, Nicole Hawe, Eric Ping Hung Li, Sarah J Dow-Fleisner, Mohammad Khalad Hasan, Nelly D Oelke, Leanne M Currie, Barbara Pesut. Originally published in JMIR Formative Research (https://formative.jmir.org), 22.08.2022.)

Prevention services, such as screening tests and vaccination, are underutilized, especially by rural populations and patients without a usual primary care provider. Little is known about the compounding impacts on preventive care of being unattached and living in a rural area and there has been no comprehensive exploration of this highly vulnerable population's prevention activities. The twofold purpose of this research was to examine rural unattached patients' prevention activity self-efficacy and completion and to explore their experiences accessing healthcare, including COVID-19 impacts. Two thirds of patients had been unattached for over one year, and over 20 % had been unattached for over 5 years; males experienced longer unattachment compared to females. Completion rates of prevention activities were relatively low, ranging from 5.9 % (alcohol screening) to 59 % (vision test). Most participants did not complete their prevention care activities in line with the Lifetime Prevention Schedule timeline: 65 % of participants had less than half of their activities up-to-date and only 6.7 % of participants were up to date on 75 % or more of their prevention activities. Participants with higher prevention self-efficacy scores were more likely to be up-to-date on associated prevention activities but the longer patients had been unattached, the fewer their up-to-date prevention activities. Patients expressed negative impacts of COVID-19 including walk-in clinics shutting down limiting access to care. These results suggest serious gaps in rural unattached patients' preventive care and highlight the need for support when they are without a usual primary care provider, which can be lengthy., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Author(s).)

Technology has played a critical role during the COVID-19 pandemic. Despite affording a safe way for people to connect with others, the potential for problematic device usage (e.g., overuse, addiction) should be considered. The goal of this study was to examine mobile device use during the COVID-19 pandemic among rural and urban people in Canada. Based on an online survey conducted in the summer of 2021 in British Columbia (n = 465), participants self-reported spending more hours per day (M = 8.35 h) using technology during the pandemic compared to prior (M = 6.02 h), with higher increases among urban participants (p < 0.001). Mobile device usage scores were highest for reasons of social connectedness and productivity, with no rural/urban differences; however, urban participants reported higher use of mobile devices for their mental well-being (p = 0.001), but also reported higher, continuous use (p < 0.001), addiction (p < 0.001), and detrimental impacts on their physical health (p < 0.001) compared to rural participants. Because urban participants were more vulnerable to mobile device overuse and addiction during the pandemic, researchers and policy makers should consider the ongoing role and positive/negative impacts of mobile device use, paying particular attention to urban populations.

Objective: Health sciences librarian roles are evolving to better meet the needs of faculty. This study explores nursing faculty needs at the University of British Columbia through the research lifecycle framework of planning, conducting, disseminating, and assessing the impact of their research., Methods: A mixed methods survey study with Likert scale, multiple-choice, or ordinal ranking-scale questions and six open-response questions was conducted. The format was a web-based Qualtrics survey; participants had approximately three weeks to respond., Results: Nursing faculty identified the dissemination phase as benefiting most from library support prioritizing reference management and archiving research data as the top needs in that phase. Assessing impact skills such as citation analysis and Altmetrics training was ranked second. The Planning phase was ranked third with systematic review and literature review support most needed. The Conducting phase was identified as the phase where they needed the least support., Conclusion: Understanding the needs of researchers and enhancing scholar productivity is vital to offering responsive library research services. Across the research lifecycle, nursing faculty identified reference management, data management, metrics evaluation, systematic reviews, and literature reviews as the key areas for which they need support., (Copyright © 2022 Robert Janke, Kathy L Rush, Katherine Miller.)

