Implementation issues of Republic Act 10754 (An Act Expanding the Benefits and Privileges of Persons with Disability) in the Philippines: a qualitative study

Worldwide there is an increasing demand for Hospital at Home as an alternative to hospital admission. Although there is a growing evidence base on the effectiveness and cost-effectiveness of Hospital at Home, health service managers, health professionals and policy makers require evidence on how to implement and sustain these services on a wider scale. (1) To identify, appraise and synthesise qualitative research evidence on the factors that influence the implementation of Admission Avoidance Hospital at Home and Early Discharge Hospital at Home, from the perspective of multiple stakeholders, including policy makers, health service managers, health professionals, patients and patients' caregivers. (2) To explore how our synthesis findings relate to, and help to explain, the findings of the Cochrane intervention reviews of Admission Avoidance Hospital at Home and Early Discharge Hospital at Home services. We searched MEDLINE, CINAHL, Global Index Medicus and Scopus until 17 November 2022. We also applied reference checking and citation searching to identify additional studies. We searched for studies in any language. We included qualitative studies and mixed-methods studies with qualitative data collection and analysis methods examining the implementation of new or existing Hospital at Home services from the perspective of different stakeholders. Two authors independently selected the studies, extracted study characteristics and intervention components, assessed the methodological limitations using the Critical Appraisal Skills Checklist (CASP) and assessed the confidence in the findings using GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research). We applied thematic synthesis to synthesise the data across studies and identify factors that may influence the implementation of Hospital at Home. From 7535 records identified from database searches and one identified from citation tracking, we included 52 qualitative studies exploring the implementation of Hospital at Home services (31 Early Discharge, 16 Admission Avoidance, 5 combined services), across 13 countries and from the perspectives of 662 service-level staff (clinicians, managers), eight systems-level staff (commissioners, insurers), 900 patients and 417 caregivers. Overall, we judged 40 studies as having minor methodological concerns and we judged 12 studies as having major concerns. Main concerns included data collection methods (e.g. not reporting a topic guide), data analysis methods (e.g. insufficient data to support findings) and not reporting ethical approval. Following synthesis, we identified 12 findings graded as high (n = 10) and moderate (n = 2) confidence and classified them into four themes: (1) development of stakeholder relationships and systems prior to implementation, (2) processes, resources and skills required for safe and effective implementation, (3) acceptability and caregiver impacts, and (4) sustainability of services. Implementing Admission Avoidance and Early Discharge Hospital at Home services requires early development of policies, stakeholder engagement, efficient admission processes, effective communication and a skilled workforce to safely and effectively implement person-centred Hospital at Home, achieve acceptance by staff who refer patients to these services and ensure sustainability. Future research should focus on lower-income country and rural settings, and the perspectives of systems-level stakeholders, and explore the potential negative impact on caregivers, especially for Admission Avoidance Hospital at Home, as this service may become increasingly utilised to manage rising visits to emergency departments.

IntroductionUnequal access to kidney transplantation is suggested, but no systematic inventory exists about factors influencing access to kidney transplantation. There is an absence of any research that has combined stakeholder...

Patient and clinician perspectives on shared decision-making in infertility treatment: A qualitative study

Prior to implementing an electronic health record–integrated patient-reported outcomes system, eSyM, the perceived facilitators and barriers to implementation from multiple stakeholder perspectives were sought. The purpose is to report the findings of the perceived facilitators and barriers to implementation of eSyM from multiple clinician stakeholder perspectives. Stakeholders included administrators, clerical staff, information technology professionals, support staff, physicians, providers, and nurses from six Symptom Management Implementation of Patient-Reported Outcomes in Oncology health systems, a diverse mix of academic/community, rural/metropolitan, and Northeastern and Southern community-based cancer centers. Site information, participant information, perceived effectiveness, and perceived patient barriers to use were collected from 173 stakeholders. RNs were the most represented participants, followed by physicians, physician assistants, and nurse practitioners. Stakeholders felt that eSyM would be effective in improving patient symptom management, keeping patients out of the hospital and emergency department, and improving clinic efficiency. Clinician stakeholders perceived eSyM as necessary and effective for improving symptom management. Most stakeholders felt that their colleagues would be supportive of using eSyM. Stakeholders perceived minor patient barriers were access to technology, distrust of technology, and English language proficiency. Computer literacy was perceived as a major barrier. Future longitudinal mixed-methods design that combines quantitative findings with qualitative observations is needed. Understanding the contextual factors that influence the facilitation or barriers of implementing eSyM is needed to scale and spread the intervention to other institutions. As a nursing intervention, the assessment of the perceptions of improvement of eSyM workflow would be especially useful.

