Consideration Of Contextual Factors Research Articles

Stroke Care Planner: A Delphi Study

Abstract Objective: The objective of the study was to analyse the efficacy and acceptability of a care planning tool for comprehensive post-stroke rehabilitation. Materials and Methods: An expert panel of physiatrists from Kerala, India, participated in a three-round Delphi study. Intervention: Nil. Results: Consensus was reached on 13 deficit-oriented modules with best practice key statements. They stress the need for supervised rehabilitation interventions provided by trained health professionals early after discharge from the acute care setting to optimise patient outcomes. Patient-specific, centre-specific and culturally appropriate factors were considered during formulation. Acute care, triage, routine workflow, outcome assessment, trajectory assessment and rationale were recommended, and several standardised outcome measures were identified. Follow-up and community-based rehabilitation suggestions were provided. Specifics on timing, service providers, need for long-term follow-up and interventions differed per module. Conclusion: A rigorous consensus method led to key recommendations in modular form using the available evidence and consideration of contextual factors to facilitate clinical practice. This is an important step towards reducing practice variation, closing the evidence–practice gap and improving the quality of rehabilitation services after stroke. Significance and Innovations: This is the first formal consensus process to integrate available evidence and expert opinion with a ‘deficit to metric to treatment to outcome’ approach to recommend key aspects of post-stroke rehabilitation from admission to return to the community. The expert panel recommended structured physiatrist-led rehabilitation, initiated early to optimise patient outcomes. In addition to physical rehabilitation, it is important to recognise cognitive and psycho-social deficits along with the influence of contextual factors that impact rehabilitation structures, processes and outcomes.

Qualitative Research Methods for Large Language Models: Conducting Semi-Structured Interviews with ChatGPT and BARD on Computer Science Education

In the current era of artificial intelligence, large language models such as ChatGPT and BARD are being increasingly used for various applications, such as language translation, text generation, and human-like conversation. The fact that these models consist of large amounts of data, including many different opinions and perspectives, could introduce the possibility of a new qualitative research approach: Due to the probabilistic character of their answers, “interviewing” these large language models could give insights into public opinions in a way that otherwise only interviews with large groups of subjects could deliver. However, it is not yet clear if qualitative content analysis research methods can be applied to interviews with these models. Evaluating the applicability of qualitative research methods to interviews with large language models could foster our understanding of their abilities and limitations. In this paper, we examine the applicability of qualitative content analysis research methods to interviews with ChatGPT in English, ChatGPT in German, and BARD in English on the relevance of computer science in K-12 education, which was used as an exemplary topic. We found that the answers produced by these models strongly depended on the provided context, and the same model could produce heavily differing results for the same questions. From these results and the insights throughout the process, we formulated guidelines for conducting and analyzing interviews with large language models. Our findings suggest that qualitative content analysis research methods can indeed be applied to interviews with large language models, but with careful consideration of contextual factors that may affect the responses produced by these models. The guidelines we provide can aid researchers and practitioners in conducting more nuanced and insightful interviews with large language models. From an overall view of our results, we generally do not recommend using interviews with large language models for research purposes, due to their highly unpredictable results. However, we suggest using these models as exploration tools for gaining different perspectives on research topics and for testing interview guidelines before conducting real-world interviews.

Factors influencing treatment decision-making for cancer patients in low- and middle-income countries: A scoping review.