We investigated the uptake and perceptions of virtual care solutions by rural Canadian primary and specialist providers during the early phase (May-June 2020) of the COVID-19 pandemic. A web-based, cross-sectional survey of rural primary and specialty care providers examined types of virtual care platforms used (eg, phone, video), appointment length, experience and satisfaction with the solution used, plans for future use of virtual care, and patients' use of virtual care services. Targeted participants were actively-practicing providers in rural Western Canada who were emailed an invitation for the study and its survey link. Fifty-nine providers (26% response rate) completed the survey. During the pandemic, 78% of providers reported using virtual care for more than 60% of their appointments, while only 3% did so frequently pre-pandemic. Most providers used phone consultations, despite believing that video provided a better virtual visit. Key barriers included workflow interruptions, unique concerns about quality of care, remuneration and sustainability, or poor internet access and bandwidth for both providers and patients. The key opportunity noted was improved access to care. While most virtual care visits were not conducted using video technologies, overall virtual care resulted in high provider satisfaction, while not increasing workload. Virtual care will continue to play an important role in future rural care practice; however, sustainability will require both provider-level and system-level changes., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Background: Rural and remote communities faced unique access challenges to essential services such as healthcare and highspeed infrastructure pre-COVID, which have been amplified by the pandemic. This study examined patterns of COVID-related challenges and the use of technology among rural-living individuals during the first wave of the COVID-19 pandemic., Methods: A sample of 279 rural residents completed an online survey about the impact of COVID-related challenges and the role of technology use. Latent class analysis was used to generate subgroups reflecting the patterns of COVID-related challenges. Differences in group membership were examined based on age, gender, education, race/ethnicity, and living situation. Finally, thematic analysis of open-ended qualitative responses was conducted to further contextualize the challenges experienced by rural-living residents., Results: Four distinct COVID challenge impact subgroups were identified: 1) Social challenges (35%), 2) Social and Health challenges (31%), 3) Social and Financial challenges (14%), and 4) Social, Health, Financial, and Daily Living challenges (19%). Older adults were more likely to be in the Social challenges or Social and Health challenges groups as compared to young adults who were more likely to be in the Social, Health, Financial, and Daily Living challenges group. Additionally, although participants were using technology more frequently during the COVID-19 pandemic to address challenges, they were also reporting issues with quality and connectivity as a significant barrier., Conclusions: These analyses found four different patterns of impact related to social, health, financial, and daily living challenges in the context of COVID. Social needs were evident across the four groups; however, we also found nearly 1 in 5 rural-living individuals were impacted by an array of challenges. Access to reliable internet and devices has the potential to support individuals to manage these challenges., (© 2022. The Author(s).)

Background: Prior to the wider adoption of digital health technologies during the COVID-19 pandemic, applications of virtual care were largely limited to specialist visits and remote care using telehealth (phone or video) applications. Data sharing approaches using tethered patient portals were mostly built around hospitals and larger care systems. These portals offer opportunities for improved communication, but despite a belief that care has improved, they have so far shown few outcome improvements beyond medication adherence. Less is known about use of virtual care and related tools in the outpatient context and particularly in rural community contexts., Objective: This study aims to reflect on the opportunities and barriers for sustainable virtual care through an example of a digitally enabled rural micropractice, which has provided 10%-15% virtual care since 2016 and 70% virtual care since March 2020., Methods: Three focus groups, 1 with providers (physician and medical office manager) and 2 with a total of 8 patients from a rural micropractice in British Columbia, were conducted in November 2020 and December 2020. Virtual care delivery was explored through the topics of communication approach, mixing virtual and in-person care, the practice team's journey in developing these approaches, and provider and patient satisfaction with the care model. Interviews were transcribed, checked for accuracy against recordings, and thematically analyzed., Results: Both patients and providers reported ease of communication and high satisfaction. Either could initiate communication, and patients found the ability to share health information asynchronously through the portal allowed time to reflect and prepare their thoughts. Patients were highly engaged and reported feeling empowered and true partners in their health care, although they noted limited care coordination with specialists. The mix of virtual and in-person visits was highly regarded by patients and providers, and patients reported feeling safe and cared for 24/7, although both expressed concern about work spilling into the provider's home life. The physician worried about missed diagnoses with virtual care. With respect to establishing the micropractice, solutions took about 5 years to optimize, with providers noting a learning curve requiring technical support for both themselves and their patients and a willingness to respond to patient feedback to identify the best solutions. Despite a mature virtual practice, patients reported deferred care due to COVID-19., Conclusions: The micropractice's hybrid care model encouraged patients to be true partners in their care and resulted in high patient engagement and satisfaction; yet, success may rely on the patient population being willing to engage and being comfortable with technology. Barriers lie in gaps in care coordination and provider fear that signs or symptoms more evident with an in-person exam could be missed. Even in this setting, deferral of care in light of COVID-19 was present, and opportunities to address care gaps should be sought., (©Lindsay Burton, Kathy L Rush, Mindy A Smith, Selena Davis, Patricia Rodriguez Echeverria, Lina Suazo Hidalgo, Matthias Görges. Originally published in JMIR Formative Research (https://formative.jmir.org), 27.04.2022.)

Atrial fibrillation (AF) is the most common arrhythmia in the world. Despite the increasing prevalence, there remains a limited understanding of how the pre-diagnosis symptom experience varies by gender. The purpose of this study was to retrospectively explore gender differences/similarities in the pre-diagnosis period of AF. Twenty-six adults (13 men and 13 women) were interviewed guided by the Symptom Experience in AF (SEAF). Data were analyzed using a two-step approach to thematic analysis. Women had greater challenges receiving a timely diagnosis, with 10 women (77%) experiencing symptoms ≥1 year prior to their diagnosis, in comparison to only three (23%) of the men. Women also reported more severe symptoms, less AF-related knowledge, viewed themselves as low risk for cardiovascular disease, and described how their comorbid conditions confused AF symptom evaluation. This study provides a foundational understanding of differences/similarities in the AF symptom experience by gender.