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Zhao FY, Conduit R, Kennedy GA, Xu PJ, Zhang WJ, Ho YS, Fu QQ, Chow CM. Why some embrace and others hesitate? A behavioral analysis of insomnia sufferers’ engagement with acupuncture treatment. World J Psychiatry 2025; 15:105802. [DOI: 10.5498/wjp.v15.i5.105802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2025] [Revised: 03/17/2025] [Accepted: 04/03/2025] [Indexed: 04/30/2025] Open
Abstract
BACKGROUND Acupuncture is emerging as a promising treatment for insomnia. However, the determinants driving patients’ decisions to pursue or adopt this treatment modality remain underexplored.
AIM To identify the key factors shaping the willingness of patients with insomnia to seek and engage in acupuncture from a patient-centered perspective.
METHODS A semi-structured focus group design was used, with a research framework integrating the capability, opportunity, motivation-behavior model, and theoretical domains framework. The results were mapped onto constructs of a behavioral wheel derived from the capability, opportunity, motivation-behavior/theoretical domains framework matrix. Data analyses employed abductive thematic analysis.
RESULTS Data saturation was achieved after ten focus group sessions, involving a total of 45 participants. Key facilitators for patients with insomnia seeking acupuncture included: (1) Cultural beliefs in ethnic medicine; (2) Concerns about the adverse effects of, and dependence on, hypnotics; (3) Expectations of improvement in comorbid symptoms; (4) Desire for more communication with the clinician; and (5) Incentives from peers and online key opinion leaders. Barriers were: (1) Limited knowledge of acupuncture indications; (2) Accessibility burden; (3) Needle-phobia; and (4) Safety concerns. Additionally, prior acupuncture experiences, family/friend attitudes, and treatment costs (reimbursement rate in health insurance) served as both facilitators and barriers.
CONCLUSION The interrelated facilitators and barriers underscore that the decision to use acupuncture for insomnia is a complex issue involving efficacy/safety, culture, economics, information dissemination, and communication factors. Expanding patient education on acupuncture, increasing media exposure, and improving governmental oversight of this process are essential. Investing in high-quality acupuncture services in public hospital nighttime clinics and community health centers is expected to address accessibility challenges. Acupuncturists need to improve doctor-patient communication, including guiding patients to set treatment expectations that are grounded in reality to enhance service quality. For patients with significant needle-phobia, cognitive manipulation or hypnosis techniques may be employed to improve treatment compliance.
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Affiliation(s)
- Fei-Yi Zhao
- Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai 201209, China
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, New South Wales, Australia
- School of Health and Biomedical Sciences, RMIT University, Bundoora 3083, Victoria, Australia
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, China
| | - Russell Conduit
- School of Health and Biomedical Sciences, RMIT University, Bundoora 3083, Victoria, Australia
| | - Gerard A Kennedy
- School of Health and Biomedical Sciences, RMIT University, Bundoora 3083, Victoria, Australia
| | - Pei-Jie Xu
- School of Computing Technologies, RMIT University, Melbourne 3000, Victoria, Australia
| | - Wen-Jing Zhang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, China
| | - Yuen-Shan Ho
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - Qiang-Qiang Fu
- Yangpu Hospital, School of Medicine, Tongji University, Shanghai 200090, China
| | - Chin-Moi Chow
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, New South Wales, Australia
- Sleep Research Group, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, New South Wales, Australia
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Birnbaum S. Reflexivity in nursing qualitative research: A problem of epistemic fluency. J Prof Nurs 2025; 58:61-67. [PMID: 40368497 DOI: 10.1016/j.profnurs.2025.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Revised: 02/27/2025] [Accepted: 02/27/2025] [Indexed: 05/16/2025]
Abstract
In the field of learning theory, the concept of epistemic fluency describes how students mature into flexible thinkers able to recognize diverse perspectives and value systems, mobilize different bodies of knowledge and logical operations, identity strengths and limitations in their own knowledge and reasoning, and envision multiple possible solutions to complex problems. While epistemic fluency is a significant area of research in sciences, engineering, and medical education, it has received little explicit attention within nursing. This article highlights a connection between epistemic fluency and reflexivity, a far more familiar concept which is associated with qualitative research methodology and has been studied extensively in nursing. The article advances epistemic fluency as an idea which warrants more attention in doctoral-level nursing education and presents an exemplar teaching activity to illustrate application of this approach in a nursing science classroom. Calling students' attention to their own default assumptions and patterns of reasoning about how knowledge is constructed, the activity is a strategy for introducing students to some of the most complex and often elusive aspects of what it means to become a scholar.
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Affiliation(s)
- Shira Birnbaum
- Rutgers University School of Nursing, Newark, NJ 07102, USA.
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Stavitz J, Porcelli R, Block-Lerner J, Marks DR, Katzman H. Burnout, Identity Loss and Institutional Gaps: A Qualitative Examination of Sport Discontinuation Among NCAA Division III Athletes. Sports (Basel) 2025; 13:116. [PMID: 40278742 PMCID: PMC12031138 DOI: 10.3390/sports13040116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2025] [Revised: 03/27/2025] [Accepted: 04/09/2025] [Indexed: 04/26/2025] Open
Abstract
Mental health challenges significantly impact NCAA Division III student athletes, often leading them to discontinue their sport. Unlike Division I athletes, they have limited institutional support, making it harder to balance academic and athletic demands. This qualitative study examines the mental health barriers influencing 21 former Division III athletes' decisions to withdraw. Key themes include stress, burnout, identity loss, inadequate institutional support and external pressures like academics and finances. The findings highlight the need for better mental health resources, reduced stigma, and stronger institutional support. Addressing these challenges can improve athlete well-being and retention in Division III programs.
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Affiliation(s)
- James Stavitz
- Department of Athletic Training Education, Kean University, 1000 Morris Avenue, Union, NJ 07083, USA
| | - Ryan Porcelli
- Department of Athletic Training Education, Kean University, 1000 Morris Avenue, Union, NJ 07083, USA
| | - Jennifer Block-Lerner
- Department of Advanced Studies in Psychology, Kean University, 1000 Morris Avenue, Union, NJ 07083, USA
| | - Donald R. Marks
- Department of Advanced Studies in Psychology, Kean University, 1000 Morris Avenue, Union, NJ 07083, USA
| | - Hallie Katzman
- Department of Advanced Studies in Psychology, Kean University, 1000 Morris Avenue, Union, NJ 07083, USA
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Kim H. Taking a Pause: Co-Designing a Reflection Tool for Meaning Creation in Patients With Type 2 Diabetes. Health Expect 2025; 28:e70182. [PMID: 39960046 PMCID: PMC11831342 DOI: 10.1111/hex.70182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 01/30/2025] [Accepted: 02/04/2025] [Indexed: 02/20/2025] Open
Abstract
OBJECTIVES This study aims to explore how the design of a self-reflection tool can assist patients with type 2 diabetes (T2D) by facilitating and sustaining their reflective practices in the context of diabetes care. Specifically, the study seeks to examine how patients utilize self-reflection tools, identify aspects they feel improve diabetes management, and uncover the opportunities and challenges they encounter when integrating such tools into their daily lives. METHODS The research involved two phases: first, the preliminary development of a self-reflection tool prototype and second, the exploration of user experience. During the second phase, five patients with T2D participated in three interview sessions bi-weekly over the period of 6 weeks. The interviews were transcribed and thematically coded, and affinity diagramming was then used to synthesize the data. RESULTS Four main themes emerged from the interviews. The designed self-reflection tool was found to have the potential to enhance participants' motivation for engaging in diabetes management by improving diabetes management, initiating self-reflection, facilitating new thoughts and meanings, and providing opportunities for the patients to share their reflections. CONCLUSIONS The designed self-reflection tool helped patients with T2D by encouraging them to adopt a more positive mindset and supporting them in addressing challenges related to their diabetes management. The study suggests that there is promising potential for the self-reflection tool to evolve into a reflection-sharing tool that can be shared with other patients. PATIENT OR PUBLIC CONTRIBUTION Participants with T2D took part in the designed interviews, and their experiences and comments meaningfully contributed to enriching the co-design of the self-reflection tool. The suggested potential for this tool to be expanded into a reflection-sharing tool is also significant.
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Affiliation(s)
- Hyeryoung Kim
- Department of Data ScienceThe Catholic University of KoreaSeoulSouth Korea
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Mphego ZJ, Mokgatle MM, Madiba S. Living in a Constant State of Fear: Phenomenological Study on Experiences of Women with High-Risk Pregnancy Waiting for Childbirth in Mpumalanga Province, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2025; 22:192. [PMID: 40003418 PMCID: PMC11854930 DOI: 10.3390/ijerph22020192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Revised: 01/16/2025] [Accepted: 01/26/2025] [Indexed: 02/27/2025]
Abstract
Research and obstetric medicine often ignore the emotional aspect of high-risk pregnant women in clinical management and care. Even more so, research does not adequately address psychosocial well-being in high-risk pregnancies, particularly in low and middle-income countries, including South Africa. Thus, this study aimed to explore and describe the experiences and psychosocial support needs of women waiting for childbirth in high-risk pregnancies. We conducted a descriptive phenomenological inquiry in special clinics in two hospitals in the Nkangala District Municipality of Mpumalanga Province, South Africa. A purposive sampling strategy was used to select 15 women aged 22 to 43 years, and in-depth interviews were conducted. An inductive thematic analysis approach was used. The women experience high levels of negative emotions such as shock and disbelief, fear, pain and sorrow, lack of control and hopelessness, and anxiety following a diagnosis of high-risk pregnancy. Fear was the most expressed feeling by the women; their thoughts were dominated by fear, and they lived in constant fear throughout the pregnancy journey due to the unpredictable pregnancy outcomes and the potential risks in high-risk pregnancies. Overall, the negative emotions are interlinked and bonded in the experiences of women with high-risk pregnancies, are experienced throughout the journey of waiting for childbirth, and contribute to high levels of stress and anxiety. Further exploration is needed to identify effective ways to support these women.
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Affiliation(s)
- Zodwa Joyce Mphego
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa;
| | - Mathildah Mpata Mokgatle
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa;
| | - Sphiwe Madiba
- Independent Researcher, Pretoria 0182, South Africa;
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Budhwani H, Ruiz De León I, Waters J, Nash P, Bond CL, Varas-Díaz N, Naar S, Nyblade L, Paulino-Ramírez R, Turan JM. Stigmas experienced by sexual and gender minority people with HIV in the Dominican Republic: a qualitative study. Ann Behav Med 2025; 59:kaae073. [PMID: 39688954 PMCID: PMC11761436 DOI: 10.1093/abm/kaae073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2024] Open
Abstract
BACKGROUND As part of a study to test the feasibility and acceptability of the Finding Respect and Ending Stigma around HIV (FRESH) intervention to reduce stigmas and improve HIV viral suppression, our team collected qualitative data from men who have sex with men (MSM) with HIV, transgender women with HIV, and HIV healthcare providers for their perspectives on different stigmas in Dominican Republic healthcare settings. PURPOSE We aimed to develop an understanding of the causes, consequences, and domains of stigma among sexual and gender minorities with HIV in Dominican Republic HIV clinics. METHODS Data collection occurred in Santo Domingo and Santiago (2020-2021) and included four focus groups with MSM with HIV (n = 26), in-depth interviews with transgender women with HIV (n = 14), and in-depth interviews with HIV healthcare providers (n = 16). All data collection occurred in person and was audio recorded. Standardized guides were used for focus groups and in-depth interviews. Using a deductive process, 2 research associates thematically coded data in the NVivo software. RESULTS On average, focus groups were 81 minutes, provider in-depth interviews were 24 minutes, and transgender women in-depth interviews were 32 minutes. We identified 4 key themes that mapped to 4 domains of stigma affecting MSM and transgender women with HIV: migrant stigma, religious stigma, sexual and gender minorities (SGM) stigma, and HIV stigma. All participant types noted the persistence of stigma and discrimination in healthcare settings in the Dominican Republic. The consequences of these stigmas were reported as being significant, including attempted suicide. CONCLUSIONS Interventions to reduce stigma experienced by SGM populations with HIV should address structural barriers, including inner and outer contexts of HIV care provision and cultural norms and values that propagate stigma. Findings offer insights about which stigmas could be targeted in future studies and how to potentially address stigma to improve population health in the Dominican Republic.
