Contested, Impractical, and Easily Forgotten? Analysing National-Level Decision-Makers’ Interpretations of Lessons Learned From the COVID-19 Pandemic Through a Qualitative Follow-up Study

Background Public health crises require and offer unique opportunities for learning. Despite abundant “lessons learned” -literature on the COVID-19, follow-up research designs are scarce. To fill in this gap we analyse how key national level decision-makers in Finland discuss the lessons from COVID-19 at its’ different stages, since they are in key positions to develop health system preparedness and crises response policies based on lessons from past shocks. Methods The qualitative interview study includes unique follow-up data on Finnish national-level decision-makers’ interpretations of the lessons learned from COVID-19. The interviewees represent key ministries, other governmental organisations with responsibilities in pandemic governance, expert organisations and authorities responsible for preparedness. The data were collected from the same informants 1) at the acute stage of the epidemic in Finland (2021, n = 21) and 2) after the vaccination coverage was at high level and the acute stage of the epidemic had passed (2022-2023, n = 16). Analyses included abductive and thematical content analyses. Results The lessons learned from COVID-19 were defined differently at different stages of the pandemic. In addition, the possibilities to assess or implement the lessons or reform the system were hampered by scarce resources and the political agenda already shifting to other crises and challenges. Results further showed the short-term nature of many of the crisis measures taken during the acute stage. Conclusions The follow-up design enabled analysis of the nature of the lessons learned during and after the acute stage of COVID-19. Temporal framing of data illustrated the changing and emergent nature of the lessons learned, highlighting the need for broad ranging analyses across multiple time spots and crisis cycles in the future. Scarce human and financial resources in the health system compel to focus on most topical issues, hampering long-term development. Key messages • Preparation for future crises requires practical measures during normal times. • Comprehensive analyses of lessons learned beyond a single crisis cycle supports continuity of crisis preparedness and management.

Purpose: Everyday activities are important factors for avoiding the development of chronic low back pain (LBP). The purpose this study was to explore LBP patients' perspective on long-term effects of participating in a counseling intervention designed to motivate them to change work routines and to exercise. Method: Follow-up qualitative study. Semi-structured interviews were made of 25 LBP patients who had received the counseling intervention. Interviews were transcribed and explored with an interpretative thematic analysis. The findings were organized around Kleinman's conception of “explanatory models”. Results: For the individual participant the beliefs about the illness were internally coherent, but most often they were idiosyncratic and fitted to the particular participants' overall explanatory model. Participation in the counseling intervention had created a sense of certainty and potential control over the disease and had legitimized their sick role at work and at home. The majority of the patients reported having integrated exercise into their explanatory models and understood exercise to be beneficial in their continual and concrete management of their LBP. Conclusions: The intervention had affected the patients' personal agency and space for action. We suggest that this effect was linked to the individually tailored approach drawing on both educational and motivational agents.Implications for RehabilitationMaintaining everyday activities, including retaining one's occupation, is an important factor in low back pain rehabilitation.Counselling on low back pain rehabilitation must be aligned with people's beliefs about their illness.A counselling intervention made patients adopt exercising into their long-term management of low back pain.

Paternal involvement of Singaporean fathers within six months postpartum: A follow-up qualitative study

BackgroundDespite the widespread proliferation of food banks in high-income countries over the past several decades, there is a paucity of data regarding the long-term experiences of the people who rely on food banks. We were unable to find any other studies with follow-up interviews later than 6 months after baseline.ObjectiveThis study examined the changes in the lived experiences of people who accessed food banks over a period of 18 months.MethodsSemi-structured interviews were conducted with 11 people who accessed food banks in Ottawa, Canada and who had participated in a 6-month study that ended one full year before this follow-up study was done. Transcripts of the interviews were analyzed through a general inductive approach involving repeated readings and coding of relevant segments of text with NVivo software according to themes that emerged iteratively. Code reports were then used to discuss and reach consensus on a final set of themes.ResultsThree main themes emerged: (1) chronic physical and mental health issues intersecting with food bank access; (2) psychosocial impact of relying on food banks; and (3) living on a low income and dealing with poverty. Chronic physical and mental health conditions were prevalent among the participants. As well, 10 of the 11 participants in this 18-month follow-up continued to rely on food banks as a regular resource – not as an emergency relief measure – to supplement their nutritional needs. While most of the participants reported that food banks helped them in some way, many shortcomings were also noted regarding food amounts, quality and choice. Overall, there was little change reported since the 6-month follow-up.ConclusionsThe shortcomings reported by participants can mostly be attributed to the dependence of food banks on charitable donations; thus, despite the commendable work of food bank staff and volunteers, participants described the food assistance as inadequate. Additionally, long-term food bank usage was a common denominator in the lived experiences of all our participants; therefore, our findings reinforce the need for assistance programs that target long-term food insecurity and its underlying causes, to replace or supplement charity-based food bank programs.

