Broad Themes Research Articles

Exploring Perspectives on HIV Vulnerability Communication among Transgender and Gender Diverse Patients and Primary Care Providers.

Transgender and gender diverse (TGD) individuals represent a population with a heavy burden of HIV. Multi-level stigma encountered by TGD individuals can create significant barriers to discussing topics related to HIV prevention; however, research on communication between TGD patients and primary care providers (PCPs) about HIV vulnerability and prevention remains limited. This study used in-depth qualitative interviews with 25 TGD patients and 15 PCPs conducted in 2022 to explore perspectives on HIV vulnerability communication during primary care encounters. Overall, 14 of the TGD patients were nonbinary, genderqueer, or another gender identity; all but two participants identified as a sexual minority. The majority of PCPs (n = 11) were physicians. The range of years practicing medicine was between two and 39years. Thematic analysis was used to organize codes and establish themes. Three broad themes regarding factors that facilitate communication regarding HIV vulnerability were identified: (1) focusing on behaviors over identities, (2) conveying impartiality, and (3) acknowledging individuality among TGD patients. Findings corroborate earlier research that identified strengths in providers refraining from behavior-based assumptions tied to a patient's gender identity and sexual orientation and conveying impartial and nonjudgmental attitudes when discussing behaviors that can increase HIV vulnerability. Additionally, these findings underscore the significance of recognizing that, within the TGD community, all persons have unique circumstances, preferences, and needs. Future work should continue to explore the dynamics of HIV vulnerability and prevention discussions, especially among TGD individuals from diverse backgrounds and regions, to identify strategies for strengthening patient-provider communication and reducing vulnerability to HIV.

Barriers to WHO prequalification of similar biotherapeutic insulin.

To identify the barriers preventing manufacturers of similar biotherapeutic human insulin from submitting their products to the World Health Organization (WHO) for prequalification. We used a self-administered questionnaire to collect data from companies producing similar biotherapeutic human insulin. We included questions about the insulin products manufactured, knowledge of WHO prequalification requirements, export of the products and compliance with good manufacturing practices. Companies had the possibility to provide additional relevant information. We sent the questionnaire to 20 manufacturers in total. We evaluated responses and organized the data into themes. We had a response rate of 55% (11/20 companies). Five broad themes emerged: (i)manufacturers and products; (ii)expressions of interest awareness and participation; (iii)need for technical assistance and training; (iv)market and supply chain challenges; and (v)approval for good manufacturing practices. The most important reasons for manufacturers' lack of response to WHO's expression-of-interest invitation were absence of a mechanism to guarantee return on investment, and perceived complexity of prequalification requirements for insulin-similar biotherapeutic products. To encourage greater participation in the WHO prequalification programme, international procurement agencies associated with the programme should consider establishing a platform to enter into advance purchasing agreements with manufacturers. In addition, WHO's Local Production and Assistance Unit should provide companies with ongoing technical assistance on the development of their human insulin products and improvement of their production facilities to comply with the WHO requirements for good manufacturing practices.

Statistical methods for clinical trials interrupted by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic: A review.

Cancellation or delay of non-essential medical interventions, limitation of face-to-face assessments or outpatient attendance due to lockdown restrictions, illness or fear of hospital or healthcare centre visits, and halting of research to allow diversion of healthcare resources to focus on the pandemic led to the interruption of many clinical trials during the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic. Appropriate analysis approaches are now required for these interrupted trials. In trials with long follow-up and longitudinal outcomes, data may be available on early outcomes for many patients for whom final, primary outcome data were not observed. A natural question is then how these early data can best be used in the trial analysis. Although recommendations are available from regulators, funders, and methodologists, there is a lack of a review of recent work addressing this problem. This article reports a review of recent methods that can be used in the setting of the analysis of interrupted clinical trials with longitudinal outcomes with monotone missingness. A search for methodological papers published during the period 2020-2023 identified 43 relevant publications. We categorised these articles under the four broad themes of missing value imputation, modelling and covariate adjustment, simulation and estimands. Although motivated by the interruption due to SARS-CoV-2 and the resulting disease, the papers reviewed and methods discussed are also relevant to clinical trials interrupted for other reasons, with follow-up discontinued.