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Affiliation(s)
- Henna Budhwani
- College of Nursing, Florida State University (FSU), Tallahassee, FL 32306, United States
| | - Ingrid Ruiz De León
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana (UNIBE), Research Hub, Santo Domingo 22333, Dominican Republic
| | - John Waters
- Caribbean Vulnerable Communities Coalition (CVC), Kingston 10, Jamaica
| | - Princess Nash
- School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, AL 35233, United States
| | - Christyenne L Bond
- College of Nursing, Florida State University (FSU), Tallahassee, FL 32306, United States
| | - Nelson Varas-Díaz
- Department of Global and Sociocultural Studies, Florida International University, Miami, FL 33199, United States
| | - Sylvie Naar
- Center for Translational Behavioral Science, College of Medicine, Florida State University (FSU), Tallahassee, FL 32310, United States
| | - Laura Nyblade
- Global Health Division, International Development Group, Research Triangle Institute (RTI) International, Research Triangle Park, NC 35124, United States
| | - Robert Paulino-Ramírez
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana (UNIBE), Research Hub, Santo Domingo 22333, Dominican Republic
| | - Janet M Turan
- School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, AL 35233, United States
- Department of Public Health, Koc University, School of Medicine, Istanbul, 34450 Sarıyer, Turkey
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Ugiagbe IM, Allan HT, Traynor M, Collins L. Thinking Theoretically in Nursing Research-Positionality and Reflexivity in an Interpretative Phenomenological Analysis (IPA) Study. Nurs Inq 2025; 32:e12684. [PMID: 39529308 PMCID: PMC11773436 DOI: 10.1111/nin.12684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 10/27/2024] [Accepted: 10/29/2024] [Indexed: 11/16/2024]
Abstract
This paper explores the application of positionality and reflexivity drawing on the experience of a British Minority Ethnic (BME) group senior nurse researching nurses with the same ethnic heritage in an IPA study. It explores how using IPA informed reflexivity and positionality as a researcher who shared the same ethnicity with the research participants. The IPA study allowed for the exploration of Internationally Educated Nurses' (IENs) perspectives on their integration into British healthcare and their navigation of career progression. The central aims of an IPA study are to understand the participant's world, its description, the development of a clear, and open interpretative analysis with a descriptive focus on the social, cultural and theoretical context, and the participant's sense-making of their lived experience. In this paper, we discuss how the lead researcher employed reflexivity, stated his intentionality and positionality in the conduct of the IPA study. This paper discusses some examples of the effects of positionality and reflexivity in the conduct of research by researchers of different racial background, and explicate the influence of personal and professional experiences of a researcher in using reflexivity and positionality to ensure cross-cultural validity and reliability of an IPA research. This paper concludes that appropriate use of reflexivity and positionality in an IPA study may recognise the personal and professional influence of a researcher's experiences on the research process, including their ethnicity.
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Affiliation(s)
- Iyore. M. Ugiagbe
- Department of Adult NursingFaculty of Health, Social Care & Education, The Williams Building, The Burroughs, Middlesex UniversityLondonUK
| | - Helen. T. Allan
- Department of Adult NursingFaculty of Health, Social Care & Education, The Williams Building, The Burroughs, Middlesex UniversityLondonUK
| | - Michael Traynor
- Department of Adult NursingFaculty of Health, Social Care & Education, The Williams Building, The Burroughs, Middlesex UniversityLondonUK
| | - Linda Collins
- Health and Human SciencesSoutheastern Louisiana UniversityHammondLouisianaUSA
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Thomas E, Verdonk P, Roeters-van Lennep J, Rhodius-Meester H, Handoko L, Schoonmade L, Muller M, Muntinga M. Studying gender in the experiences of patients with heart failure: A scoping review of qualitative studies and methodological recommendations. WOMEN'S HEALTH (LONDON, ENGLAND) 2025; 21:17455057241305078. [PMID: 39883432 PMCID: PMC11783506 DOI: 10.1177/17455057241305078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 11/11/2024] [Accepted: 11/19/2024] [Indexed: 01/31/2025]
Abstract
BACKGROUND Considering how gendered experiences play a role in the lives of patients with heart failure (HF) is critical in order to understand their experiences, optimise clinical care and reduce health inequalities. OBJECTIVES The aim of our study was to review how gender is being studied in qualitative research in HF, specifically to (1) analyse how gender is conceptualised and applied in qualitative HF research; and (2) identify methodological opportunities to better understand the gendered experiences of patients with HF. ELIGIBILITY CRITERIA We conducted a systematic search of literature, including qualitive or mixed-methods articles focussing on patients' perspectives in HF and using gender as a primary analytical factor, excluding articles published before 2000. SOURCES OF EVIDENCE Our search returned 3121 records, which were independently screened by two authors, resolving disagreements through a consensus procedure. CHARTING METHODS Two reviewers extracted the characteristics of the included studies and methodological quality. We applied the Integrating Sex and Gender Checklist and gender theory as an analytical tool to synthesise results relating to the conceptualisation and application of gender in the included studies. RESULTS We included 11 qualitative articles that used interviews (n = 10) or focus groups (n = 1) to investigate the role of gender in experiences of patients with HF. None of the included studies defined their conceptual approach to gender, or used gender-related theoretical frameworks. This led to results and conclusions which were drawn along binary lines - representing gender as two separate, oppositional and mutually exclusive categories, and paying little attention to the dynamic, relational and context-dependent aspects of gender. CONCLUSIONS Although researchers have investigated the role of gender in the experiences of patient with HF, methodological improvements are needed to prevent the current retelling of gender as a binary variable with two opposed and mutually exclusive categories. To better understand gendered experiences in HF, researchers need to avoid a reductionist and essentialist approach to gender. To this end, researchers should clearly state their conceptual approach to gender and analyse their findings using state-of-the-art gender theoretical frameworks and intersectional approaches. Ultimately, this will allow the development of tailored and effective clinical care.
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Affiliation(s)
- Elias Thomas
- Department of Internal Medicine – Geriatrics Section, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Ethics Law and Humanities, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
| | - Petra Verdonk
- Department of Ethics Law and Humanities, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Hanneke Rhodius-Meester
- Department of Internal Medicine – Geriatrics Section, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, the Netherlands
- Department of Geriatric Medicine, The Memory Clinic, Oslo University Hospital, Oslo, Norway
| | - Louis Handoko
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Linda Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Majon Muller
- Department of Internal Medicine – Geriatrics Section, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Science, Amsterdam, the Netherlands
| | - Maaike Muntinga
- Department of Ethics Law and Humanities, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
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9
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Jenkins E, Szanton S, Hornstein E, Reiff JS, Seau Q, Huynh G, Gray J, Wright RS, Li Q, Cotter V, Curriero S, Taylor J. The use of photovoice to explore the physical disability experience in older adults with mild cognitive impairment/early dementia. DEMENTIA 2025; 24:40-70. [PMID: 39132879 DOI: 10.1177/14713012241272754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Although co-occurring cognitive impairment and physical disability in older adults is common, there is little understanding of how this group perceives their ability to do their daily activities. This study used photovoice to explore how older adults with MCI/early dementia and physical disability without and with care partners (dyads) perceive challenges with their daily activities. Photovoice is a visual research methodology to capture participants' insight on aspects of their daily lives. No known studies have taken this approach to explore the experiences of older adults with MCI/early dementia and co-occurring physical disability. We used a cross-sectional, exploratory research design to understand participants' (n = 12) experiences in their home environment. Photos and participant thoughts on the photos were categorized based on the Blackfoot Breath of Life Theory and the Hierarchy Model of Needs in Dementia, an adaptation of Maslow's Model. Notable findings included: awareness of physical/cognitive difficulties by older adults, solutions for ADL difficulty in persons with MCI/early dementia, care partners' difficulty recognizing pain without the presence of severe emotional or physical responses, reducing mood severity, and self-esteem needs met with structured, memory-issue adapted, meaningful activities. Older adults with co-occurring physical disability and MCI/early dementia identified both physiological and psychological needs despite challenges impacting their cognition. Photovoice evoked daily situations of these individuals and revealed the importance of developing individualized intervention elements for older adults with dementia and physical disability.
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Affiliation(s)
| | - Sarah Szanton
- School of Nursing, Johns Hopkins University, USA
- Bloomberg School of Public Health, Johns Hopkins University, USA
- Department of Health Policy and Management, Johns Hopkins University, USA
| | | | | | - Quinn Seau
- School of Nursing, Johns Hopkins University, USA
| | - Grace Huynh
- School of Nursing, Johns Hopkins University, USA
| | - Ja'Lynn Gray
- School of Nursing, Johns Hopkins University, USA
| | | | - Qiwei Li
- School of Nursing, Johns Hopkins University, USA
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Nemati D, McKee D, Rothman EF. Abortion Law Changes and Occupational Therapy Practice in the United States. Am J Occup Ther 2024; 78:7806205120. [PMID: 39383306 DOI: 10.5014/ajot.2024.050820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2024] Open
Abstract
IMPORTANCE The U.S. Supreme Court overturned Roe v. Wade in 2022, changing access to abortion in many states. The impact of these changes on occupational therapy practice has not yet been explored through empirical research. OBJECTIVE To explore the perspectives of occupational therapy practitioners on how restrictions to abortion in the United States may have influenced their clients' needs and thus their practice. DESIGN This was a qualitative research study. We used an interpretivist epistemological approach and an inductive, thematic content analysis. Participants were recruited through state occupational therapy associations and social media. Two independent researchers coded data and had an initial agreement percentage of 88%. Data trustworthiness was enhanced through documentation of decisions, reflexive thinking about our positionality and the data, and team-based discussions. PARTICIPANTS Occupational therapy practitioners (N = 15) working in states with new abortion law changes at the time of interviews. RESULTS The four key themes of this study were as follows: (1) abortion restriction laws are affecting some occupational therapy clients' mental health, (2) clients are discussing reproductive health with occupational therapy practitioners across a variety of settings, (3) occupational therapy practitioners are using clinical judgment and their personal beliefs to support clients affected by abortion restrictions, and (4) occupational therapy practitioners are seeking guidance and evidence-based resources to best support clients in the wake of abortion-related legislation changes. CONCLUSIONS AND RELEVANCE Our findings underscore the relevance of reproductive health to occupational therapy practice and highlight the importance of preparing occupational therapy practitioners to respond to client needs related to abortion care. Plain-Language Summary: We sought to determine whether occupational therapy practitioners perceive that the 2022 abortion-related restrictions are affecting occupational therapy practice; specifically, we wanted to know whether and how practice is being affected and what resources occupational therapy practitioners might need to address clients' needs. Fifteen occupational therapy practitioners were interviewed and revealed that many of their clients were experiencing stress and anxiety (i.e., mental health challenges) specifically related to abortion access. We also found that occupational therapy practitioners who routinely discuss reproductive health with clients were commonly hearing from clients about abortion-related needs. Overall, this research uncovers a need for resources and guidance from state or national occupational therapy organizations so that occupational therapy practitioners can better support their clients given these new changes in abortion access. Positionality Statement: We are a team of three researchers who identify as cisgender women, and we reside in an urban area in the northeastern United States. Two of us identify as White, and one identifies as a person of color. We have all participated in reproductive health access advocacy and critically examined our own lenses as we engaged in this analysis.
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Affiliation(s)
- Darya Nemati
- Darya Nemati, OTD, is Graduate, Entry-Level Doctor of Occupational Therapy Program, Boston University, Boston, MA;
| | - Delaney McKee
- Delaney McKee, OTD, is Graduate, Entry-Level Doctor of Occupational Therapy Program, Boston University, Boston, MA
| | - Emily F Rothman
- Emily F. Rothman, ScD, is Professor, Department of Occupational Therapy, Boston University, Boston, MA
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11
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Öz GÖ, Arslanli SE, Pekyiğit A. Pediatric nurses' experiences of implementing the 'ten right principles' in safe medication management: A descriptive phenomenological study. J Pediatr Nurs 2024; 78:97-105. [PMID: 38908342 DOI: 10.1016/j.pedn.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 06/06/2024] [Accepted: 06/06/2024] [Indexed: 06/24/2024]
Abstract
PURPOSE In medication management, the ten right principles framework is an accepted global nursing standard and an important component of medication safety. Especially pediatric patients have a higher risk of harm in medication administration compared to adults. This study aimed to examine the experiences of pediatric nurses in implementing the ten right principles in safe medication management. DESIGN AND METHODS A descriptive phenomenological approach was used in this study. The study was conducted with 16 pediatric nurses in a public hospital's Pediatric Service and Neonatal Intensive Care Unit. Pediatric nurses' medication practices were observed, and semi-structured interviews were conducted with the nurses after the observation. Observations were conducted using an observation tool, and interviews were conducted using a semi-structured interview form. Qualitative data were analyzed using thematic analysis. RESULTS In this study, it was observed that although pediatric nurses generally adhered to the ten right principles, they had the most difficulties with the right dose and time principles. As a result of the interviews conducted after the observation, two themes (factors facilitating the implementation of the ten right principles and difficulties in implementing the ten right principles) were formed. CONCLUSIONS The findings revealed that pediatric nurses achieved safe and effective medication administration and generally adhered to the ten right principles. PRACTICE IMPLICATIONS This study highlights the positive contribution of pediatric nurses to patient safety by using multiple sources of information and clinical reasoning strategies despite the difficulties they experience in drug administration.