In this scoping review, we evaluated existing literature related to factors influencing treatment decision-making for patients diagnosed with cancer in low- and middle-income countries, noting factors that influence decisions to pursue treatment with curative versus non-curative intent. We identified an existing framework for adult cancer developed in a high-income country (HIC) context and described similar and novel factors relevant to low-and middle-income country settings. We used scoping review methodology to identify and synthesize existing literature on factors influencing decision-making for pediatric and adult cancer in these settings. Articles were identified through an advanced Boolean search across six databases, inclusive of all article types from inception through July 2022. Seventy-nine articles were identified from 22 countries across six regions, primarily reporting the experiences of lower-middle and upper-middle-income countries. Included articles largely represented original research (54%), adult cancer populations (61%), and studied patients as the targeted population (51%). More than a quarter of articles focused exclusively on breast cancer (28%). Approximately 30% described factors that influenced decisions to choose between therapies with curative versus non-curative intent. Of 56 reported factors, 22 novel factors were identified. Socioeconomic status, reimbursement policies/cost of treatment, and treatment and supportive care were the most commonly described factors. This scoping review expanded upon previously described factors that influence cancer treatment decision-making in HICs, broadening knowledge to include perspectives of low- and middle-income countries. While global commonalities exist, certain variables influence treatment choices differently or uniquely in different settings. Treatment regimens should further be tailored to local environments with consideration of contextual factors and accessible resources that often impact decision-making.

An Evaluation of Cognitive Behavioral Therapy for Substance Use Disorder: A Systematic Review and Application of the Society of Clinical Psychology Criteria for Empirically Supported Treatments.

Cognitive behavioral therapy (CBT) is a commonly used treatment for substance use disorders (SUDs) but has not been evaluated using the American Psychological Association's "Tolin Criteria" for determining the empirical basis of psychological treatments. The current systematic review evaluated five meta-analyses of CBT for SUD. One meta-analysis had sufficient quality to be considered in the evaluation of effect sizes. CBT produced small to moderate effects on substance use when compared to inactive treatment and was most effective at early follow-up (1-6 months post-treatment) compared to late follow-up (8+ months post-treatment). Sensitivity analyses including all five meta-analyses found similar results. A "strong recommendation" was provided for CBT as an empirically supported treatment for SUD, based on effects on substance use, quality of evidence, and consideration of contextual factors (e.g., efficacy in diverse populations).

DIGITAL MEDIA USE IN PUBLIC SPACE – AN OBSERVATIONAL STUDY OF SELF-SERVICE TECHNOLOGY DURING COVID19-PANDEMIC.

The spread of digital media and devices in public spaces, so-called self-service technology (SST), is reaching more and more areas, so that it is now possible to interact with them for example when shopping, ordering or sending parcels. The use of SST is mostly supposed to be self-explanatory and intuitive, nevertheless it implicitly presupposes a certain degree of technical literacy. If this is not the case, digital stress can be triggered. But how do people deal with these devices, what role does the presence of others, the device itself and how it works, and the situational context plays? What influence do the measures to deal with the Covid-19 virus and the pandemic-related constraints have on the nexus of device, users and situation? This was investigated qualitatively in the present study by conducting participant observations. The advantage of this methodological approach is the consideration of contextual factors of the different practices and the direct observation of subjective evaluation processes on the use or even non-use of SST. This shows that characteristics of the devices – e.g. functionality, initiation and optionality – , situational contextual conditions – e.g. time and social pressure and spatial conditions –, and the subject themselves – e.g. age, routinisation and carried along baggage– play a role in dealing with SST and moderate the emergence of digital stress.

Safety training in context: technical, cultural and political factors affecting its design, delivery and transfer

Introduction: Safety training is integral to modern safety management systems. However, what is trained in the classroom is not always adopted and applied in the workplace, creating the training transfer problem. Taking an alternative ontological stance, the aims of this study were to conceptualize this problem as one of ‘fit’ between what is trained and the contextual factors in the work environment of the adopting organization. Method: Twelve semi-structured interviews were conducted with experienced health andsafety trainers having diverse backgrounds and experience. Data were thematically coded ‘bottom-up’ to capture reasons for safety training and where consideration of context occurs in the design and delivery of training. Then, the codes were thematically grouped against a pre-existing framework to categorize contextual factors that affect ‘fit’ into technical, cultural, and political factors each operating at different levels of analysis. Results: Safety training occurs to satisfy external stakeholder expectations and meet internal perceptions of need. Consideration of contextual factors can occur both in the design and delivery of training. A range of technical, cultural, and political factors were identified, which can operate at individual, organizational, or supra-organizational levels to influence safety training transfer. Conclusions: The study draws particular attention to the influence of political factors and the impact of supra-organizational factors on the successful transfer of training, areas not consistently considered in safety training design and delivery. Practical Application: The application of the framework adopted in this study provides a useful tool for discriminating between different contextual factors and the level at which they operate. This could enable more effective management of these factors to improve the potential for transfer of safety training from the classroom to the workplace.