Exploring staff and student experiences of group-work assessment in higher education

Group work in higher education is well known to promote deep learning through collaboration with peers. However, there can be issues with facilitation, perceived fairness, and motivation. The aim of this project was to explore staff and student views of a new group presentation assessment. A student survey explored preparation, experiences, and learning/skills. Two academics were interviewed. According to the survey, students felt prepared for the group work, but less so for the presentation. Students also felt their group worked well, although some did not agree that everyone contributed. Most agreed that the task was enjoyable and that they gained new knowledge. Two broad themes arose from the interviews (preparedness and student support), which link to the findings in the survey. Though the assessment format was well received, there was room to develop the support resources. The individual contribution grade for the assessment could include more weight on quality to enhance engagement. This article was published open access under a CC BY licence: https://creativecommons.org/licences/by/4.0/ .

Developing Independent Living Support for Older Adults Using Internet of Things and AI-Based Systems: Co-Design Study.

The number of older people with unmet health care and support needs is increasing substantially due to the challenges facing health care systems worldwide. There are potentially great benefits to using the Internet of Things coupled with artificial intelligence to support independent living and the measurement of health risks, thus improving quality of life for the older adult population. Taking a co-design approach has the potential to ensure that these technological solutions are developed to address specific user needs and requirements. The aim of this study was to investigate stakeholders' perceptions of independent living and technology solutions, identify stakeholders' suggestions on how technology could assist older adults to live independently, and explore the acceptability and usefulness of a prototype Internet of Things solution called the NEX system to support independent living for an older adult population. The development of the NEX system was carried out in 3 key phases with a strong focus on diverse stakeholder involvement. The initial predesign exploratory phase recruited 17 stakeholders, including older adults and family caregivers, using fictitious personas and scenarios to explore initial perceptions of independent living and technology solutions. The subsequent co-design and testing phase expanded this to include a comprehensive web-based survey completed by 380 stakeholders, encompassing older adults, family caregivers, health care professionals, and home care support staff. This phase also included prototype testing at home by 7 older adults to assess technology needs, requirements, and the initial acceptability of the system. Finally, in the postdesign phase, workshops were held between academic and industry partners to analyze data collected from the earlier stages and to discuss recommendations for the future development of the system. The predesign phase revealed 3 broad themes: loneliness and technology, aging and technology, and adopting and using technology. The co-design phase highlighted key areas where technology could assist older adults to live independently: home security, falls and loneliness, remote monitoring by family members, and communication with clients. Prototype testing revealed that the acceptability aspects of the prototype varied across technology types. Ambient sensors and voice-activated assistants were described as the most acceptable technology by participants. Last, the postdesign analysis process highlighted that ambient sensors have the potential for automatic detection of activities of daily living, resulting in key recommendations for future developments and deployments in this area. This study demonstrates the significance of incorporating diverse stakeholder perspectives in developing solutions that support independent living. Additionally, it emphasizes the advantages of prototype testing in home environments, offering crucial insights into the real-world experiences of users interacting with technological solutions.

Understanding leadership challenges faced by humanitarian aid workers: insights from the experiences of NNPHL training participants

This paper examines the self-reported leadership challenges experienced by humanitarian aid workers who participated in the National NGO Program on Humanitarian Leadership (NNPHL) Program. Data were drawn from NNPHL program participants describing leadership challenges they faced in their humanitarian work. Responses were analyzed qualitatively revealing 10 broad themes of leadership challenges: (1) organizational capacity and resource constraints, (2) managerial decision-making styles, (3) bureaucracy and external influence, (4) purpose, motivation, and influence, (5) coordination and cooperation, (6) trust and cohesion within teams, (7) staff well-being and burnout, (8) identity and diversity, (9) self-efficacy and confidence, (10) security. These findings were then situated in the broader literature on challenges identified in humanitarian aid contexts. Humanitarian aid workers offer valuable first-hand insights into the leadership challenges they face in their work. Understanding leadership challenges from the perspective of aid workers provides valuable insight that can be used to inform decision-making and policy development within humanitarian organizations. The findings can also help inform and shape the development of humanitarian training programs by tailoring humanitarian education curricula to address the challenges encountered by aid workers themselves.