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Affiliation(s)
- Gözde Özaras Öz
- Cankiri Karatekin University, Faculty of Health Sciences, Nursing Department, 18200 Cankiri, Turkey.
| | - Sevilay Ergun Arslanli
- Cankiri Karatekin University, Faculty of Health Sciences, Midwifery Department, 18200 Cankiri, Turkey
| | - Aylin Pekyiğit
- Cankiri Karatekin University, Faculty of Health Sciences, Nursing Department, 18200 Cankiri, Turkey
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Shahzad M, Jamil B, Bushra M, Mahboob U, Elmigdadi F. Gender-based differences in the representation and experiences of academic leaders in medicine and dentistry: a mixed method study from Pakistan. BMC MEDICAL EDUCATION 2024; 24:885. [PMID: 39152420 PMCID: PMC11330139 DOI: 10.1186/s12909-024-05811-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 07/23/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Research evidence suggests gender-based differences in the extent and experiences of academic leaders across the globe even in developed countries like USA, UK, and Canada. The under-representation is particularly common in higher education organizations, including medical and dental schools. The current study aimed to investigate gender-based distribution and explore leaders' experiences in the medical and dental institutes in a developing country, Pakistan. METHODS A mixed-method approach was used. Gender-based distribution data of academic leaders in 28 colleges including 18 medical and 10 dental colleges of Khyber Pakhtunkhwa, Pakistan were collected. Qualitative data regarding the experiences of academic leaders (n = 10) was collected through semi-structured interviews followed by transcription and thematic analysis using standard procedures. RESULTS Gender-based disparities exist across all institutes with the greatest differences among the top-rank leadership level (principals/deans) where 84.5% of the positions were occupied by males. The gender gap was relatively narrow at mid-level leadership positions reaching up to as high as > 40% of female leaders in medical/dental education. The qualitative analysis found gender-based differences in the experiences under four themes: leadership attributes, leadership journey, challenges, and support. CONCLUSIONS The study showed that women are not only significantly under-represented in leadership positions in medical and dental colleges in Pakistan, they also face gender-based discrimination and struggling to maintain a decent work life balance. These findings are critical and can have important implications for government, organizations, human resource managers, and policymakers in terms of enacting laws, proposing regulations, and establishing support mechanisms to improve gender-based balance and help current and aspiring leaders in their leadership journey.
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Affiliation(s)
- Muhammad Shahzad
- Faculty of Dentistry, Zarqa University, Zarqa, Jordan.
- Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan.
| | - Brekhna Jamil
- Institute of Health Professions Education and Research, Khyber Medical University, Peshawar, Pakistan
| | - Mehboob Bushra
- Department of Oral and Maxillofacial Surgery, Peshawar Dental College, Peshawar, Pakistan
| | - Usman Mahboob
- Institute of Health Professions Education and Research, Khyber Medical University, Peshawar, Pakistan
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Robles EH, Castro Y, Najera S, Cardoso J, Gonzales R, Mallonee J, Segovia J, Salazar-Hinojosa L, De Vargas C, Field C. Men of Mexican ethnicity, alcohol use, and help-seeking: "I can quit on my own.". JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 163:209359. [PMID: 38677598 DOI: 10.1016/j.josat.2024.209359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 03/25/2024] [Accepted: 04/07/2024] [Indexed: 04/29/2024]
Abstract
INTRODUCTION Hispanics report higher rates of problematic alcohol use compared to non-Hispanic Whites while also reporting lower rates of alcohol treatment utilization compared to non-Hispanics. The study employs Anderson's Behavioral Model of Healthcare Utilization Model to guide the exploration of alcohol use, help-seeking and healthcare utilization. METHODS The present qualitative study explored help-seeking and alcohol treatment utilization for Hispanic men of Mexican ethnicity. A total of 27 participants (Mage = 35.7, SD = 10.82) completed a semi-structured interview that explored the treatment experiences and underlying psychological mechanisms that shaped their help-seeking. RESULTS Through a thematic content analysis, the following themes emerged: 1) perceiving need with subthemes of familismo, role as protector and provider, and positive face; 2) predisposing beliefs on help-seeking; and 3) treatment experiences and elements of patient satisfaction with subthemes of monetized treatment, respect, and perceiving professional stigma. CONCLUSIONS The findings in this article may assist in improving strategies for increasing alcohol treatment utilization among men of Mexican ethnicity. By exploring beliefs, values, and experiences health researchers can develop culturally informed intervention strategies.
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Affiliation(s)
- Eden Hernandez Robles
- Worden School of Social Service, Our Lady of the Lake University, United States of America.
| | - Yessenia Castro
- Steve Hicks School of Social Work, The University of Texas at Austin, United States of America
| | - Sarah Najera
- Department of Psychology, The University of Texas at El Paso, United States of America
| | - Juliana Cardoso
- Department of Psychology, Hastings College, United States of America
| | - Rubi Gonzales
- St. Louis School of Medicine, Washington University, United States of America
| | - Jason Mallonee
- Department of Social Work, The University of Texas at El Paso, United States of America
| | - Javier Segovia
- Worden School of Social Service, Our Lady of the Lake University, United States of America
| | | | - Cecilia De Vargas
- Department of Psychiatry, Texas Tech University Health Sciences Center El Paso, United States of America
| | - Craig Field
- Department of Psychology, The University of Texas at El Paso, United States of America
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Thomas EG, Goodarzi B, Frese H, Schoonmade LJ, Muntinga ME. Pregnancy experiences of transgender and gender-expansive individuals: A systematic scoping review from a critical midwifery perspective. Birth 2024. [PMID: 38766984 DOI: 10.1111/birt.12834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 01/15/2024] [Accepted: 05/02/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Evidence suggests that transgender and gender-expansive people are more likely to have suboptimal pregnancy outcomes compared with cisgender people. The aim of this study was to gain a deeper understanding of the role of midwifery in these inequities by analyzing the pregnancy experiences of transgender and gender-expansive people from a critical midwifery perspective. METHODS We conducted a systematic scoping review. We included 15 papers published since 2010 that reported on pregnancy experiences of people who had experienced gestational pregnancy at least once, and were transgender, nonbinary, or had other gender-expansive identities. RESULTS Three themes emerged from our analysis: "Navigating identity during pregnancy," "Experiences with mental health and wellbeing," and "Encounters in the maternal and newborn care system." Although across studies respondents reported positive experiences, both within healthcare and social settings, access to gender-affirmative (midwifery) care and daily social realities were often shaped by trans-negativity and transphobia. DISCUSSION To improve care outcomes of transgender and gender-expansive people, it is necessary to counter anti-trans ideologies by "fixing the knowledge" of midwifery curricula. This requires challenging dominant cultural norms and images around pregnancy, reconsidering the way in which the relationship among "sex," "gender," and "pregnancy" is understood and given meaning to in midwifery, and applying an intersectional lens to investigate the relationship between gender inequality and reproductive inequity of people with multiple, intersecting marginalized identities who may experience the accumulated impacts of racism, ageism, and classism. Future research should identify pedagogical frameworks that are suitable for guiding implementation efforts.
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Affiliation(s)
- Elias G Thomas
- Department of Internal Medicine, Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
- Department of Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, The Netherlands
| | - Bahareh Goodarzi
- Amsterdam Public Health, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, The Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, the Netherlands
- Department of General Practice & Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Linda J Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Maaike E Muntinga
- Amsterdam Public Health, Amsterdam, The Netherlands
- Department of Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, The Netherlands
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Jorissen A, van de Kant K, Ikiz H, van den Eertwegh V, van Mook W, de Rijk A. The importance of creating the right conditions for group intervision sessions among medical residents- a qualitative study. BMC MEDICAL EDUCATION 2024; 24:375. [PMID: 38580954 PMCID: PMC10996180 DOI: 10.1186/s12909-024-05342-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 03/22/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND The burnout rates among residents urge for adequate interventions to improve resilience and prevent burnout. Peer reflection, also called group intervision sessions, is a potentially successful intervention to increase the resilience of young doctors. We aimed to gain insight into the perceived added value of intervision sessions and the prerequisite conditions to achieve this, according to residents and intervisors. Our insights might be of help to those who think of implementing intervision sessions in their institution. METHODS An explorative, qualitative study was performed using focus groups and semi-structured interviews with both residents (n = 8) and intervisors (n = 6) who participated in intervision sessions in a university medical center in the Netherlands. The topic list included the perceived added value of intervision sessions and factors contributing to that. The interviews were transcribed verbatim and coded using NVivo. Thematic analysis was subsequently performed. RESULTS According to residents and intervisors, intervision sessions contributed to personal and professional identity development; improving collegiality; and preventing burn-out. Whether these added values were experienced, depended on: (1) choices made during preparation (intervisor choice, organizational prerequisites, group composition, workload); (2) conditions of the intervision sessions (safety, depth, role of intervisor, group dynamics, pre-existent development); and (3) the hospital climate. CONCLUSIONS Intervision sessions are perceived to be of added value to the identity development of medical residents and to prevent becoming burned out. This article gives insight in conditions necessary to reach the added value of intervision sessions. Optimizing preparation, meeting prerequisite conditions, and establishing a stimulating hospital climate are regarded as key to achieve this.
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Affiliation(s)
- Anouk Jorissen
- Department of Social Medicine, Care and Public Health, Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Kim van de Kant
- Academy for Postgraduate Medical Training, Maastricht University Medical Center, PO Box 5800, Maastricht, 6202 AZ, the Netherlands.
- Department of Family Medicine, Care and Public Health, Research Institute (CAPHRI), Maastricht University, PO Box 5800, Maastricht, 6202 AZ, the Netherlands.
| | - Habibe Ikiz
- Department of Gynecology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Valerie van den Eertwegh
- Skillslab, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Walther van Mook
- Academy for Postgraduate Medical Training, Maastricht University Medical Center, PO Box 5800, Maastricht, 6202 AZ, the Netherlands
- Intensive Care Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- School of Health Professions Education (SHE), Maastricht University, Maastricht, the Netherlands
| | - Angelique de Rijk
- Department of Social Medicine, Care and Public Health, Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
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Ekezie W, Cassambai S, Czyznikowska B, Curtis F, O'Mahoney LL, Willis A, Chudasama Y, Khunti K, Farooqi A. Health and social care experience and research perception of different ethnic minority populations in the East Midlands, United Kingdom (REPRESENT study). Health Expect 2024; 27:e13944. [PMID: 39102736 PMCID: PMC10733974 DOI: 10.1111/hex.13944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 08/07/2024] Open
Abstract
INTRODUCTION Ethnic minority populations experience significant health and social care disparities; despite experiencing a greater burden of diseases, these groups are underrepresented in health and social care research. Consequently, related research can be less applicable to these population groups. The REPRESENT study aims to explore the health and social care experiences of ethnic minorities and other minoritised populations, their research interests and appropriate research practices. METHODS Focus groups and semistructured interviews were conducted between May and September 2022 with members of a number of ethnic minority communities in England. Data were audio recorded, transcribed and thematically coded using NVivo 12. Rigour was determined through extensive sampling, iterative data collection and analysis. FINDINGS Fifty-two ethnic minority members were engaged in group interviews and one-to-one interviews. Participants included representatives of the following groups: African Caribbean, Eastern European, Gypsy Travellers, Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual+, Refugee/Asylum Seekers, Somali and South Asian communities. Interviews were also conducted with ethnic minority healthcare providers and researchers. Three overarching categories were identified: health information, medical service experiences, health and social care concerns and health research. Health and social care services challenges were mostly attributed to discrimination, delayed services, poor cultural relevance and language and cultural barriers. The most influential information sources were local community organisations and word-of-mouth. The main health and social care concerns were chronic long-term health conditions, mental health, maternal health and child development. Recommendations for research involved understanding the motivations for participation, improving communication and empowering communities. Top research priorities were long-term health conditions, health promotion and education, early care interventions and understanding community needs. INTERPRETATION Discrimination and bias in health and social care provision have severe implications for worsening ethnic health inequalities. Healthcare commissioning authorities and policymakers can leverage the preference of ethnic minority groups for pharmacy services and community organisations to improve access to care. Improving research interest and engagement requires understanding individual community needs, community sensitivity, research relevance and cultural appropriateness. PATIENT OR PUBLIC CONTRIBUTION Members of ethnic minority Patient and Public Involvement and Engagement group and Community Advisory Board supported the REPRESENT study design, conceptualisation and report development.
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Affiliation(s)
- Winifred Ekezie
- National Institute for Health and Social Care Research (NIHR), Applied Research CollaborationEast Midlands (ARC EM)LeicesterUK
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- Centre for Ethnic Health ResearchUniversity of LeicesterLeicesterUK
- Department of Sociology and PolicyAston UniversityBirminghamUK
| | - Shabana Cassambai
- National Institute for Health and Social Care Research (NIHR), Applied Research CollaborationEast Midlands (ARC EM)LeicesterUK
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- Centre for Ethnic Health ResearchUniversity of LeicesterLeicesterUK
| | - Barbara Czyznikowska
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- Centre for Ethnic Health ResearchUniversity of LeicesterLeicesterUK
| | - Ffion Curtis
- National Institute for Health and Social Care Research (NIHR), Applied Research CollaborationEast Midlands (ARC EM)LeicesterUK
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- Centre for Ethnic Health ResearchUniversity of LeicesterLeicesterUK
- Liverpool Reviews and Implementation Group (LRiG)University of Liverpool, Institute of Population HealthLiverpoolUK
| | - Lauren L. O'Mahoney
- National Institute for Health and Social Care Research (NIHR), Applied Research CollaborationEast Midlands (ARC EM)LeicesterUK
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
| | - Andrew Willis
- National Institute for Health and Social Care Research (NIHR), Applied Research CollaborationEast Midlands (ARC EM)LeicesterUK
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- Centre for Ethnic Health ResearchUniversity of LeicesterLeicesterUK
- HRB Clinical Research Facility & School of Public HealthUniversity College CorkIreland
| | - Yogini Chudasama
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- Leicester Real World EvidenceUniversity of LeicesterLeicesterUK
| | - Kamlesh Khunti
- National Institute for Health and Social Care Research (NIHR), Applied Research CollaborationEast Midlands (ARC EM)LeicesterUK
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- Centre for Ethnic Health ResearchUniversity of LeicesterLeicesterUK
- Leicester Real World EvidenceUniversity of LeicesterLeicesterUK
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Griffin CP, Bowen JR, Walker MM, Lynam J, Paul CL. Understanding the value of brain donation for research to donors, next-of-kin and clinicians: A systematic review. PLoS One 2023; 18:e0295438. [PMID: 38117774 PMCID: PMC10732432 DOI: 10.1371/journal.pone.0295438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/21/2023] [Indexed: 12/22/2023] Open
Abstract
PURPOSE Post-mortem brain donation affords the opportunity to characterise disease by exploring global neuropathological changes. Such opportunities are essential to progress knowledge of CNS tumours such as Glioblastoma. A comprehensive understanding of the experience of consenting to brain donation is crucial to maximising consent rates while providing patient-centred care. This review aimed to synthesise the reported facilitators and barriers according to potential donors, next-of-kin (NOK) and clinician respondents. DESIGN Database searches included Embase, Medline, PsycINFO, Psychology and Behavioural Science and Scopus. Search terms focused on motivations, attitudes and psychosocial experiences of brain donation. Exclusions included organ transplantation and brain death. All studies were assessed for quality and validity using tools from the Joanna Briggs Institute. To determine perceptions of benefit and harm, a method guided by the thematic analysis of Braun and Clarke was employed to reflexively assess and identify common themes and experiences. RESULTS 40 studies (15 qualitative, 25 quantitative) were included involving participants with paediatric cancer, neurodegenerative and psychological diseases. Perceptions of benefit included benefit to future generations, aiding scientific research, avoidance of waste, improved treatments and the belief that donation will bring consolation or aid in the grieving process. Perceptions of harm included a perceived conflict with religious beliefs, disfigurement to the donor, emotional distress at the time of autopsy and discord or objections within the family. CONCLUSION Brain donation can afford a sense of purpose, meaning and empowerment for donors and their loved ones. Careful strategies are required to mitigate or reduce potential harms during the consent process.