Background: Healthcare workers (HCWs) are central and serve in the frontlines when epidemics threaten public health. Thus, certain communities may be hardest hit by these challenges. Interventions supporting HCWs are important, and to develop these, understanding their experiences is essential. Aim: To explore how HCWs in Norwegian public in-home services experienced work during the COVID-19 pandemic over time. Method: A longitudinal qualitative study with two data collections approximately one year apart (2021 and 2022) was performed. Individual interviews were conducted with HCWs. Results: The analysis resulted in six main themes: Changing everything, Redefining ‘necessary tasks’, Distancing and loneliness, Cooperation and coordination, More infections and fewer worries and Lessons for the future. These indicate capabilities and processes, how they are evolving over time, and outcomes. The first two themes focus on the first period of the pandemic, the next two on the ongoing intermediate period, and the final two cover the last period. Conclusion: The HCWs’ narratives have demonstrated their collective coping based on adaptive and transformative capacities. Further, they have enlisted experienced social resilience in their strategies for coping with the COVID-19 challenges.

Government social media is widely used for providing updates to and engaging with the public in the COVID-19 pandemic. While Facebook is one of the popular social media used by governments, there is only a scant of research on this platform. This paper aims to understand how government social media should be used and how its engagement changes in prodromal, acute and chronic stages of the pandemic. We collected 1664 posts and 10,805 comments from the Facebook pages of the Macao government from 1 January to 31 October 2020. Using word frequency and content analysis, the results suggest that the engagement was relatively low at the beginning and then surged in the acute stage, with a decreasing trend in the chronic stage. Information about public health measures maintained their engagement in all stages, whereas the engagement of other information was dropping over time. Government social media can be used for increasing vigilance and awareness in the prodromal stage; disseminating information and increasing transparency in the acute stage; and focusing on mental health support and recovery policies in the chronic stage. Additionally, it can be a tool for controlling rumors, providing regular updates and fostering community cohesion in public health crises.

Techbits The first SPE Technical Summit, titled “Hydraulic Fracturing: Ensuring Groundwater Protection,” was held in conjunction with the SPE Hydraulic Fracturing Technology Conference in the Woodlands, Texas, in January. About 80 people representing industry producers and service companies, consulting firms, academia, national laboratories, state and federal government, and national governmental organizations (NGOs) participated. The discussion focused on the impact of fracturing on groundwater. The summit began with a keynote presentation by a state regulatory official on how state oil and gas agencies are evaluating and regulating hydraulic fracturing. Organized into four 90-minute sessions, each session had two or three short presentations by experts who provided information and stimulated discussion. The themes were: What is hydraulic fracturing? What are the issues? Environmental risks and issues—facts vs. perception How to move forward? State Regulations US states have the lead role in regulating most oil and gas activities, including hydraulic fracturing. Among the approximately 30 oil- and gas-producing states, there is a range of requirements and levels of detail regarding the type of hydraulic fracturing information that must be reported to the agencies. One presentation introduced the collaborative efforts of a nonprofit, multi-stakeholder group known as the State Review of Oil and Natural Gas Environmental Regulations (STRONGER) that provides critical reviews of state oil and gas programs and offers suggestions for improvement. Teams made up of members from states, industry, NGOs, and others periodically conduct detailed reviews of state oil and gas regulatory programs. The group developed guidelines for hydraulic fracturing in January 2010. They set forth general principles such as: Wells should be properly designed and constructed. Water, wastewater, and waste management should be planned and conducted in a careful manner. Information on the chemicals used in hydraulic fracturing operations should be disclosed and reported. Focused reviews of state hydraulic fracturing requirements have been conducted in Pennsylvania and Ohio, and reviews of Oklahoma and Louisiana requirements are in progress. STRONGER also is an advocate for sufficient funding and training of state agency staff in order to provide a better oversight of oil and gas activities. What is Hydraulic Fracturing? This session discussed the history of hydraulic fracturing and its impact on the oil and natural gas industry both past and future. It laid out the foundation of horizontal wellbore construction and described the principles of hydraulic fracturing and its integral role in recovering natural gas. The first use of the combination of horizontal drilling and hydraulic fracturing began in 1985 in the Austin Chalk in Texas. These efforts showed good results and were soon transferred to the Barnett Shale and later to other shale formations.