Tobacco companies, corporate social responsibility and the use of third-party awards: a framing analysis

ObjectiveCorporate social responsibility activities, such as third-party awards, provide an opportunity for tobacco companies (TCs) to promote themselves as socially, economically and environmentally responsible organisations. This study aimed to determine...

Study of Salvation based on 1 Peter 3:18-22 among Batak Toba Christians, North Sumatra

Salvation is a very broad subject and very important to understand properly in the Bible. Salvation in Jesus Christ can be responded to by believing in Christ and His work. The understanding of salvation is now understood in universalism, and not a few people or groups have also turned to syncretism. The emergence of many teachers, pastors, and theologians had a great impact on providing different understandings among Christians. Each tribe has a belief in their ancestors, which later becomes a culture or custom. Initially, every Batak culture or custom was inseparable from magical elements. Any rituals or traditional ceremonies performed by certain groups or people are believed to keep them away from danger so that they are fine. But in reality, not a few of them experience the opposite. The initial motivation for getting blessings and safety turns out to be the tribulation or wretchedness that befalls their lives. The purpose of this research is to find out the magnitude of the confirmation of salvation in Jesus Christ. The most dominant dimension determines the confirmation of salvation, and the most dominant background category determines the confirmation of salvation based on 1 Peter 3:18-22 among Batak Toba Christians in Sumatra North. The method used is a quantitative approach using explanatory and confirmatory surveys. Research Results: Confirmation level about salvation based on 1 Peter 3:18-22 is in the high category. The most dominant dimension determining Confirmation about salvation is Preaching the Gospel by Jesus Christ (D3). The dominant background category determining confirmation of safety is age.

Participant Motivators and Expectations in the MEL-SELF Randomized Clinical Trial of Patient-Led Surveillance for Recurrent Melanoma: Content Analysis of Survey Responses.

Limited data exist on the motivations and expectations of participants when enrolling in dermatology clinical trials, including melanoma early detection trials. Understanding participant motivators for research engagement has been identified as a prioritized area for trial methodology research. The study aimed to determine motivators of participation and expectations from trial involvement among patients enrolled in the MEL-SELF randomized clinical trial of patient-led surveillance for new or recurrent melanoma. The MEL-SELF trial is recruiting patients previously treated for localized melanoma, who own a smartphone, have a partner to assist with skin self-examination (SSE), and attend routinely scheduled follow-up at specialist and primary care skin clinics in Australia. We evaluated responses from the first 100 randomized participants to 2 open-ended questions about their motivations and expectations for participating in the trial, administered through the internet-based baseline questionnaire. A total of 3 coders independently coded the free-text responses and resolved discrepancies through consensus. Qualitative content analysis by an iterative process was used to group responses into themes. Responses from potential participants who were not randomized and the 404 participants randomized subsequently into the trial, were also checked for new themes. Coding and analysis were conducted in Microsoft Excel. Out of the 100 survey participants, 98 (98%) answered at least 1 of the 2 questions. Overall, responses across the motivation and expectation items indicated 3 broad themes: community benefit, perceived personal benefit, and trusting relationship with their health care provider. The most common motivators for participation were related to community benefit. These included progressing medical research, benefitting future melanoma patients who may have similar experiences, and broader altruistic sentiments such as "helping others" or "giving back." The most common expectations from the trial related to personal benefit. These included perceived improved outcomes such as earlier diagnosis and treatment, access to additional care, and increased self-empowerment to take actions themselves that benefit their health. Patients expressed a desire to gain health-related knowledge and skills and were interested in the potential advantages of teledermatology. There were no new themes in responses from those who were not randomized or were randomized subsequent to the first 100. We report a tailorable, patient-focused approach to identify drivers of research engagement in clinical research. Clinical trials offer an opportunity to collate a substantial evidence base on determinants of research participation and to identify context-specific factors. Results from the MEL-SELF trial emphasized notable altruism, self-empowerment, and perceived advantages of teledermatology as specific motivators. These findings informed consent processes, recruitment, retention, response to trial tasks, and intervention adherence for the MEL-SELF host trial. Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000176864. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379527.