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Affiliation(s)
- Cassandra P. Griffin
- College of Health, Medicine and Wellbeing University of Newcastle, Tamworth, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Jenna R. Bowen
- College of Health, Medicine and Wellbeing University of Newcastle, Tamworth, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Marjorie M. Walker
- College of Health, Medicine and Wellbeing University of Newcastle, Tamworth, NSW, Australia
| | - James Lynam
- College of Health, Medicine and Wellbeing University of Newcastle, Tamworth, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- Department of Medical Oncology, Calvary Mater, Newcastle, NSW, Australia
| | - Christine L. Paul
- College of Health, Medicine and Wellbeing University of Newcastle, Tamworth, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- Priority Research Centre Cancer Research, Innovation and Translation, University of Newcastle, Callaghan, Australia
- Priority Research Centre Health Behaviour, University of Newcastle, Callaghan, Australia
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Burch J, Taylor C, Wilson A, Norton C. "You're just on your own": Exploring bowel symptom management needs after rectal cancer surgery through patient and clinician focus groups. Eur J Oncol Nurs 2023; 67:102406. [PMID: 37804751 DOI: 10.1016/j.ejon.2023.102406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 07/11/2023] [Accepted: 08/26/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE Currently cancer survivorship often leaves the needs of patients unidentified and unmet. The study aims to establish the views of experts on managing bowel symptoms following rectal cancer surgery. METHOD People living with bowel symptoms as well as clinicians with expertise in rectal cancer and subsequent bowel changes were invited to participate in online focus groups. Focus groups were recorded, transcribed verbatim and analysed using a modified framework analysis. Results were presented narratively with interpretations and quotations. RESULTS Fourteen patients following rectal cancer treatment attended one of two focus groups. Sixteen clinicians attended one of four groups. Participants described their opinions about bowel symptom management. Three themes were described by both patients and clinicians: expectations of bodily changes, supported self-repair and knowledgeable self-repair. Data from participants frequently concurred; all recognised clinicians needed to support and empower patients to independently manage their cancer consequences. CONCLUSION Well-managed expectations enable patients to set realistic goals and make plans. Clinicians need to support patients to understand potential bowel changes that might occur after rectal cancer surgery, providing support, information and signposting to other relevant information and colleagues. Effective communication through avoidance of jargon and rapport building as well as providing a point of contact help prevent patients feeling alone with their symptoms. Education is needed by both clinicians and patients to ensure consistent and useful advice is provided and understood. A recommendation from the focus groups is to create opportunities for patients to access information with clinician support and signposting.
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Affiliation(s)
- Jennie Burch
- Department of Surgery, St Mark's Hospital, London, UK.
| | - Claire Taylor
- Department of Surgery, London North West University Healthcare NHS Trust, London, UK
| | - Ana Wilson
- Wolfson Unit for Endoscopy, St Mark's Hospital and Department of Surgery and Cancer, Imperial College London, UK
| | - Christine Norton
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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Clark KD, Coco L, Zaugg T, DeFrancesco S, Kaelin C, Henry JA, Carlson KF. A Qualitative Study of Veterans' Perspectives on Tinnitus: An Invisible Wound. Am J Audiol 2023:1-14. [PMID: 37983172 DOI: 10.1044/2023_aja-23-00040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023] Open
Abstract
PURPOSE Tinnitus is highly prevalent among U.S. military Veterans, yet referral to, and use of, tinnitus rehabilitation services to improve quality of life and functional status with tinnitus is low. Veterans with tinnitus often have other health issues that overlap or exacerbate the impact of tinnitus, potentially complicating referral and rehabilitative pathways. This qualitative study explores views on the daily impacts of tinnitus and experiences with tinnitus-related health care among Veterans. The goal of this research is to amplify the voices of Veterans regarding their experiences with tinnitus to illuminate the physiological and socioemotional sequelae associated with the condition and to increase clinician awareness of the complex, interdisciplinary rehabilitative needs among Veterans with bothersome tinnitus. METHOD This qualitative study was part of a larger study about tinnitus and traumatic brain injury (TBI). Veterans were sampled to represent national Department of Veterans Affairs (VA) users with and without comorbid TBI, and who were or were not interested in tinnitus rehabilitation services. Forty Veterans with tinnitus were interviewed (32 men, eight women). Data were analyzed using a modified grounded theory approach. RESULTS Major themes across the Veteran interviews included (a) functional effects of tinnitus on daily life, (b) tinnitus and other health conditions, (c) reactions to the lack of a cure for tinnitus, (d) strategies to improve quality of life and function, and (e) use of VA services for tinnitus. CONCLUSIONS Our findings highlight that bothersome tinnitus negatively impacted various aspects of daily functioning, including communication, sleep, concentration, and mood, suggesting a need for audiologists to work closely with mental health services to improve quality of life and functional status for those negatively impacted by the condition. Future work is needed to obtain the viewpoints of clinicians and other health care partners to better understand the barriers and facilitators to providing evidence-based tinnitus treatment in VA and non-VA settings.
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Affiliation(s)
- Khaya D Clark
- VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland
- VA Health Services Research & Development Center of Innovation, Center to Improve Veteran Involvement in Care, VA Portland Health Care System, OR
| | - Laura Coco
- VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
- VA Health Services Research & Development Center of Innovation, Center to Improve Veteran Involvement in Care, VA Portland Health Care System, OR
- Department of Otolaryngology-Head & Neck Surgery, School of Medicine, Oregon Health and Science University, Portland
- School of Speech, Language, and Hearing Sciences, San Diego State University, CA
| | - Tara Zaugg
- School of Speech, Language, and Hearing Sciences, San Diego State University, CA
| | - Susan DeFrancesco
- VA Health Services Research & Development Center of Innovation, Center to Improve Veteran Involvement in Care, VA Portland Health Care System, OR
- Oregon Health and Science University-Portland State University School of Public Health
| | - Christine Kaelin
- VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
| | - James A Henry
- VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
- Department of Otolaryngology-Head & Neck Surgery, School of Medicine, Oregon Health and Science University, Portland
| | - Kathleen F Carlson
- VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
- VA Health Services Research & Development Center of Innovation, Center to Improve Veteran Involvement in Care, VA Portland Health Care System, OR
- Oregon Health and Science University-Portland State University School of Public Health
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Bains K, Bicknell S, Jovanović N, Conneely M, McCabe R, Copello A, Fletcher-Rogers J, Priebe S, Janković J. Healthcare professionals' views on the accessibility and acceptability of perinatal mental health services for South Asian and Black women: a qualitative study. BMC Med 2023; 21:370. [PMID: 37784145 PMCID: PMC10546637 DOI: 10.1186/s12916-023-02978-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/13/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Perinatal mental illness affects one third of new and expectant mothers. Individuals from ethnic minority groups experience higher rates of mental health problems and higher suicide rates. Despite this, women from ethnic minorities-Black and South Asian women in particular-are less likely to receive support from mental health services in the perinatal period. Healthcare professionals (HCPs) who have contact with women during this period have a unique perspective, and their views may provide insights to understand and remedy this health inequality. This study aimed to identify healthcare professionals' views on the current accessibility and acceptability of perinatal mental health services, and ways of improving services by addressing the barriers for these women. METHODS Semi-structured interviews were conducted with twenty-four healthcare professionals who work with patients in the perinatal period. Purposive sampling was used to select HCPs from a range of different professions (including mental health staff, midwifery, primary care, social care). The data were analysed using Framework Analysis. RESULTS Three main themes were identified from the data: (1) lack of awareness and understanding of perinatal mental illness and service structure in both healthcare professionals and patients; (2) patients' relationships with family, friends and healthcare professionals can both hinder and facilitate access to services; (3) healthcare professionals encourage raising awareness, flexibility, developing shared understandings and questioning assumptions to improve the accessibility and acceptability of services. CONCLUSION Key insights into explaining and remedying the health inequalities observed between ethnic groups were proposed by healthcare professionals. Recommendations included sharing information; taking steps to ensure each woman was considered as an individual in her relationship with her culture, ethnicity and childrearing practices; and healthcare professionals addressing their possible unconscious biases through engaging in personal reflexive practices. Reasons these are currently not being implemented deserve further research, and the potential of novel roles such as peer support workers in bridging the space between ideals and practice needs further investigation.
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Affiliation(s)
- Kiren Bains
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK.
| | - Sarah Bicknell
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Nikolina Jovanović
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary, University of London, London, UK
- East London NHS Foundation Trust, London, UK
| | - Maev Conneely
- East London NHS Foundation Trust, London, UK
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, UK
| | - Rosemarie McCabe
- School of Health and Psychological Sciences, City University of London, London, UK
| | - Alex Copello
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
- School of Psychology, University of Birmingham, Birmingham, UK
| | | | - Stefan Priebe
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, UK
| | - Jelena Janković
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
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Vader K, Donnelly C, Lane T, Newman G, Tripp DA, Miller J. Delivering Team-Based Primary Care for the Management of Chronic Low Back Pain: An Interpretive Description Qualitative Study of Healthcare Provider Perspectives. Can J Pain 2023; 7:2226719. [PMID: 37701549 PMCID: PMC10494733 DOI: 10.1080/24740527.2023.2226719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 09/14/2023]
Abstract
Background Chronic low back pain (LBP) is a prevalent and disabling health issue. Team-based models of primary care are ideally positioned to provide comprehensive care for patients with chronic LBP. A better understanding of primary care team perspectives can inform future efforts to improve how team-based care is provided for patients with chronic LBP in this practice setting. Aims The aim of this study was to understand health care providers' experiences, perceived barriers and facilitators, and recommendations when providing team-based primary care for the management of chronic LBP. Methods We conducted an interpretive description qualitative study based on focus group discussions with health care providers from team-based primary care settings in Ontario, Canada. Data were analyzed using thematic analysis. Results We conducted five focus groups with five different primary care teams, including a total of 31 health care providers. We constructed four themes (each with subthemes) related to experiences, perceived barriers and facilitators, and recommendations to providing team-based primary care for the management of chronic LBP, including (1) care pathways and models of service delivery, (2) team processes and organization, (3) team culture and environment, and (4) patient needs and readiness. Conclusions Primary care teams are implementing diverse care pathways and models of service delivery for the management of patients with chronic LBP, which can be influenced by patient, team, and organizational factors. Results have potential implications for future research and practice innovations to improve how team-based primary care is delivered for patients with chronic LBP.