Association of Physical Activity and Gait Speed: Does Context Matter?

Background: Physical activity (PA) is associated with gait speed, and both are recognized predictors of important health outcomes. The role of social context, such as PA of one’s spouse, in the association between PA and gait speed is largely unexplored. Methods: In our dyadic study of 69 couples, we objectively assessed each partner’s moderate to vigorous PA (MVPA) and gait speed. Associations of MVPA and gait speed were tested using actor-partner interdependence models in a structural equation modeling framework. Whether partners’ typically exercise together was examined as a moderator of these associations. Results: A nonlinear association was observed where higher MVPA was associated with faster gait speed, but only when MVPA was below average (husbands β = −.517; P = .002; wives β = −.483; P = .009). No moderating effects of exercising together were detected for husbands’ or wives’ MVPA on their own or their partners’ gait speed. Conclusions: In this investigation of couples, the association between MVPA and gait speed emerged only when nonlinear effects were considered. Findings suggest that the PA and gait speed association may be more nuanced than previously examined. Additional consideration of contextual factors that may alter the complex association between MVPA and gait speed is warranted.

Infrastructure, policy and regulatory interventions to increase physical activity to prevent cardiovascular diseases and diabetes: a systematic review

BackgroundNoncommunicable diseases are major contributors to morbidity and mortality worldwide. Modifying the risk factors for these conditions, such as physical inactivity, is thus essential. Addressing the context or circumstances in which physical activity occurs may promote physical activity at a population level. We assessed the effects of infrastructure, policy or regulatory interventions for increasing physical activity.MethodsWe searched PubMed, Embase and clinicaltrials.gov to identify randomised controlled trials (RCTs), controlled before-after (CBAs) studies, and interrupted time series (ITS) studies assessing population-level infrastructure or policy and regulatory interventions to increase physical activity. We were interested in the effects of these interventions on physical activity, body weight and related measures, blood pressure, and CVD and type 2 diabetes morbidity and mortality, and on other secondary outcomes. Screening and data extraction was done in duplicate, with risk of bias was using an adapted Cochrane risk of bias tool. Due to high levels of heterogeneity, we synthesised the evidence based on effect direction.ResultsWe included 33 studies, mostly conducted in high-income countries. Of these, 13 assessed infrastructure changes to green or other spaces to promote physical activity and 18 infrastructure changes to promote active transport. The effects of identified interventions on physical activity, body weight and blood pressure varied across studies (very low certainty evidence); thus, we remain very uncertain about the effects of these interventions. Two studies assessed the effects of policy and regulatory interventions; one provided free access to physical activity facilities and showed that it may have beneficial effects on physical activity (low certainty evidence). The other provided free bus travel for youth, with intervention effects varying across studies (very low certainty evidence).ConclusionsEvidence from 33 studies assessing infrastructure, policy and regulatory interventions for increasing physical activity showed varying results. The certainty of the evidence was mostly very low, due to study designs included and inconsistent findings between studies. Despite this drawback, the evidence indicates that providing access to physical activity facilities may be beneficial; however this finding is based on only one study. Implementation of these interventions requires full consideration of contextual factors, especially in low resource settings.Trial registrationPROSPERO 2018 CRD42018093429.

Safety considerations for assessing the quality of apps used during pregnancy: A scoping review.