Patient and family aftercare enhance interactions between Helicopter Emergency Medicine Services and former patients and families

BackgroundHelicopter Emergency Medical Services (HEMS) in the United Kingdom (UK) deliver enhanced care to high-acuity, critically ill and injured patients. To enable patients to meet the HEMS team who treated them, many services within the UK have developed or are in the process of developing a Patient and Family Aftercare Service (PFAS). This study aims to evaluate whether the introduction of PFAS mitigates anxiety associated with patient aftercare visits.MethodsA service evaluation of anxiety in HEMS team members before and after patient aftercare visits were conducted. The study was carried out between 1 September 2023, and 31 October 2023, and patient visits were undertaken between March 2022 and July 2023. An electronic survey was distributed to the respondents who provided informed consent for participation. The survey comprised the validated generalised anxiety disorder anxiety scale (GAD-7) and five additional contextualised statements developed through the wider PFAS. Anonymised data were collected using REDCap, a secure electronic database and was analysed in R programming. Free-text comments were reported by content analysis, placed into themes, and discussed with a narrative to complement the quantitative analysis.ResultsOf the 33 recipients, 25 completed the questionnaire. Between the pre- and post-aftercare visits, a statistically significant difference was found between scores for GAD-7 (0.004, p < 0.05) and contextualised statements (0.001, p < 0.05). In addition, six broad themes were identified through content analysis. These include the emotional impact of patient interaction, coping strategies and structural changes in the aftercare system, challenges in patient and family expectations, anxieties relating to operational commitments, memory and recall of the incident, and a positive impact on personal growth.ConclusionAnxiety related to patient aftercare visits was reduced when measured before and after the patient visits. Following this service evaluation, we can hypothesise that within pre-hospital care, PFAS plays an important structural role. Future research should focus on affirming the correct tool to measure anxiety in multi-disciplinary teams and prospectively evaluating these methods collaboratively across multiple pre-hospital services.

Celebrating the research career of Douglas Nelson

AbstractThis special issue celebrates Prof. Douglas Nelson's body of research. It comprises articles by many of his co‐authors, colleagues and students. They address two broad themes: the interplay between trade and investment flows and employment and equity on the one hand and the interaction between trade‐related policies and patterns of trade and investment on the other.

Deepening the Decade: Collaborative Action for Advancing Deep‐Ocean Science and Policy in the United Nations Decade of Ocean Science for Sustainable Development

AbstractThe current United Nations Decade of Ocean Science for Sustainable Development (2021–2030; hereafter, the Decade) offers a unique opportunity and framework to globally advance ocean science and policy. Achieving meaningful progress within the Decade requires collaboration and coordination across Decade Actions (Programs, Projects, and Centres). This coordination is particularly important for the deep ocean, which remains critically under‐sampled compared to other ecosystems. Despite the limited sampling, the deep ocean accounts for over 95% of Earth's habitable space, plays a crucial role in regulating the carbon cycle and global temperatures, and supports diverse ecosystems. To collectively advance deep‐ocean science, we gathered representatives from 20 Decade Actions that focus at least partially on the deep ocean. We identified five broad themes that aim to advance deep‐ocean science in alignment with the Decade's overarching 10 Challenges: natural capital and the blue economy, biodiversity, deep‐ocean observing, best practices in data sharing, and capacity building. Within each theme, we propose concrete objectives (termed Cohesive Asks) and milestones (Targets) for the deep‐ocean community. Developing these Cohesive Asks and Targets reflects a commitment to better coordination across deep‐ocean Decade Actions. We aim to build bridges across deep‐ocean disciplines, which encompass natural science, ocean observing, policy, and capacity development.

Virtual simulation for teaching cardiology in nursing: a scoping review protocol

IntroductionVirtual simulation (VS) can be an effective learning strategy in the context of nursing education on cardiovascular disease; however, its use in teaching cardiology in nursing is less studied. The...

Vaping to quit smoking: Qualitative study of people receiving opioid agonist treatment.