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Affiliation(s)
- Kyle Vader
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - Catherine Donnelly
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - Therese Lane
- Chronic Pain Network, McMaster University, Hamilton, Ontario, Canada
- Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Gillian Newman
- Patient Engagement Research Ambassadors, Institute of Musculoskeletal Health and Arthritis, Canadian Institutes of Health Research, Toronto, Ontario, Canada
- Curvy Girls Scoliosis, Toronto, Ontario, Canada
| | - Dean A. Tripp
- Department of Psychology, Queen’s University, Kingston, Ontario, Canada
- Department of Anesthesiology, Queen’s University, Kingston, Ontario, Canada
- Department of Urology, Queen’s University, Kingston, Ontario, Canada
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
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Shaughnessy AF, Vicini Sj A, Zgurzynski M, O'Reilly-Jacob M, Duggan AP. Indicators of the dimensions of trust (and mistrust) in early primary care practice: a qualitative study. BMC PRIMARY CARE 2023; 24:150. [PMID: 37468845 PMCID: PMC10357788 DOI: 10.1186/s12875-023-02098-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 07/03/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Trust occurs when persons feel they can be vulnerable to others because of the sincerity, benevolence, truthfulness and sometimes the competence they perceive. This project examines the various types of trust expressed in written reflections of developing healthcare clinicians. Our goal is to understand the roles trust plays in residents' self-examination and to offer insight from relationship science to inform the teaching and clinical work for better trust in healthcare. METHODS We analyzed 767 reflective writings of 33 residents submitted anonymously, to identify explicit or implicit indicators attention to trust or relationship development. Two authors independently coded the entries based on inductively identified dimensions. Three authors developed a final coding structure that was checked against the entries. These codes were sorted into final dimensions. RESULTS We identified 114 written reflections that contained one or more indicators of trust. These codes were compiled into five code categories: Trust of self/trust as the basis for confidence in decision making; Trust of others in the medical community; Trust of the patient and its effect on clinician; Assessment of the trust of them exhibited by the patient; and Assessment of the effect of the patient's trust on the patient's behavior. DISCUSSION Broadly, trust is both relationship-centered and institutionally situated. Trust is a process, built on reciprocity. There is tacit acknowledgement of the interplay among what the residents do is good for the patient, good for themselves, and good for the medical institution. An exclusive focus on moments in which trust is experienced or missed, as well as only on selected types of trust, misses this complexity. CONCLUSION A greater awareness of how trust is present or absent could lead to a greater understanding and healthcare education for beneficial effects on clinicians' performance, personal and professional satisfaction, and improved quality in patients' interactions.
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Affiliation(s)
- Allen F Shaughnessy
- Department of Family Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Andrea Vicini Sj
- Theology Department, Boston College, 140 Commonwealth Ave, Chestnut Hill, MA, USA
| | - Mary Zgurzynski
- Undergraduate Student, Boston College, 140 Commonwealth Ave, Chestnut Hill, MA, 02467, USA
| | - Monica O'Reilly-Jacob
- William F. Connell School of Nursing, Boston College, 140 Commonwealth Ave, Chestnut Hill, MA, USA
| | - Ashley P Duggan
- Department of Family Medicine, Tufts University School of Medicine, Boston, MA, USA.
- Communication Department, Boston College, 140 Commonwealth Ave, Chestnut Hill, MA, USA.
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23
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Affiliation(s)
- Gillian Wilson
- School of Nursing and Midwifery, University of Hull, Hull, UK
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24
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Barnes K, Hladkowicz E, Dorrance K, Bryson GL, Forster AJ, Gagné S, Huang A, Lalu MM, Lavallée LT, Saunders C, Moloo H, Nantel J, Power B, Scheede-Bergdahl C, Taljaard M, van Walraven C, McCartney CJL, McIsaac DI. Barriers and facilitators to participation in exercise prehabilitation before cancer surgery for older adults with frailty: a qualitative study. BMC Geriatr 2023; 23:356. [PMID: 37280523 DOI: 10.1186/s12877-023-03990-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 04/22/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Older adults with frailty are at an increased risk of adverse outcomes after surgery. Exercise before surgery (exercise prehabilitation) may reduce adverse events and improve recovery after surgery. However, adherence with exercise therapy is often low, especially in older populations. The purpose of this study was to qualitatively assess the barriers and facilitators to participating in exercise prehabilitation from the perspective of older people with frailty participating in the intervention arm of a randomized trial. METHODS This was a research ethics approved, nested descriptive qualitative study within a randomized controlled trial of home-based exercise prehabilitation vs. standard care with older patients (≥ 60 years) having elective cancer surgery, and who were living with frailty (Clinical Frailty Scale ≥ 4). The intervention was a home-based prehabilitation program for at least 3 weeks before surgery that involved aerobic activity, strength and stretching, and nutritional advice. After completing the prehabilitation program, participants were asked to partake in a semi-structured interview informed by the Theoretical Domains Framework (TDF). Qualitative analysis was guided by the TDF. RESULTS Fifteen qualitative interviews were completed. Facilitators included: 1) the program being manageable and suitable to older adults with frailty, 2) adequate resources to support engagement, 3) support from others, 4) a sense of control, intrinsic value, noticing progress and improving health outcomes and 5) the program was enjoyable and facilitated by previous experience. Barriers included: 1) pre-existing conditions, fatigue and baseline fitness, 2) weather, and 3) guilt and frustration when unable to exercise. A need for individualization and variety was offered as a suggestion by participants and was therefore described as both a barrier and facilitator. CONCLUSIONS Home-based exercise prehabilitation is feasible and acceptable to older people with frailty preparing for cancer surgery. Participants identified that a home-based program was manageable, easy to follow with helpful resources, included valuable support from the research team, and they reported self-perceived health benefits and a sense of control over their health. Future studies and implementation should consider increased personalization based on health and fitness, psychosocial support and modifications to aerobic exercises in response to adverse weather conditions.
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Affiliation(s)
- Keely Barnes
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Emily Hladkowicz
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kristin Dorrance
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Gregory L Bryson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, The Ottawa Hospital Civic Campus, Room B311, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
| | - Alan J Forster
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Division of General Internal Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Canada
| | - Sylvain Gagné
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, The Ottawa Hospital Civic Campus, Room B311, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
| | - Allen Huang
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Division of Geriatric Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Canada
| | - Manoj M Lalu
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, The Ottawa Hospital Civic Campus, Room B311, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
| | - Luke T Lavallée
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Division of Urology, University of Ottawa and The Ottawa Hospital, Ottawa, Canada
| | - Chelsey Saunders
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, The Ottawa Hospital Civic Campus, Room B311, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
| | - Hussein Moloo
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Division of General Surgery, University of Ottawa and The Ottawa Hospital, Ottawa, Canada
| | - Julie Nantel
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Barbara Power
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Division of Geriatric Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Canada
| | | | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Canada
| | - Carl van Walraven
- Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, The Ottawa Hospital Civic Campus, Room B311, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
- Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Canada
| | - Colin J L McCartney
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, The Ottawa Hospital Civic Campus, Room B311, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
| | - Daniel I McIsaac
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
- Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, The Ottawa Hospital Civic Campus, Room B311, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada.
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Canada.
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Young A, Charania NA, Gauld N, Norris P, Turner N, Willing E. Informing women about maternal vaccination in Aotearoa New Zealand: Is it effective? Midwifery 2023; 120:103636. [PMID: 36827756 DOI: 10.1016/j.midw.2023.103636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/06/2023] [Accepted: 02/14/2023] [Indexed: 02/20/2023]
Affiliation(s)
- Amber Young
- School of Pharmacy, University of Otago, PO Box 56, Dunedin 9054, New Zealand.
| | - Nadia A Charania
- Department of Public Health, School of Public Health and Interdisciplinary Studies, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand
| | - Natalie Gauld
- Department of Paediatrics: Child and Youth Health, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; School of Pharmacy, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Pauline Norris
- Va'a o Tautai-Centre for Pacific Health, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - Nikki Turner
- Immunisation Advisory Centre, University of Auckland, Grafton Campus, Building 507, Level 3, 22-30 Park Avenue, Grafton, Auckland 1023, New Zealand
| | - Esther Willing
- Kōhatu-Centre for Hauora Māori, Otago Medical School, University of Otago, PO Box 56, Dunedin 9054, New Zealand
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Tarfa A, Pecanac K, Shiyanbola OO. A qualitative inquiry into the patient-related barriers to linkage and retention in HIV care within the community setting. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 9:100207. [PMID: 36568895 PMCID: PMC9772845 DOI: 10.1016/j.rcsop.2022.100207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/07/2022] Open
Abstract
Background People with the Human Immunodeficiency Virus (PWH) experience barriers to care within the community that impedes their progress from when they discover that they are HIV positive to becoming virally suppressed. For individuals with HIV to achieve sustained viral suppression, they must be linked to care to start receiving anti-retroviral therapy and remain retained in care for continuous treatment. However, HIV surveillance data shows that many PWH are not linked to care and become lost to continuous follow-up care. Although pharmacists, PWH, and social workers interact with one another and are aware of their roles in HIV care, their perspectives on barriers to linkage and retention in care have not been investigated collectively. Objectives Explore the perspectives of PWH, pharmacists, and social workers on barriers to linkage and retention of HIV care within the community setting. Methods Convenience sampling was used to recruit 15 stakeholders (five PWH, five community pharmacists, and five social workers) who participated in 1-h, semi-structured interviews based on three domains of the Patient-centered Medical Home Model including (1) experiences (individual and system-level barriers to care experienced by PWH), (2) activities (social workers and pharmacists initiatives that impact adherence to care)and (3) interventions (critical issues pharmacists can address in the community to engage PWH in their HIV care). We conducted a directed content analysis based on deductive coding. To establish rigor, we focused on Lincoln and Guba's criteria of rigorous qualitative methodology: credibility, dependability, confirmability, and transferability. Similarities and divergences of themes were discussed during data analysis and agreement was reached before interpretation. Results Emergent themes uncovered barriers to linkage and retention in HIV care as HIV-related stigma, having mental health illnesses including a history of substance abuse and social determinants of health such as homelessness, food insecurity, and insurance issues. Conclusion The perspectives of pharmacists, social workers, and PWH can provide insight into barriers that should be identified and addressed in people living with HIV to enhance their linkage and retention in care.
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Affiliation(s)
- Adati Tarfa
- 2506 Rennebohm Hall, School of Pharmacy, University of Wisconsin, 777 Highland Ave., Madison, WI 53705-222, United States of America,Corresponding author.
| | - Kristen Pecanac
- 4167 Signe Skott Cooper Hall, University of Wisconsin, 701 Highland Avenue, Madison, WI 53705, United States of America
| | - Olayinka O. Shiyanbola
- 2517 Rennebohm Hall, School of Pharmacy, University of Wisconsin, 777 Highland Ave., Madison, WI 53705-222, United States of America
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Stechler N, Henton I. "If only he were blind": Shame, trauma, and dissociation among women with body dysmorphic disorder in physically intimate relationships. Int J Qual Stud Health Well-being 2022; 17:2015871. [PMID: 35037584 PMCID: PMC8774146 DOI: 10.1080/17482631.2021.2015871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Body Dysmorphic Disorder (BDD) involves a debilitating preoccupation with one's appearance and associated difficulties in social and interpersonal relationships, according to the Diagnostic and Statistical Manual for Mental Disorders (DSM-5). Quantitative research has investigated the severity of relationship difficulties in BDD, while qualitative research has primarily focused on intrapersonal phenomena, although interpersonal difficulties, including with physical intimacy, have frequently emerged from these studies. AIMS This study explores how women with BDD make sense of their lived experiences of physical intimacy in the context of current partner relationships. METHOD Six adult women participated in individual semi-structured interviews. The data was analysed using Interpretative Phenomenological Analysis. RESULTS The analysis generated three superordinate themes: 1) The shame in being seen, 2) Disgust and detachment during intimacy, and 3) A flawed self, unworthy of relationships. CONCLUSIONS This study demonstrates how appearance-related concerns filter into the cognitive, behavioural, and emotional intersubjective spaces of physically intimate partnerships. Shame or trauma may be triggered and may be managed through disengagement or dissociation. CLINICAL IMPLICATIONS These findings support calls for a full psychological assessment of the contextual and interpersonal components of BDD, and further suggest that psychological interventions for shame, trauma, and dissociation, such as compassion-focused therapy, imagery rescripting, or body-focused therapies, may be helpful additions to cognitive-behavioural or exposure and response prevention interventions for practitioners working with BDD.
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Affiliation(s)
- Natalie Stechler
- Department of Counselling Psychology, Regent's University London, Inner Circle, Regent's Park, London, NW14NS
| | - Isabel Henton
- Department of Counselling Psychology, Regent's University London, Inner Circle, Regent's Park, London, NW14NS
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Shahabi S, Skempes D, Mojgani P, Bagheri Lankarani K, Heydari ST. Stewardship of physiotherapy services in Iran: common pitfalls and policy solutions. Physiother Theory Pract 2022; 38:2086-2099. [PMID: 33760676 DOI: 10.1080/09593985.2021.1898705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 11/15/2020] [Accepted: 01/30/2021] [Indexed: 02/08/2023]
Abstract
Physiotherapy (PT) is a key component of the rehabilitative health strategy and an effective approach to the management and treatment of a wide range of health conditions. However, it remains underdeveloped and poorly implemented in many national health systems. Previous studies show that weak stewardship of rehabilitation services is, among others, a significant barrier to equitable access to services and supports in many parts of the world, including in Iran. This study investigated the common pitfalls and potential policy solutions to improve the stewardship of PT services in Iran from the perspective of key stakeholders. Semi-structured interviews were conducted by telephone, via the internet, and in face-to-face sessions in Iran with a purposive sample of health planners and policy decision-makers, university professors, rehabilitation managers, and physiotherapists. In total, 30 individuals agreed to participate. Participants identified several pitfalls across the six dimensions of stewardship: 1) strategy formulation; 2) inter-sectoral collaboration; 3) governance and accountability; 4) health system design; 5) policy and regulation; and 6) intelligence generation. In addition, several policy options and solutions to address critical deficiencies in the system were suggested to improve the stewardship of PT services. The study identified challenges and pitfalls affecting the stewardship of the PT sector in Iran as perceived by key stakeholders. Participants' insights can inform deliberative dialogue processes, agenda-setting, and strategy formulation to support the development, expansion, and implementation of PT services.