Coronavirus Disease-19 Testing Strategies for Patients and Health Care Workers to Improve Workplace Safety.

The ethical use of placebos in herbal medicine (HM) clinical trials remains contested, particularly in contexts where traditional medical systems shape patients’ beliefs and expectations. Complexities in placebo preparation, insufficient transparency, and inconsistent consent practices pose challenges not only to scientific validity but also to ethical standards. This study aimed to explore stakeholder perspectives on placebo use in HM trials, with a specific focus on ethical concerns related to trust, informed consent, and trial integrity. In-depth qualitative interviews were conducted with 23 stakeholders, including clinical investigators, research coordinators, trial managers, pharmaceutical staff, and patient representatives. We applied an inductive, framework-based thematic analysis to identify key perceptions, challenges, and needs regarding placebo use. Participants demonstrated diverse understandings and attitudes toward placebos. Medical professionals, who often had higher levels of formal medical training, tended to describe placebos from a scientific perspective, whereas patients more commonly expressed skepticism rooted in concerns about trust and transparency. Pharmacists reported substantial challenges in developing indistinguishable HM placebos, raising questions about the ethical implications of adding small amounts of active ingredients. Participants also highlighted inconsistent practices in placebo composition and similarity evaluation, which raised concerns about blinding integrity and transparency, as well as insufficient communication that affected participant trust and overall trial integrity. Differences in professional and educational background appeared to shape how stakeholders perceived HM placebos, influencing informed consent and ethical conduct in trials. Enhancing understanding and transparency in placebo composition and similarity evaluation is essential to uphold ethical and scientific integrity of HM trials and to guide the development of clear guidelines for HM placebo design and communication. not applicable.

A critical global health concern in the last few decades is the widened gap between what we recognized scientifically as best practice interventions and what patients actually receive in clinical settings. Despite the fact that the past two decades has witnessed a preponderance of new and more effective interventions for acute stroke care globally, uptake of such interventions is inadequate and remains largely inaccessible to stroke patients. To be specific, uptake rates in low-middle income countries (LMICs) is pervasively slow, notwithstanding the fact that these countries bear a greater proportion of the global stroke burden. Yet, research on the application of contemporary interventions for acute stroke care in these contexts has been limited. Contextualizing this from the theoretical standpoints of evidence-based practice and knowledge translation, the overall purpose of this thesis was to advance understandings on the extent to which proven interventions for acute stroke care are implemented in standard practice in Ghanaian hospital settings This thesis aimed to 1) examine hospital-based services for acute stroke care and the extent to which such services are consistent with international best practice guidelines for acute stroke care; 2) evaluate in-hospital mortality outcomes among acute stroke patients in Ghanaian hospitals; and 3) explore acute stroke care professionals’ views on the practical barriers to the provision of evidence-based care for acute stroke patients. This thesis comprised three separate but interlinked studies. The first was a multi-site, hospital based survey conducted in 11 referral hospitals (regional and tertiary/teaching hospitals) in Ghana among neurologists, physician specialists and general medical officers. A structured questionnaire was used to gather data on available hospital-based acute stroke services, which were then analysed descriptively. The second study was a retrospective cohort study which evaluated in-hospital mortality outcomes among consecutive acute stroke patients admitted to six referral hospitals, comprising a sample of 300 participants selected randomly, representing about 50 patients from each site. Both descriptive and inferential statistics were used to conduct the analysis. The final study involved a multisite in-depth, semi-structured interview conducted in the retrospective study sites, comprising a purposive sample of 40 acute stroke care professionals (neurologists, emergency physician specialist, non-specialist medical doctors, nurses, physiotherapists, clinical psychologists and dietitian) to explore potential barriers to acute stroke care. Thematic and grounded theory approaches were employed to analyse the data. Overall, the findings showed the availability of evidence-based services for acute stroke care were limited. Only one tertiary-teaching hospital had a stroke unit. Although aspirin therapy was administered in all hospitals, none of the hospitals surveyed offered thrombolytic therapy (thrombolysis). Although eight study sites reported having a brain computed tomographic (CT) scanning, only 7 were functional. Magnetic resonance imaging (MRI scan) services were also limited to only 4 hospitals (only functional in three) within the sample hospitals. Acute stroke care specialists, especially neurologists, were available in 4 of the study hospitals whilst none of the study hospitals had an occupational or speech therapists. The results further highlight inadequate health policy priority towards acute stroke care across the sample hospitals. Evidence from the retrospective study revealed that the delivery of acute stroke care remained variable and patient outcomes, mainly in-hospital mortality, were also higher and varied across the study sites by international comparisons. However, patients provided with aspirin recorded less in-hospital mortality. There was also insignificant variance in-hospital mortality across admitting wards. Hypertension was identified as a significant risk factor for in-hospital mortality. The qualitative interviews also identified four key potential barriers impeding the implementation of evidence-based acute stroke care. These included barriers at the patient (financial constraints, delays, socio-cultural or religious practices, discharge against medical advice, denial of stroke), health system (inadequate medical facilities, lack of stroke care protocol, limited staff, inadequate staff development opportunities), health professionals (poor collaboration, limited knowledge of stroke care interventions) and broader national health policy (lack of political will) levels. Perceived barriers varied across professional disciplines and hospitals. In summary, the findings highlight evidence of only limited application of contemporary acute stroke care interventions, and relatively high in-hospital mortality and morbidity rates, which may be due to multiple barriers to provision of acute stroke care. Decisive and critical decisions are thus required to increase political support for acute stroke care by developing relevant policy to support well-targeted interventions that improve uptake of new treatment options for excellent clinical outcomes, with the ultimate goal of closing the current evidence-practice gap in Ghana and potentially other LMICs.