Most patients receiving opioid agonist treatment (OAT) smoke tobacco. Approved cessation interventions are less effective in this group than the wider population. We investigated how people on OAT experience nicotine vaping to quit smoking. Patients on OAT randomised to the vaping arm of a smoking cessation trial were invited to participate in structured interviews incorporating broad pre-determined themes. A qualitative descriptive approach employing template analysis was used. Four authors coded transcripts, discussed discrepancies, modified the template using both inductive and deductive approaches. Authors made explicit their starting orientations and independent authors sought disconfirmatory data in a subsequent round of analysis. Four women and eight men (median age 44 years) participated, including four who identified as Aboriginal. Participants reported vaping as cheaper, more acceptable and less stigmatising than smoking but expressed concerns about ongoing accessibility due to the Australian prescription access model. Some found it technically challenging at first, but not more so than standard nicotine replacement therapies. Participants gave accounts of craving and withdrawal experiences, including supplementary use of nicotine patches, and compulsions to vape frequently and intensely, potentially indicating need for higher nicotine dosage. Participants generally reported that vaping helped them quit smoking, though some worried about swapping nicotine addictions. Others were glad to be using a lower-risk alternative. This group reported varied experiences of nicotine vaping but were mainly optimistic that it could help them and others quit smoking. This was despite initial nicotine cravings and concerns about remaining addicted long-term.

Voters’ perceptions of the policy making and performance of the elected government after 2018 general election in Pakistan

In this study, the phenomenological approach was used to explore the perceptions of Pakistan Tahreek Insaf (PTI) voters regarding PTI policy making and performance six months after the Pakistani general election of 2018 (GE-2018). The sample comprised 20 PTI voters, and data was collected through one-to-one interview. The thematic analysis led to the following broad and sub themes: The first broad theme, pre-election party ideology, was described by the following sub-themes: vision of change, fight against corruption, and developing Pakistan along the lines of the State of Medina. The second broad theme, the performance of the elected government, was understood through the following sub-themes: accountability, political stability, poor policy making, and false election pledges. And the last broad theme, the public’s perceptions of the future performance of the elected government can be explained by its single sub-theme, i.e., giving the elected government a chance to complete its tenure of five years. It can be concluded that most of the participants were optimistic that the elected government of Pakistan would fulfill its pre-election promises.

“I feel like I'm always on edge”: Perceptions of parole supervision by parolees with substance use disorders

IntroductionWhile extant research has looked at parole and its various actors as an institution, few studies recount the parole experience from the perspective of parolees. Additionally, despite the prevalence of substance use disorders (SUDs) within the criminal justice system, research that assesses the additional challenges this population faces throughout parole supervision is even scarcer. MethodsTo address this gap, we analyze in-depth qualitative interviews (n = 51) conducted with reentering men with SUDs as they navigate parole in Pennsylvania. Three independent coders identified all narratives relating to a broad theme of “parole and probation experiences.” The authors then completed iterative rounds of more fine-grained independent coding within that theme. ResultsOur results emphasize that SUDs present a significant barrier to reentry success, and the tension of surveillance and revocation is amplified for those enduring simultaneous reentry and recovery. Importantly, our respondents regard parole officers more positively than they view parole as an institution, yet this perception of officers does not equate to provision of reintegration and recovery support. Respondents perceive that parole presents unnecessary additional hurdles to their reentry success, and their perceived risk level impacts their surveillance intensity. ConclusionsThe information gleaned through inclusion of perspectives from those enduring parole supervision calls for a critical assessment of current parole practices. Further, the current approach to SUDs within community supervision criminalizes relapse without provision of treatment resources or support.

It takes a village: Feedback from personnel in addiction treatment programs indicates support for changing the intake process