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Affiliation(s)
- Saeed Shahabi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, School of Medicine, Shiraz, Iran
| | - Dimitrios Skempes
- Disability Policy and Implementation Research Group, Swiss Paraplegic Research (SPF), Nottwil, Switzerland
| | - Parviz Mojgani
- Iran-Helal Institute of Applied Science and Technology, Tehran
- Research Center for Emergency and Disaster Resilience, Red Crescent Society of The Islamic Republic of Iran, Tehran, Tehran
| | - Kamran Bagheri Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, School of Medicine, Shiraz, Iran
| | - Seyed Taghi Heydari
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, School of Medicine, Shiraz, Iran
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Denney KE, Anderson KL, Watson JM. Exploring the communication needs and challenges of adults with autism spectrum disorders: Communication partners' perspectives. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:607-615. [PMID: 35044885 DOI: 10.1080/17549507.2022.2027520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Purpose: Individuals with autism spectrum disorders (ASD) and Complex Communication Needs (CCN) require additional support from communication partners in order to communicate effectively. This study aimed to address a current gap in the literature by exploring communication partners' perspectives of their role. Method: A qualitative multiple case study design was used. The sample consisted of four participants who represented a diverse range of relationships with adults with ASD and CCN. Individual, in-depth, semi-structured interviews were conducted. Interview transcripts were analysed using the Framework Method of thematic analysis. Result: Four key themes were identified: (1) respecting the individual (2) flexibility (3) reaching beyond the dyad and (4) underlying beliefs. Due to the diverse range of relationships represented in this study, each case provided a unique perspective and therefore the results of each individual case were contrasted within each theme. Conclusion: The findings of this study highlight the crucial role that communication partners play in enabling interactions with adults who have ASD and CCN. Additionally, these findings provide preliminary evidence to support an expansion of the existing framework of communicative competence for individuals with CCN. Future research should aim to expand on these findings in order to investigate their generalisability.
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Affiliation(s)
- Kathleen E Denney
- School of Health and Social Development, Deakin University, Melbourne, Australia
| | - Kate L Anderson
- School of Health and Social Development, Deakin University, Melbourne, Australia
| | - Joanne M Watson
- School of Health and Social Development, Deakin University, Melbourne, Australia
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Harvey G, Carter-Snell C. Exploring the meaning of critical incident stress experienced by undergraduate nursing students: A hermeneutic study. Nurse Educ Pract 2022; 65:103465. [DOI: 10.1016/j.nepr.2022.103465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022]
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Hladkowicz E, Dorrance K, Bryson GL, Forster A, Gagne S, Huang A, Lalu MM, Lavallée LT, Moloo H, Squires J, McIsaac DI. Identifying barriers and facilitators to routine preoperative frailty assessment: a qualitative interview study. Can J Anaesth 2022; 69:1375-1389. [PMID: 35978162 DOI: 10.1007/s12630-022-02298-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/20/2022] [Accepted: 05/19/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Preoperative frailty assessment is recommended by multiple practice guidelines and may improve outcomes, but it is not routinely performed. The barriers and facilitators of routine preoperative frailty assessment have not been formally assessed. Our objective was to perform a theory-guided evaluation of barriers and facilitators to preoperative frailty assessment. METHODS This was a research ethics board-approved qualitative study involving physicians who perform preoperative assessment (consultant and resident anesthesiologists and consultant surgeons). Semistructured interviews were conducted by a trained research assistant informed by the Theoretical Domains Framework to identify barriers and facilitators to frailty assessment. Interview transcripts were independently coded by two research assistants to identify specific beliefs relevant to each theoretical domain. RESULTS We interviewed 28 clinicians (nine consultant anesthesiologists, nine consultant surgeons, and ten anesthesiology residents). Six domains (Knowledge [100%], Social Influences [96%], Social Professional Role and Identity [96%], Beliefs about Capabilities [93%], Goals [93%], and Intentions [93%]) were identified by > 90% of respondents. The most common barriers identified were prioritization of other aspects of assessment (e.g., cardio/respiratory) and a lack of awareness of evidence and guidelines supporting frailty assessment. The most common facilitators were a high degree of familiarity with frailty, recognition of the importance of frailty assessment, and strong intentions to perform frailty assessment. CONCLUSION Barriers and facilitators to preoperative frailty assessment are multidimensional, but generally consistent across different types of perioperative physicians. Knowledge of barriers and facilitators can guide development of evidence-based strategies to increase frailty assessment.
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Affiliation(s)
- Emily Hladkowicz
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Kristin Dorrance
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Gregory L Bryson
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Alan Forster
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Departments of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Sylvain Gagne
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Allen Huang
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Departments of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Manoj M Lalu
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Luke T Lavallée
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of Urology, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Husein Moloo
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of General Surgery, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Janet Squires
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada.
- Department of Anesthesiology, The Ottawa Hospital Civic Campus, Room B311, 1053 Carling Ave., Ottawa, ON, K1Y 4E9, Canada.
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Buys T, Casteleijn D, Heyns T, Untiedt H. A Reflexive Lens on Preparing and Conducting Semi-structured Interviews with Academic Colleagues. QUALITATIVE HEALTH RESEARCH 2022; 32:2030-2039. [PMID: 36194785 DOI: 10.1177/10497323221130832] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In qualitative research, researchers often conduct semi-structured interviews with people familiar to them, but there are limited guidelines for researchers who conduct interviews to obtain curriculum-related information with academic colleagues who work in the same area of practice but at different higher education institutions. Using a pragmatic constructivist stance, we address the practicalities of conducting semi-structured interviews with fellow educators who work in the same area of professional practice, where the researcher has to address the dual roles of "insider" and "outsider" as well as that of researcher and participant. Interviewing academic colleagues offers a unique opportunity for rich data collection, but researchers should adopt a flexible conversational style during interviewing within research parameters and be acutely aware of their positionality and fluidity of roles. This article contributes to existing knowledge by drawing on the work of previous scholars in various areas of research and research methodology thereby offering a practical and theoretical perspective on conducting qualitative research interviewing in higher education institutions where the role of researcher and participant can become blurred. These guidelines and insights will also benefit researchers who conduct research with peers who work together in the same area of expertise, in similar contexts and with whom there are varying levels of working relationships.
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Affiliation(s)
- Tania Buys
- Department of Occupational Therapy, Faculty of Health Sciences, 72042University of Pretoria, Arcadia, South Africa
- Department of Occupational Therapy, Faculty of Health Sciences, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Daleen Casteleijn
- Department of Occupational Therapy, Faculty of Health Sciences, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tanya Heyns
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Arcadia, South Africa
| | - Hannelie Untiedt
- Department of Education Innovation, Faculty of Health Sciences, 72042University of Pretoria, Arcadia, South Africa
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Gilmore A, Saheb R, Reis A. Exploring experiences of a telephone crisis support workplace training program in Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4574-e4584. [PMID: 35689425 DOI: 10.1111/hsc.13861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/27/2021] [Accepted: 05/28/2022] [Indexed: 06/15/2023]
Abstract
Telephone crisis support (TCS) is considered by the World Health Organization to be an integral part of an effective suicide prevention framework. However, as TCS lines worldwide are primarily staffed by volunteers, they frequently experience high staff turnover impacting on their ability to provide crucial crisis counselling to the population. One group that has been identified as potentially lessening staff shortages is university students, who may be attracted to TCS as a way to gain professional experience and qualifications. However, challenges are associated with the recruitment of this cohort, due to the potential impacts working in crisis support may have on the well-being of a group that is identified as being at higher risk of poor mental health. This study used semi-structured interviews, conducted between March and May 2020, to explore university students' experiences of a Crisis Support Workplace Training Program. It included 16 university students who completed (fully or partially) the training programme. Thematic analysis was used to identify patterns across the dataset. NVivo 12© was used throughout the analysis to assist with organisation and coding of data. Two overarching themes were identified: 1) Becoming and being the role, and 2) Experiencing and managing barriers to helping. Results illustrate how students experienced varying levels of distress due to empathetic engagement with callers, while also highlight the impact of students' experiences on the development of their professional identities. This study is amongst the first to examine the perceptions and experiences of training for and delivering TCS, and the first to focus specifically on university students as volunteer workers. The study's findings highlight the challenges participants face in undertaking crisis support training and our discussions provide a range of recommendations for future practice and research.
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Affiliation(s)
- Amanda Gilmore
- School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
| | - Rowena Saheb
- Mental Health and Wellbeing Promotions Team, Western Sydney University, Penrith, New South Wales, Australia
| | - Arianne Reis
- School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
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Allen EM, Frisancho A, Llanten C, Knep ME, Van Skiba MJ. Community Health Agents Advancing Women's Empowerment: A Qualitative Data Analysis. J Community Health 2022; 47:806-813. [PMID: 35749009 PMCID: PMC9477897 DOI: 10.1007/s10900-022-01107-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 11/30/2022]
Abstract
Community health agents (CHAs) play a critical role in primary healthcare delivery and health promotion in low-resource settings. Though there is substantial evidence of the benefits of CHAs in achieving targeted community health outcomes, there is limited research into the impact of empowerment experienced by CHAs themselves. This study examined how working as a CHA impacts the lives and self-perceptions of women in Peru volunteering with Catholic Medical Mission Board’s (CMMB) markedly successful robust CHA model. We conducted six focus group discussions (FGDs) of 53 CHAs who implement CMMB programming in Trujillo and Huancayo, Peru. The FGDs were designed to explore themes related to empowerment, changes in women’s lives, and perceptions of themselves. We identified four major themes related to women’s empowerment: achievements, agency, meaningfulness, and resources. The most common empowerment theme was achievements, expressed through subthemes of changes in family behavior, self worth, education, health and nutrition, and rights and politics. The second most common empowerment theme was agency, with subthemes related to increases in using their voice, confidence, decision making, and participation. CHAs also reported experiencing empowerment through enhanced meaningfulness. CMMB’s CHA model is an example of how well-structured community programs can facilitate women’s empowerment. Providing meaningful community leadership opportunities can have far-reaching effects on women’s perceptions of themselves as valuable, capable, and empowered leaders. This work deepens our understanding of how to practically improve community health through empowering women to catalyze gender equality in communities with disproportionate barriers and limited opportunities burdening them.
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Affiliation(s)
- Elizabeth M Allen
- Department of Public Health, St. Catherine University, 2004 Randolph Ave, St. Paul, MN, 55104, USA.
| | | | | | - Maren E Knep
- Department of Public Health, St. Catherine University, 2004 Randolph Ave, St. Paul, MN, 55104, USA
| | - Michael J Van Skiba
- Department of Public Health, St. Catherine University, 2004 Randolph Ave, St. Paul, MN, 55104, USA
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Young A, Charania NA, Gauld N, Norris P, Turner N, Willing E. Knowledge and decisions about maternal immunisation by pregnant women in Aotearoa New Zealand. BMC Health Serv Res 2022; 22:779. [PMID: 35698133 PMCID: PMC9192336 DOI: 10.1186/s12913-022-08162-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal vaccinations for influenza and pertussis are recommended in New Zealand to protect mothers and their infant from infection. However, maternal immunisation coverage in New Zealand is suboptimal. Furthermore, there is unacceptable inequitable maternal immunisation rates across the country with Māori and Pacific women having significantly lower maternal immunisation rates than those of other New Zealanders. METHODS This research set out to explore what pregnant/recently pregnant Māori and Pacific women knew about immunisation during pregnancy and what factors influenced their decision to be vaccinated. A semi-structured interview guide was developed with questions focusing on knowledge of pertussis and influenza vaccination during pregnancy and decision-making. Māori and Pacific women aged over 16 years were purposively sampled and interviewed in Dunedin and Gisborne, New Zealand between May and August 2021. Interviews were analysed following a directed qualitative content approach. Data were arranged into coding nodes based on the study aims (deductive analysis) informed by previous literature and within these participant experiences were inductively coded into themes and subthemes. RESULTS Not all women were aware of maternal vaccine recommendations or they diseases they protected against. Many underestimated how dangerous influenza and pertussis could be and some were more concerned about potential harms of the vaccine. Furthermore, understanding potential harms of infection and protection provided by vaccination did not necessarily mean women would choose to be vaccinated. Those who decided to vaccinate felt well-informed, had vaccination recommended by their healthcare provider, and did so to protect their and their infant's health. Those who decided against vaccination were concerned about safety of the vaccines, lacked the information they needed, were not offered the vaccine, or did not consider vaccination a priority. CONCLUSIONS There is a lack of understanding about vaccine benefits and risks of vaccine-preventable diseases which can result in the reinforcement of negative influences such as the fear of side effects. Furthermore, if vaccine benefits are not understood, inaccessibility of vaccines and the precedence of other life priorities may prevent uptake. Being well-informed and supported to make positive decisions to vaccinate in pregnancy is likely to improve vaccine coverage in Māori and Pacific Island New Zealanders.