ImportanceNegative online experiences (NOE) are highly prevalent and pose significant dangers for youth with mental health and neurodevelopmental conditions.ObjectiveIdentify risk factors of NOE and reporting barriers in youths.DesignCross-sectional survey study (January to July 2023) and qualitative follow-up study (March to May 2023).SettingA community-based sample from the Child Mind Institute’s Healthy Brain Network (HBN), a transdiagnostic research initiative in New York.ParticipantsA total of 1,009 youth aged 9-15 years (mean [SD] age, 11.79 [1.71] years; 585 [58.55%] male) completed a 310-item quantitative survey. The qualitative follow-up study (n=109) included four administrations of a 3-day online bulletin board.Exposure(s)Not applicable.Main Outcomes and MeasuresMain outcomes include prevalence and risk factors of NOE and reporting behaviors and barriers. Qualitative analyses provided insights into youths’ mental models and cognitive schemas about different NOE forms.ResultsOf the 1,129 enrolled participants, 1,009 participants completed the study (89.37%). Over one-fourth (265 [26.6%]) encountered NOE in the past year, with 182 [68.7%] reporting multiple incidents. However, only 53 [20.0%] reported the incident. Mental health symptoms (p<.01) and parenting styles (p<.001) increased the risk of NOE. Factor analyses identified three key reporting barriers: Reporting Process, Reporting Policy, and Emotional Barriers. Age, social aptitude, mental health symptoms, and parenting styles predicted the likelihood of experiencing the reporting barriers. Analyses of the qualitative follow-up study noted that youths’ decision-making process regarding reporting considers three areas: degree of malice, perpetrator’s intent, and included NOE forms. Ambiguity in these areas contributed to higher reporting uncertainty.Conclusions and RelevanceFindings highlight a gap between the prevalence of NOE and reporting rates in youths with mental health and neurodevelopmental conditions. Demographic, clinical, and parenting factors were risk factors of experiencing NOE or a reporting barrier, underscoring the need for targeted and multifaceted solutions. Potential solutions to aid in safer online spaces are proposed for policymakers, technology developers, clinicians, and educators.Key pointsQuestionWhen encountering negative online experiences (NOE), what influences reporting likelihood in youth with mental health conditions?FindingsHigh prevalence and low reporting rates of NOE were observed. Analyses identified Reporting Process, Reporting Policy, and Emotional as key reporting barriers. Parenting styles, mental health symptoms, and demographics were associated with increased likelihood of experiencing NOE or the identified barriers. The qualitative follow-up study provided insights into youths’ thought processes regarding NOE.MeaningOur findings document key reporting barriers in children and adolescents with mental health and neurodevelopmental conditions and potential suggestions to aid in the development of safer online spaces.

This study explores how the protracted exposure to the COVID-19 pandemic influenced role expectations and leadership practices among Norwegian school principals. Following up Lien et al. (2022). School principals’ experiences and learning from the COVID-19 pandemic in Norway. Scandinavian Journal of Educational Research, 1–16, nine Norwegian school principals were re-interviewed 18 months into the pandemic. Four main themes emerged: (a) increased demands and expectations describes how the pandemic still poses a significant additional workload, (b) dilemmas and uncertainty outlines how the school principals have become more aware of their responsibilities and liabilities, (c) social support and relationships details an increased sense of community and peer support from fellow teachers, colleagues and the community at large, and (d) self-efficacy describes how the pandemic has instilled confidence in the principals as school leaders. The findings are discussed in the context of leadership practices in education and research on crisis leadership.

Nurse education plays an essential role in preparing future nurses to engage with quality improvement (QI) initiatives in their organisations and improve patient care. However, frontline nurses continue to report that a lack of QI knowledge hinders their abilities to engage in improvement work. In the UK, student nurses are now trained in QI within their degree to enable them to contribute to improvements once qualified. This qualitative follow-up study investigated the sustainability of QI engagement in nurses who undertook QI training and a QI project during their degree and explored the factors influencing their engagement in QI once qualified. This paper followed the COREQ criteria to report upon 10 semi-structured interviews undertaken with registered nurses and focuses on their experiences of QI engagement post-registration. The data were investigated using an inductive thematic analysis and Nvivo 14. Five themes emerged: transition to a newly qualified nurse, QI knowledge decline, influencing factors (hierarchy, leadership, COVID-19 pandemic, data access and location), and skill transferability. This study showed that qualified nurses can sustain their QI knowledge and remain engaged with QI where they experience positive QI leadership and were exposed to ongoing QI activity in their preceptorship year. However, a lack of QI opportunities and a culture which does not consider QI a responsibility of new nurses is seen to hinder engagement. Educational institutions and practice partners require careful collaboration to assess and develop ongoing QI learning activities that support new nurses to engage in QI.