This qualitative study systematically documents pre-service teachers' responses to a writing prompt asking them to name a personal “unearned” privilege on an end-of-term final assessment. Findings suggest that typical White/European heritage pre-service teachers can name privileges that have advantaged their own lives, even after one 14-week critical multicultural education course. Categories reveal patterns in participants' responses about their own privilege that are traditionally attended to in critical multicultural education curriculum, such as White privilege. However, student responses show that students are most comfortable talking about inherited privileges related to social class and race is named at a lower rate. Other responses show a range of privileges that students can draw on when they reflect on the structured nature of privilege in society. Overall, our findings suggest that when opportunities are created for students to grapple with complex, personal, emotional concepts, the vast majority of students are willing and able to perform this type of reflection and analysis. This work begins a discussion of what kinds of social privilege are more easily discussed in a high stakes assessment after experiences in critical multicultural education. Our findings provide nuanced understandings of how typical pre-service teachers name their own personal unearned privileges and deconstruct their experiences of privilege. Our findings suggest that attention to privileges associated with social class could provide powerful entry into examinations of other personal privileges in critical multicultural education.

Background Multiple Family Group Therapy (MFGT) shows promise for improving outcomes among adolescents living with HIV (ALHIV), but strategies for successful implementation and positive outcomes in resource‐constrained settings remain unexplored. This study explored multistakeholder perspectives on effective strategies to support the implementation of the MFGT in Ghana. Methods A qualitative descriptive study was conducted at a district hospital in the Lower Manya Krobo District, Ghana. Data were collected through focus group discussions with ALHIV ( n = 12), caregivers ( n = 13), and health professionals ( n = 5), supplemented by three in‐depth interviews (with ALHIV). All stakeholder groups were recruited purposively with assistance from health workers. Data were analyzed using contextual thematic analysis guided by the Consolidated Framework for Implementation Research. Results Five themes emerged: (1) incentives and motivation for participants and healthcare workers, including transportation support and fair compensation; (2) skills building and capacity development through multimodal training approaches; (3) program design elements focusing on creating a sense of belonging through program identifiers and clear expectations; (4) addressing attendance barriers through flexible scheduling and reminder systems; and (5) program delivery optimization via diversified facilitation, adolescent engagement, and preprogram disclosure support. Conclusions Successful MFGT implementation requires comprehensive strategies that address the needs of multiple stakeholders across individual, organizational, and contextual levels. The findings provide evidence‐based implementation strategies that balance intervention fidelity with contextual adaptation for family‐based HIV interventions in resource‐constrained settings.

A Multiple-Stakeholder Perspective on Bank Performance Measurement

The Multiple Family Group Therapy (MFGT) has demonstrated effectiveness in addressing behavioral problems and mental health disorders among adolescents in high-income settings. Limited evidence exists on whether the MFGT can be implemented successfully in Ghana and other SSA for adolescents living with HIV (ALHIV), given the contextual differences between Ghana and high-income countries. This study aimed to identify factors and processes from multiple stakeholders that can support a successful implementation of the MFGT intervention for ALHIV and their families in the Lower Manya Krobo District of Ghana. A qualitative exploratory study was conducted at Atua Government Hospital. Data were collected through focus group discussions with ALHIV (n = 12), caregivers (n = 13), and health professionals (n = 5), supplemented by three in-depth interviews (with ALHIV). Contextual thematic analysis was employed to identify patterns and themes within the data, with attention to rigor through triangulation, member checking, and reflexivity. Six key enablers for MFGT implementation emerged: (1) existing support systems and infrastructure, including established HIV programs and dedicated adolescent clinic days; (2) willingness of health workers to participate and sustain the intervention; (3) practical implementation considerations including scheduling preferences and privacy concerns; (4) participation support needs such as material and logistical support and preference for diverse educational approaches(5) content preferences emphasizing comprehensive topics beyond HIV management and interactive learning approaches. Five key enablers emerged for successful MFGT implementation. Implementation strategies should integrate MFGT into existing adolescent clinic days, provide transportation assistance and reminder systems, accommodate Sunday scheduling preferences, train diverse facilitators, including peer mentors, and incorporate spiritual elements while maintaining flexible group compositions based on discussion topics.