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Affiliation(s)
- Amber Young
- Division of Health Sciences , Kōhatu-Centre for Hauora Māori, Otago Medical School, University of Otago, PO Box 56 , 9054, Dunedin, New Zealand.
| | - Nadia A Charania
- Department of Public Health, School of Public Health and Interdisciplinary Studies, Auckland University of Technology, Auckland, New Zealand
| | - Natalie Gauld
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.,School of Pharmacy, University of Auckland, Auckland, New Zealand
| | - Pauline Norris
- Va'a o Tautai - Centre for Pacific Health, University of Otago, Dunedin, New Zealand
| | - Nikki Turner
- Immunisation Advisory Centre, Department of General Practice and Primary Care, University of Auckland, Auckland, New Zealand
| | - Esther Willing
- Division of Health Sciences , Kōhatu-Centre for Hauora Māori, Otago Medical School, University of Otago, PO Box 56 , 9054, Dunedin, New Zealand
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English W, Gott M, Robinson J. Being reflexive in research and clinical practice: a practical example. Nurse Res 2022; 30:30-35. [PMID: 35642591 DOI: 10.7748/nr.2022.e1833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Reflexivity is an invaluable skill for nurses and researchers, as it assists in closing the gap between research and practice and improves nursing practice. However, there is some doubt about how well reflexivity is implemented in nursing. There has also been little published showing how reflexivity can be applied in research and nursing. AIM To provide an example of reflexivity in research to demonstrate that knowledge and experiences are transferable to nursing practice. DISCUSSION Reflexivity is an important tool for research and nursing in finding the meeting points or interface of research and practice. This article provides an example of being reflexive that identified how the research skills of 'listening to understand' and 'finding meaning' filtered into nursing practice. CONCLUSION Reflexivity helped to generate knowledge about research skills filtering across a research project into clinical practice. Being reflexive as a researcher and a nurse can transform the care of patients and families. IMPLICATIONS FOR PRACTICE This article provides an example of how reflexivity can be applied to research and nursing practice. It also suggests reframing the gap between research and practice as an interface between the two. This could encourage nurses to think of research skills and knowledge as transferable into real-time nursing practice.
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Affiliation(s)
- Wendy English
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Merryn Gott
- Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jackie Robinson
- Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
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Chaudhary N, Dutt A. Women as Agents of Change: Exploring Women Leaders' Resistance and Shaping of Gender Ideologies in Pakistan. Front Psychol 2022; 13:800334. [PMID: 35465518 PMCID: PMC9019585 DOI: 10.3389/fpsyg.2022.800334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
Despite a growing focus on processes to promote gender equity, women remain significantly underrepresented in leadership positions in the Global South. In the present study we focus on the role of familial experiences in shaping and contesting gender ideologies of Pakistani women in the workplace. We specifically examine the reciprocal ways in which women leaders and their family members shape each other’s gender ideologies regarding the workplace. Data collected and analyzed for this study were semi-structured interviews with eight women in positions of leadership in Lahore, Pakistan, and interviews with one family members of each of the women leaders (thus 16 interviews total). Using thematic narrative analysis, we identified three thematic phases: learning gender expectations, resistance, and familial transformation. These phases reflect the progression of developing, resisting, and influencing individual and familial gender ideologies. We document the manifestation of these phases in three specific domains: education, marriage and motherhood, and the workplace. We then discuss how these findings contribute to understanding the experiences of women leaders and perceptions of their family members regarding women’s role in the workplace. Findings from our research provide novel insights into the ways globalization and capitalism continue to shape the socio-cultural context for women leaders in the Global South.
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Affiliation(s)
- Nabiha Chaudhary
- Psychology Department, University of Cincinnati, Cincinnati, OH, United States
| | - Anjali Dutt
- Psychology Department, University of Cincinnati, Cincinnati, OH, United States
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Olmos-Vega FM, Stalmeijer RE, Varpio L, Kahlke R. A practical guide to reflexivity in qualitative research: AMEE Guide No. 149. MEDICAL TEACHER 2022; 45:1-11. [PMID: 35389310 DOI: 10.1080/0142159x.2022.2057287] [Citation(s) in RCA: 385] [Impact Index Per Article: 128.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Qualitative research relies on nuanced judgements that require researcher reflexivity, yet reflexivity is often addressed superficially or overlooked completely during the research process. In this AMEE Guide, we define reflexivity as a set of continuous, collaborative, and multifaceted practices through which researchers self-consciously critique, appraise, and evaluate how their subjectivity and context influence the research processes. We frame reflexivity as a way to embrace and value researchers' subjectivity. We also describe the purposes that reflexivity can have depending on different paradigmatic choices. We then address how researchers can account for the significance of the intertwined personal, interpersonal, methodological, and contextual factors that bring research into being and offer specific strategies for communicating reflexivity in research dissemination. With the growth of qualitative research in health professions education, it is essential that qualitative researchers carefully consider their paradigmatic stance and use reflexive practices to align their decisions at all stages of their research. We hope this Guide will illuminate such a path, demonstrating how reflexivity can be used to develop and communicate rigorous qualitative research.
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Affiliation(s)
| | - Renée E Stalmeijer
- Department of Educational Development and Research, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Lara Varpio
- Department of Medicine and Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Renate Kahlke
- Division of Education and Innovation, Department of Medicine and Scientist, McMaster University, Hamilton, Canada
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Demystifying Qualitative Research for Musculoskeletal Practitioners Part 2: Understanding the Foundations of Qualitative Research. J Orthop Sports Phys Ther 2021; 51:559-561. [PMID: 34847695 DOI: 10.2519/jospt.2021.0113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In this second editorial about qualitative research for musculoskeletal practitioners, we turn our attention to the foundational assumptions that underpin all qualitative research. Specifically, we discuss research paradigms, which consist of ontological and epistemological assumptions, as well as the "lens" of the researcher. Understanding these foundational assumptions will help readers interpret the findings of qualitative studies relevant to a musculoskeletal context. J Orthop Sports Phys Ther 2021;51(12):559-561. doi:10.2519/jospt.2021.0113.
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Abstract
Zusammenfassung. Hintergrund: Qualitative Methoden ermöglichen bei unterschiedlichen Fragestellungen vertieften Erkenntnisgewinn im Feld der Suchtforschung. Allerdings ist der Zugang zu den entsprechenden Methoden nicht einfach, da ihre Komplexität und Vielfalt nicht leicht zu überblicken ist und die Umsetzung umfangreiches theoretisches und methodologisches Wissen erfordert. Bisher scheint der Einsatz qualitativer Methoden in der deutschen Suchtforschung nicht ausreichend methodisch untermauert zu sein. Wir fordern daher eine fundierte, reflektierte und methodisch korrekte Nutzung qualitativer Methoden im Feld der Suchtforschung. Ziel: Ziel dieses Artikels ist, anhand von Methodenliteratur und Originalarbeiten, in denen qualitative Methoden angewandt wurden, aufzuzeigen, wie qualitative Forschungsdesigns verstanden werden können, um Forschende zu ermutigen und zu befähigen, qualitative Methoden in angemessener Weise zu nutzen. In diesem Artikel werden mögliche Einsatzgebiete und grundlegende methodologische Überlegungen für die Entwicklung eines qualitativen Forschungsdesigns dargestellt. Dabei wird zusätzlich auf diverse Erhebungsmethoden sowie ethische Aspekte im Rahmen der Datengenerierung eingegangen.
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Affiliation(s)
- Annette Binder
- Sektion Suchtmedizin und Suchtforschung, Universitätsklinik für Psychiatrie und Psychotherapie Universitätsklinikum Tübingen
| | - Christine Preiser
- Institut für Arbeitsmedizin, Sozialmedizin und Versorgungsforschung, Universitätsklinikum Tübingen
- Zentrum für Öffentliches Gesundheitswesen und Versorgungsforschung, Universitätsklinikum Tübingen
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Reimagining Pharmacy Education through the Lens of a Choose Your Own Adventure Activity-A Qualitative Evaluation. PHARMACY 2021; 9:pharmacy9030151. [PMID: 34564558 PMCID: PMC8482149 DOI: 10.3390/pharmacy9030151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Successful pharmacy curricula expose students to a variety of teaching and assessment methods to prepare students for clinical practice. However, development of clinical decision-making skills is often challenging for learners. To meet this need, the Choose Your Own Adventure (CYOA) Patient Case Format was developed to enhance traditional paper patient cases by integrating problem-based and case-based learning to improve pharmacy student learning. The objectives of this evaluation were to qualitatively evaluate the CYOA case format. The qualitative assessment of the student pharmacist’s learning experience utilizing this novel patient case format was used to formulate a template for extrapolation to other disease states. Methods: Focus groups were conducted with second year Pharm.D. students enrolled at the University of Tennessee Health Science Center (UTHSC) College of Pharmacy. The focus groups were conducted in Fall 2020, beginning the week after they were exposed to the CYOA case format. The corpus of data was analyzed thematically to identify themes using inductive coding. To establish the validity of this evaluation, the team met to assess the consistency of the data reduction methods and guard against methodological issues that could influence and affect coding decisions. Results: Participants were recruited until thematic saturation was achieved. Out of 25 participants, 23 participants provided demographic information, with 74% identifying as female. Thematic analysis identified three themes: (1) “It was just fun!” (2) Empowering Pharmacy Students through Groupwork: “Collaboration [is] going to be vital” and (3) Meeting the Need for Real-Life Scenarios: “This is a real person.” Conclusions: The data highlight that there are numerous advantages of adopting the CYOA format for delivering applied pharmacotherapy content. The CYOA format presents students with a realistic scenario that is fun and engaging and challenges students to justify their decisions regarding patient care in a structured group environment.
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Walsh L, Hyett N, Howley J, Juniper N, Li C, MacLeod-Smith B, Rodier S, Hill SJ. The risks and benefits of using social media to engage consumers in service design and quality improvement in Australian public hospitals: findings from an interview study of key stakeholders. BMC Health Serv Res 2021; 21:876. [PMID: 34445972 PMCID: PMC8393819 DOI: 10.1186/s12913-021-06927-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/12/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Engaging consumers - patients, families, carers and community members who are current or potential service users - in the planning, design, delivery, and improvement of health services is a requirement of public hospital accreditation in Australia. There is evidence of social media being used for consumer engagement in hospitals internationally, but in Australia this use is uncommon and stakeholders' experiences have not been investigated. The aim of the study was to explore the experiences and beliefs of key Australian public hospital stakeholders around using social media as a consumer engagement tool. This article focuses on the study findings relating to methods, risks, and benefits of social media use. METHODS Semi-structured interviews were conducted with Australian public hospital stakeholders in consumer representative, consumer engagement/patient experience, communications or quality improvement roles. Qualitative data were analysed using a deductive content analysis method. An advisory committee of consumer and service provider stakeholders provided input into the design and conduct of this study. RESULTS Twenty-six Australian public hospital service providers and consumers were interviewed. Participants described social media being used to: recruit consumers for service design and quality improvement activities; as an online space to conduct consultations or co-design; and, to gather feedback and patient experience data. The risks and benefits discussed by interview participants were grouped into five themes: 1) overcoming barriers to engagement, 2) consumer-initiated engagement; 3) breadth vs depth of engagement, 4) organisational transparency vs control and 5) users causing harm. CONCLUSIONS Social media can be used to facilitate consumer engagement in hospital service design and quality improvement. However, social media alone is unlikely to solve broader issues commonly experienced within health consumer engagement activities, such as tokenistic engagement methods, and lack of clear processes for integrating consumer and patient feedback into quality improvement activities.
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Affiliation(s)
| | | | | | | | - Chi Li
- Albury Wodonga Health, Albury, Australia
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Melia R, Monahan L, Duggan J, Bogue J, O’Sullivan M, Young K, Chambers D, McInerney S. Exploring the experiences of mental health professionals engaged in the adoption of mobile health technology in Irish mental health services. BMC Psychiatry 2021; 21:412. [PMID: 34412601 PMCID: PMC8375610 DOI: 10.1186/s12888-021-03426-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 08/10/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The World Health Organization report that an estimated 793,000 people died by suicide in 2016 globally. The use of digital technology has been found to be beneficial in the delivery of Web-based suicide prevention interventions. Research on the integration of digital technology within mental health services has indicated that despite the proliferation of technology, engagement by patients and professionals in adopting such technology can be poor. OBJECTIVES The current study aims to explore the experiences of 15 mental health professionals involved in integrating mobile health technology into their practice. A secondary aim was to identify the drivers and barriers to the adoption of such technology by mental health professionals, and to consider what theoretical models could best account for the data. METHODS Semi-structured interviews, conducted from July to October 2019, were used to explore the experiences of mental health professionals engaged in the adoption of mobile health technology within mental health services. Mental Health professionals and clinician managers working in HSE Child and Adolescent Mental Health, Adult Mental Health, and Primary Care Psychology services were recruited for the study. Qualitative interview data was transcribed and analysed using NVivo. Thematic Analysis was used to identify themes. RESULTS Four major themes were identified: Accessibility, 'Transitional Object', Integration, and Trust. Within these 4 major themes, a total of 9 subthemes were identified: Service Accessibility, Immediate Access, Client Engagement, Adjunct-to-therapy, Therapeutic Relationship, Infrastructural Support, Enhancing Treatment, Trust in the Technology, Trust in the Organisation. CONCLUSIONS Overall, Diffusion of Innovation Theory provides a useful theoretical framework which is consistent with and can adequately account for many of the Major and Subthemes identified in the data. In addition, 'Transitional Objects', a key concept within Object Relations Theory, could offer a means of better understanding how patients and professionals engage with digital technology within mental health services particularly.