ObjectiveIn the late 1980s unaccompanied children began arriving in Sweden. Many of them were teenage boys who had been called up or were at risk of being called up for military service in a war in their home country. Others had fled their homeland for political reasons. The purpose of the study was to describe how unaccompanied young adult refugees experienced their own life situation and well-being seven years after they had gained permanent residency. DesignThe original sample comprised 34 unaccompanied refugees who at 16–26 years of age were placed in a municipality in Sweden. Eleven of these participated in the present second follow-up study after a mean of 10 years in their new country. Qualitative interviews were conducted and analysed according to Giorgi's descriptive phenomenology. ResultsMost of the participants expressed contentedness with their lives and had begun to adjust to their new country. They had a social network of friends from the same ethnic group, and their Swedish contacts were mostly workmates. A few felt lonely and expressed despondency and depression. They were single and reported a small network and limited social support. One participant described symptoms of post-traumatic stress disorder (PTSD), even after 11 years in the new homeland. ConclusionIt appears that most of the participants in the present follow-up study had worked through the problems that typically face refugees and had begun adapting to their new country, while a few still felt lonely and did not feel part of the community. The results may be affected by non-response. Those who dropped out may live with more distress in everyday life and suffer depression more frequently.

More Than Two Developmental Pathways in Children With Gender Dysphoria?

In low-income and middle-income countries, such as those in sub-Saharan Africa and Latin America, the COVID-19 pandemic has had substantial implications for women's wellbeing. Policy responses to the COVID-19 pandemic have highlighted the gendered aspect of pandemics; however, addressing the gendered implications of the COVID-19 pandemic comprehensively and effectively requires a planetary health perspective that embraces systems thinking to inequalities. This Viewpoint is based on collective reflections from research done by the authors on COVID-19 responses by international and regional organisations, and national governments, in Latin America and sub-Saharan Africa between June, 2020, and June, 2021. A range of international and regional actors have made important policy recommendations to address the gendered implications of the COVID-19 pandemic on women's health and wellbeing since the start of the pandemic. However, national-level policy responses to the COVID-19 pandemic have been partial and inconsistent with regards to gender in both sub-Saharan Africa and Latin America, largely failing to recognise the multiple drivers of gendered health inequalities. This Viewpoint proposes that addressing the effects of the COVID-19 pandemic on women in low-income and middle-income countries should adopt a systems thinking approach and be informed by the question of who is affected as opposed to who is infected. In adopting the systems thinking approach, responses will be more able to recognise and address the direct gendered effects of the pandemic and those that emerge indirectly through a combination of long-standing structural inequalities and gendered responses to the pandemic.

Purpose of ReviewThe COVID-19 pandemic changed people’s lifestyles and such changed lifestyles included the potential of increasing addictive behaviors. The present systematic review and meta-analysis aimed to estimate the prevalence of different behavioral addictions (i.e., internet addiction, smartphone addiction, gaming addiction, social media addiction, food addiction, exercise addiction, gambling addiction, and shopping addiction) both overall and separately.Recent FindingsFour databases (PubMed, Scopus, ISI Web of Knowledge, and ProQuest) were searched. Peer-reviewed papers published in English between December 2019 and July 2022 were reviewed and analyzed. Search terms were selected using PECO-S criteria: population (no limitation in participants’ characteristics), exposure (COVID-19 pandemic), comparison (healthy populations), outcome (frequency or prevalence of behavioral addiction), and study design (observational study). A total of 94 studies with 237,657 participants from 40 different countries (mean age 25.02 years; 57.41% females). The overall prevalence of behavioral addiction irrespective of addiction type (after correcting for publication bias) was 11.1% (95% CI: 5.4 to 16.8%). The prevalence rates for each separate behavioral addiction (after correcting for publication bias) were 10.6% for internet addiction, 30.7% for smartphone addiction, 5.3% for gaming addiction, 15.1% for social media addiction, 21% for food addiction, 9.4% for sex addiction, 7% for exercise addiction, 7.2% for gambling addiction, and 7.2% for shopping addiction. In the lockdown periods, prevalence of food addiction, gaming addiction, and social media addiction was higher compared to non-lockdown periods. Smartphone and social media addiction was associated with methodological quality of studies (i.e., the higher the risk of boas, the higher the prevalence rate). Other associated factors of social media addiction were the percentage of female participants, mean age of participants, percentage of individuals using the internet in country, and developing status of country. The percentage of individuals in the population using the internet was associated with all the prevalence of behavioral addiction overall and the prevalence of sex addiction and gambling addiction. Gaming addiction prevalence was associated with data collection method (online vs. other methods) that is gaming addiction prevalence was much lower using online methods to collect the data.SummaryBehavioral addictions appeared to be potential health issues during the COVID-19 pandemic. Healthcare providers and government authorities should foster some campaigns that assist people in coping with stress during COVID-19 pandemics to prevent them from developing behavioral addictions during COVID-19 and subsequent pandemics.

Implementation of adaptation to climate change in public health in Europe: qualitative thematic analysis