IntroductionThe initial intake encounter represents a critical point for treatment engagement in outpatient addiction treatment programs. Despite the intake assessment being more comprehensive, personalized, and capable of matching clients to level of treatment, addiction treatment programs continue to have among the highest attrition rates. Thus, it may not be what, but how services are delivered that contributes to attrition. The Consolidated Framework for Implementation Research (CFIR) offers a comprehensive framework to attend to sources of needed innovation for the intake process. The current study used a mixed method design, guided by CFIR, to obtain feedback from personnel in addiction treatment programs on the current intake process, as well as the facilitators and barriers to changing the intake process. MethodsPersonnel within New Mexico-based addiction treatment programs completed measures of individual and organizational readiness to make changes within their programs (N = 79; 76 % women, 79 % White, 55 % Latino/a). From this sample, 38 participants completed a CFIR-based semi-structured interview to identify potential barriers and facilitators to changing the intake process. ResultsParticipants reported moderate-to-high scores on readiness and capability to make organizational changes. For qualitative data, we identified nine broad themes, grouped based on (1) perspectives of current intake process (Intake Process, Organization Culture, Change Perspectives, Internal Communication, Client Needs) and (2) perspectives of changing the intake to an MI session (MI knowledge/attitudes, MI at intake, MI in organization, MI fit with Client Needs). ConclusionsFindings highlight that there are specific components of the intake content and process that appear to disengage clients, specific policies and procedures that appear to overburden staff, and key stakeholders and resources needed to improve the intake process. Recommendations are provided for intake-specific and procedural-level changes both in the organization and with outside agencies to improve the intake process.

Impact of COVID-19 Pandemic on Caregivers of Children with Neurodevelopmental Disabilities: A Qualitative Study

Background/Aim: It is well known that caregivers of children with neurodevelopmental disabilities (NDD) face challenges. These challenges increased further due to the coronavirus disease 2019 (COVID-19) pandemic and the related restrictions. There was very little data from India on these challenges. This study was done with the primary aim to gain insights about the challenges faced by parents of children with NDD through their personal stories. Methods: Participants were recruited using purposive sampling method and semi-structured interviews were conducted through a telephone or in person. Data saturation was achieved by the sixth participant and 2 more interviews were performed for further confirmation. Interviews were transcribed, and a 7-step Colaizzi’s phenomenological method was used to identify different themes. Results: The impact of COVID-19 on caregivers of children with NDD can be summarized into 4 broad themes. First, there were challenges related to “therapy” which included closure of day-care centers and schools, inaccessibility to professionals, and disruption in home-based learning. Second, there were “child” related challenges which included inappropriate behaviors. Third, there were “family” challenges which included misunderstandings between parents and difficulties in adhering to family routines. Lastly, there were “personal” challenges related to physical and psychological health. Conclusion: The personal stories of caregivers of children with NDD highlight the pressing need to provide appropriate support and formulate holistic models to enhance well-being of caregivers during difficult periods.

Health information exchange and 42 CFR part two: Incorporating the voice of people with histories of substance use disorder

IntroductionWe set out to understand patient attitudes and concerns about sharing information about substance use disorder (SUD) history through a Health Information Exchange (HIE), in the context of 42 CFR Part 2. MethodsThe study conducted semi-structured qualitative interviews of people with SUD history, recruited through an association of recovery communities in Rhode Island. Interviews were recorded and transcribed. Two Research Assistants coded the interviews using Atlas.ti™ in consultation with the principal investigator. Each first coded a sample of interviews independently. The team then discussed the coding and agreed on broad coding categories. The team met regularly to discuss emerging constructs and agree on a detailed coding schema. We came to consensus on broad themes and selected illustrative quotations. Interpretation was pragmatic, focusing on the nature and consequences of participants' experiences, and their wishes and intentions with respect to information sharing. ResultsOf 27 respondents, all but three reported negative experiences with health care providers because of current or former SUD, ranging from judgmental to neglectful or inappropriate treatment, to disparagement and abuse. With few exceptions, they would not consider sharing their SUD history through an HIE without specific, revocable control over which individual providers could receive the information. ConclusionsRespondents' requirements are consistent with the legal requirements of 42 CFR Part 2. Implementing Part 2 compliant HIE will require overcoming substantial technical and procedural challenges.

Meeting practitioners where they are: A conversation on engaged learning in policy and management

Our paper is a practitioner reflection that explores the concepts of engaged learning as a means of erasing the specious divide between academia and policy/management practice. It takes the form of a conversation between the two authors, each of whom have significant experience in both camps, but who also would seem to fall more neatly into one than the other. The paper outlines our experiences in professional development, with an emphasis on a specific series of organisational trust workshops, which use an ‘embodied values’ approach so that learning outcomes are built into the structure and process of the session rather than just in content. We utilise a conversational approach as this enables us to expand on broader themes as well as draw on our experiences. More importantly, it also is redolent of the embodied values approach and demonstrates the types of shared learning we seek to promote as useful for the future.