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Affiliation(s)
- Ruth Melia
- Health Service Executive, Dublin, Ireland. .,National University of Ireland, Galway, Ireland.
| | - Luke Monahan
- grid.435607.30000 0004 0488 8940Irish Management Institute, Dublin, Ireland
| | - Jim Duggan
- grid.6142.10000 0004 0488 0789National University of Ireland, Galway, Ireland
| | - John Bogue
- grid.6142.10000 0004 0488 0789National University of Ireland, Galway, Ireland
| | | | - Karen Young
- grid.6142.10000 0004 0488 0789National University of Ireland, Galway, Ireland
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McDonnell KK, Gallerani DG, Newsome BR, Owens OL, Beer J, Myren-Bennett AR, Regan E, Hardin JW, Webb LA. A Prospective Pilot Study Evaluating Feasibility and Preliminary Effects of Breathe Easier: A Mindfulness-based Intervention for Survivors of Lung Cancer and Their Family Members (Dyads). Integr Cancer Ther 2021; 19:1534735420969829. [PMID: 33118443 PMCID: PMC7604980 DOI: 10.1177/1534735420969829] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective: Symptom burden remains a distressing problem for survivors with non-small-cell lung cancer (stages I-IIIa). This pilot study evaluated feasibility and preliminary effects of a tailored mindfulness-based intervention, Breathe Easier, which encompasses meditation, 2 levels of mindful hatha yoga, breathing exercises, and participant interaction. METHODS Participants were recruited from 2 cancer programs in the US Southeast. A family member was required for participation. Sixty-two participants enrolled (20% recruitment) and 49 completed the intervention (79% retention). Participants chose level 1 yoga (basic) or level 2 (more advanced). Of the completers, survivors were 39% male and 65% Black. A community-based participatory research framework helped identify the specific needs and interests of potential participants and foreseeable barriers to implementation. A 2-month prospective, 1-group, pre-post design evaluated feasibility. Intervention dosage was measured using written protocols. Attendance and completion of daily home assignments measured adherence. Acceptability was assessed using a 10-item questionnaire, completed at three time points. Preliminary outcome data collected pre- and post-intervention tested the hypothesis that participants who received the 8-week intervention Breathe Easier would, post-intervention, demonstrate (a) less dyspnea, (b) less fatigue, (c) less stress, (d) improved sleep, (e) improved anxiety and depression, and (f) improved functional exercise capacity. Exit interviews were conducted, transcribed verbatim, and analyzed for content using descriptive statistics. RESULTS Quantitative and qualitative measures indicated strong feasibility. Over time, level 1 participants had statistically less dyspnea, fatigue and improved exercise capacity, as well as improved sleep, and stress scores. Level 2 participants experienced slightly increased dyspnea and fatigue but improved sleep, stress, and exercise capacity. All participants experienced anxiety and depression within normal limits pre- and post-intervention. Five major themes emerged out of exit interviews: Learning to Breathe Easier; Interacting with Others as a Personal Benefit; Stretching, Releasing Tension, and Feeling Energized; Enhancing Closeness with Committed Partners; Refocusing on Living; and Sustaining New Skills as a Decision. CONCLUSIONS The study offers insight into the feasibility of an 8-week in-person mindfulness-based intervention with a unique subset of understudied survivors of lung cancer and family members. Outcome data interpretation is limited by the 1-group design and sample size.
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Cohen JA, Kassan A, Wada K, Suehn M. The personal and the political: how a feminist standpoint theory epistemology guided an interpretative phenomenological analysis. QUALITATIVE RESEARCH IN PSYCHOLOGY 2021. [DOI: 10.1080/14780887.2021.1957047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Julie A. Cohen
- The University of Calgary Educational Studies in Counselling Psychology, Werklund School of Education, Calgary, Canada
| | - Anusha Kassan
- The University of British Columbia School and Applied Child Psychology, Vancouver, Canada
| | - Kaori Wada
- The University of Calgary Educational Studies in Counselling Psychology, Werklund School of Education, Calgary, Canada
| | - Megan Suehn
- The University of Calgary Educational Studies in Counselling Psychology, Werklund School of Education, Calgary, Canada
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Samardzic T, Soucie K, Schramer K, Katzman R. “I didn’t feel normal”: Young Canadian women’s experiences with polycystic ovary syndrome. FEMINISM & PSYCHOLOGY 2021. [DOI: 10.1177/09593535211030748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Polycystic ovary syndrome (PCOS), which affects 8 to 13% of reproductive-aged women, is a highly gendered disorder whose symptoms disrupt Western conceptions of femininity. This may be especially debilitating for young women, who are targeted by societal discourses governing how they “should” be. We interviewed 10 young Canadian women, aged 18 to 22, about how PCOS has influenced and/or conflated their conceptions of identity and (ab)normality within the current socio-cultural context. Using reflexive thematic analysis through a critical feminist lens, we present three themes: justifying abnormality, pathologizing the abnormal, and fear of failure in pregnancy. Young women described feeling “weird” and “not normal” as a result of their symptoms and expressed worries about their ability to adhere to gendered expectations. We argue that the blanketing of these desirable states as “normal” has pervasive implications for women’s lives and leaves them feeling defective and/or inadequate, which was further reinforced by implicit, gender-based power dynamics in medical institutions when women sought care. We suggest the need for engagement with discomfort and leveraging PCOS as a unique entryway into an analysis of intersectional issues to capture complexities in lived experience.
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Affiliation(s)
| | - Kendall Soucie
- University of Windsor, Canada
- University of Windsor, Canada
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Al-Shamaly HS. A focused ethnography of the culture of inclusive caring practice in the intensive care unit. Nurs Open 2021; 8:2973-2985. [PMID: 34318598 PMCID: PMC8510735 DOI: 10.1002/nop2.1009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/05/2021] [Accepted: 07/10/2021] [Indexed: 11/16/2022] Open
Abstract
Aim To explore and understand the culture of nurses' multidimensional “caring‐for” practice in intensive care unit (ICU). Design A focused ethnography. Methods Data were collected from 35 Registered Nurses through participant observations, field notes, documentation reviews, interviews, informal conversations and Participants' additional information forms over 6 months in one ICU. Thematic data analysis was used. Findings Different dimensions of nursing caring in ICU were found. The inclusivity of a culture of nurses' “caring‐for” involved the following: oneself, patients and their families, different colleagues, and caring as ecological consciousness in the ICU environment and organization.
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Campbell C, Braund R, Morris C. A mixed methods study on medicines information needs and challenges in New Zealand general practice. BMC FAMILY PRACTICE 2021; 22:150. [PMID: 34246231 PMCID: PMC8272906 DOI: 10.1186/s12875-021-01451-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/05/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Medicines are central to healthcare in aging populations with chronic multi-morbidity. Their safe and effective use relies on a large and constantly increasing knowledge base. Despite the current era of unprecedented access to information, there is evidence that unmet information needs remain an issue in clinical practice. Unmet medicines information needs may contribute to sub-optimal use of medicines and patient harm. Little is known about medicines information needs in the primary care setting. The aim of this study was to investigate the nature of medicines information needs in routine general practice and understand the challenges and influences on the information-seeking behaviour of general practitioners. METHODS A mixed methods study involving 18 New Zealand general practitioner participants was undertaken. Quantitative data were collected to characterize the medicines information needs arising during 642 consultations conducted by the participants. Qualitative data regarding participant views on their medicines information needs, resources used, challenges to meeting the needs and potential solutions were collected by semi-structured interview. Integration occurred by comparison of results from each method. RESULTS Of 642 consultations, 11% (n = 73/642) featured at least one medicines information need. The needs spanned 14 different categories with dosing the most frequent (26%) followed by side effects (15%) and drug interactions (14%). Two main themes describing the nature of general practitioners' medicines information needs were identified from the qualitative data: a 'common core' related to medicine dose, side effects and interactions and a 'perplexing periphery'. Challenges in the perplexing periphery were the variation in information needs, complexity, 'known unknowns' and 'unknown unknowns'. Key factors affecting general practitioners' strategies for meeting medicines information needs were trust in a resource, presence of the patient, how the information was presented, scarcity of time, awareness of the existence of a resource, and its accessibility. CONCLUSIONS General practitioners face challenges in meeting wide-ranging medicines information needs in patients with increasingly complex care needs. Recognising the challenges and factors that influence resource use in practice can inform optimisation of medicines information support resources. Resources for general practitioners must take into account the complexity and time constraints of real-world practice. An individually responsive approach involving greater collaboration with pharmacists and specialist medicines information support services may provide a potential solution.
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Affiliation(s)
- Chloë Campbell
- School of Pharmacy, University of Otago, Dunedin, New Zealand.
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand.
- Pharmaceutical Society of New Zealand, Wellington, New Zealand.
| | - Rhiannon Braund
- School of Pharmacy, University of Otago, Dunedin, New Zealand
- New Zealand Pharmacovigilance Centre, University of Otago, Dunedin, New Zealand
| | - Caroline Morris
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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Peter K, Hegarty J, R DK, O Donovan A. 'They don't actually join the dots': An exploration of organizational change in Irish opiate community treatment services. J Subst Abuse Treat 2021; 135:108557. [PMID: 34272130 DOI: 10.1016/j.jsat.2021.108557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/26/2021] [Accepted: 06/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND People who use community-based drug treatment services spend a considerable amount of their time in treatment in direct contact with frontline staff. These staff are also fundamental to supporting the implementation of change to meet service user needs. Yet, very little is known about staff perspectives on the process and internal dynamics of drug treatment services, their views about what makes services work effectively, and how services can more effectively adopt to changes in practice. AIM AND METHOD Conducted across Irish community opiate prescribing services and drawing on data from 12 in-depth qualitative interviews with frontline staff. This paper examines the narratives of staff about the factors which influence the dynamics and process of treatment services, particularly in relation to the implantation of change. FINDINGS Change itself was described both in respect of how a service responded to immediate service user needs or supported planned change. Little distinction was made in respect of service attributes which facilitated a response in either context. Overwhelmingly, staff contextualised current service effectiveness, historical change, and desired change in how effectively their services met service user needs, which was also viewed as a significant motivation for change. Differences in operational standards across services in terms of practices, policy implementation, job roles, divisions between professional groups, and recruitment and retention of staff inhibited change adoption. Factors which were identified in terms of inhibiting or facilitating planned change were consistent with the wider literature on change implementation but provided unique insights in the context of substance misuse services. CONCLUSIONS A range of interdependent factors which influence an 'eco-system' of service delivery were identified. Effective policy implementation in Ireland remains aspirational, but findings reported in this paper have important implications for future planning and design of services for people who use drugs, and provide a good basis for further investigation.
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Affiliation(s)
- Kelly Peter
- College of Medicine and Health, School of Nursing and Midwifery, University College Cork, T12 AK54, Ireland.
| | - J Hegarty
- College of Medicine and Health, School of Nursing and Midwifery, University College Cork, T12 AK54, Ireland
| | - Dyer Kyle R
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, Denmark Hill, London SE58BB, United Kingdom
| | - A O Donovan
- College of Medicine and Health, School of Nursing and Midwifery, University College Cork, T12 AK54, Ireland
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Afrashtehfar KI, Bryant SR. Understanding the Lived Experience of North American Dental Patients With a Single-Tooth Implant in the Upper Front Region of the Mouth: Protocol for a Qualitative Study. JMIR Res Protoc 2021; 10:e25767. [PMID: 33886491 PMCID: PMC8277304 DOI: 10.2196/25767] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 03/16/2021] [Accepted: 04/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Assessment of the subjective experiences of individuals with maxillary anterior (ie, the upper front region of the mouth) single-tooth implants is limited mainly to quantitative measurements of satisfaction with appearance. Interestingly, there is unexplained variability in the relationship between satisfaction and appearance. OBJECTIVE This qualitative study protocol aims to explore and better understand the satisfaction with appearance and function in a Canadian population with maxillary anterior single-tooth implants treated at a postgraduate university clinic. Thus, we aim to obtain diversity among participants relating to the identification of esthetically pleasing and displeasing cases from a clinician perspective. METHODS A qualitative research design using interpretative phenomenology analysis (IPA) will provide an adaptable inductive research approach. The participants will be recruited, and consent documents, photographs, digital intraoral scans, and self-administered questionnaire responses will be obtained from them. The transcribed verbatim data from audio-recorded, in-depth, semistructured, one-to-one interviews of the participants will be managed, coded, and analyzed thematically with computer-assisted qualitative data analysis software. The IPA will consider the COnsolidated criteria for REporting Qualitative (COREQ) guidelines when applicable. RESULTS For the qualitative interview, we plan to include at least eight patients to conduct up to 1.5 hours of open-ended interviews with each participant aided by an interview guide. Ethical approval was granted by the University of British Columbia Behavioral Research Ethics Board (H19-00107) in May 2019. Two American dental foundations funded this study. CONCLUSIONS The analysis in this study will elucidate the aspects (including their value) that influence participant satisfaction at different dental implant treatment stages. This will be the first qualitative study on this group of the population to explore and obtain a better understanding of their satisfaction with appearance and function, as well as any other patient-reported outcome measures that could be identified. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/25767.
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Affiliation(s)
- Kelvin Ian Afrashtehfar
- Division of Restorative Dental Sciences, Clinical Sciences Department, Ajman University, Ajman City, United Arab Emirates.,Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Berne, Switzerland.,Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Dubai, United Arab Emirates.,Department of Oral Surgery and Stomatology, Faculty of Medicine, University of Bern, Berne, Switzerland
| | - Stephen Ross Bryant
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada.,Division of Prosthodontics and Dental Geriatrics, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
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