The Multiple Family Group Therapy (MFGT) has demonstrated effectiveness in addressing behavioral problems and mental health disorders among adolescents in high-income settings. Limited evidence exists on whether the MFGT can be implemented successfully in Ghana and other SSA for adolescents living with HIV (ALHIV), given the contextual differences between Ghana and high-income countries. This study aimed to identify factors and processes from multiple stakeholders that can support a successful implementation of the MFGT intervention for ALHIV and their families in the Lower Manya Krobo District of Ghana. A qualitative exploratory study was conducted at Atua Government Hospital. Data were collected through focus group discussions with ALHIV (n = 12), caregivers (n = 13), and health professionals (n = 5), supplemented by three in-depth interviews (with ALHIV). Contextual thematic analysis was employed to identify patterns and themes within the data, with attention to rigor through triangulation, member checking, and reflexivity. Six key enablers for MFGT implementation emerged: (1) existing support systems and infrastructure, including established HIV programs and dedicated adolescent clinic days; (2) willingness of health workers to participate and sustain the intervention; (3) practical implementation considerations including scheduling preferences and privacy concerns; (4) participation support needs such as material and logistical support and preference for diverse educational approaches(5) content preferences emphasizing comprehensive topics beyond HIV management and interactive learning approaches. Five key enablers emerged for successful MFGT implementation. Implementation strategies should integrate MFGT into existing adolescent clinic days, provide transportation assistance and reminder systems, accommodate Sunday scheduling preferences, train diverse facilitators, including peer mentors, and incorporate spiritual elements while maintaining flexible group compositions based on discussion topics.

The World Health Organization (WHO) is revising the ICD-10 classification of mental and behavioural disorders, under the leadership of the Department of Mental Health and Substance Abuse and within the framework of the overall revision framework as directed by the World Health Assembly. This article describes WHO's perspective and priorities for mental and behavioural disorders classification in ICD-11, based on the recommendations of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders. The WHO considers that the classification should be developed in consultation with stakeholders, which include WHO member countries, multidisciplinary health professionals, and users of mental health services and their families. Attention to the cultural framework must be a key element in defining future classification concepts. Uses of the ICD that must be considered include clinical applications, research, teaching and training, health statistics, and public health. The Advisory Group has determined that the current revision represents a particular opportunity to improve the classification's clinical utility, particularly in global primary care settings where there is the greatest opportunity to identify people who need mental health treatment. Based on WHO's mission and constitution, the usefulness of the classification in helping WHO member countries, particularly low- and middle-income countries, to reduce the disease burden associated with mental disorders is among the highest priorities for the revision. This article describes the foundation provided by the recommendations of the Advisory Group for the current phase of work.

A Global Call for Action to Prioritize Healthcare Worker Suicide Prevention During the COVID-19 Pandemic and Beyond.

This study examined a sample of French persons with schizophrenia to explore the occupational history between onset of illness and first request for disability status, the duration of this period, and the demographic and clinical characteristics associated with a long duration. Persons with schizophrenia or schizoaffective disorder (N=110) requesting a disability allowance or the status of disabled worker for the first time were assessed by using a standardized questionnaire that collected information on clinical, occupational, and income history. Characteristics associated with a long duration were explored by using multivariate analyses. The majority of persons (92%) worked at least once during their lifetime, but this proportion fell dramatically to less than half after the onset of illness. Nearly half of the participants did not receive any income outside of financial support from the family after the onset of illness. The median delay between the onset of illness and the first request for disability status was four years. The characteristics independently predicting a long duration (that is, any time longer than the median, or four or more years) of the period between illness onset and first request were older age, higher educational level, a longer period of working after illness onset, and more than one psychiatric hospitalization. Professionals who choose to delay requesting disability benefits for their clients in order to promote social rehabilitation may paradoxically exacerbate the social consequences of the disease because of clients' lack of resources. Future studies should further explore the implicit and explicit criteria used by mental health professionals and social workers in deciding whether a person with schizophrenia should request disability benefits.