Pregnant women are increasingly turning to apps targeting knowledge and behaviour change for supporting healthy lifestyles and managing medical conditions. Yet, there is growing concern over the credibility and safety of content within mobile health (mHealth) apps. This scoping review aimed to systematically and thematically consolidate safety considerations described in reviews evaluating pregnancy-specific apps. PubMed, Ovid MEDLINE® and EPub, CINAHL, Web of Science, Cochrane Libraries, and SCOPUS were systematically searched to identify reviews that assessed apps targeting pregnant women. Data related to safety were extracted and thematically analysed to establish a set of relevant safety considerations. Sixteen reviews met the inclusion criteria. The included reviews assessed an average of 27 apps each and targeted pregnancy topics, such as nutrition and physical activity. Five major and 20 minor themes were identified, including information, transparency, credibility, privacy and security, and app tailoring. Information, transparency, and credibility relate to the evidence base of information within the app, privacy and security of apps relate to the protection of personal information and data, and app tailoring relates to the consideration of contextual factors, such as local guidelines and digital health literacy. Results present possible safety considerations when evaluating pregnancy-specific apps and emphasise a clear need for consumer guidance on how to make informed decisions around engagement and use of mHealth apps during pregnancy.

An Optimization Model for the Student-to-Project Supervisor Assignment Problem-The Case of an Engineering Department

Purpose. Empirical studies on the topic of assigning university project students to supervisors are currently underexplored. Such studies are critical to success of both the students and the university. Whilst extant research on this topic has contributed to an understanding of student assignments, what appears to be missing is application of a comprehensive framework to inform formulation and validation of a robust solution approach that takes account of both student and supervisor preferences, to optimize a real-life student-to-project supervisor assignment problem. Methodology. Questionnaire and interview surveys with project coordinators, project supervisors, head of department and students were conducted to identify factors surrounding the student-to-project supervisor assignment, through a case study approach in a university department offering engineering degree programs. This study not only develops a framework to understand an effective student-to-project supervisor assignment decision but also applies it in practice, through a case study in a University department offering engineering degree programs. An integer linear programming model was developed and implemented in an optimization software to optimize the student-to-project supervisor assignment, using data from the case study. Findings. Using OpenSolver, validated model results show improvements in matching both students and project supervisors’ preferences, whilst complying with supervisors’ workloads. These results also reveal an improvement in minimizing the project coordinator’s time in doing the assignment by introducing a standardized approach that concurrently considers all variables in a consistent manner. Originality. The contribution lies in: (1) development of a robust framework for student-to-supervisor assignments, (2) explicit consideration of contextual factors that recognize different assignment scenarios, (3) identification of feedback loops to recognize not only the need for continuous improvement in student-to-supervisor assignments but also links to performance in final year projects, (4) unique insights to guide project coordinators in relation to an efficient, effective, comprehensive, and standardized approach to the student-to-project supervisor assignment, and (5) a deeper understanding of a comprehensive range of factors that play a role in student-to-project supervisor assignments in higher education institutions.

Choice and Partnership Approach to community mental health and addiction services: a realist-informed scoping review

ObjectivesThe Choice and Partnership Approach (CAPA) was developed to create an accessible, child-centred and family-centred model of child and adolescent mental health service delivery that is adaptable to different settings....

User Experience Research in the Work Context: Maps, Gaps and Agenda

User experience (UX) research has been criticized for focusing on leisure contexts and overlooking the work contexts. Moreover, researchers have been drawing attention to how UX at work differs from UX in leisure contexts, requiring development of domain specific knowledge. Inspired by these discussions, our motivation is to see the current state of UX at work research. Based on the systematic review of 52 papers, our results revealed that UX at work research is still immature. It is run by dichotomies; the conceptualizations such as the definition and the dimensions of UX at work are ambiguous; the variety of the studied work domains are limited and do not contribute to the understanding of UX at work; and the consideration of contextual factors are arbitrary and coincidental. To advance this important field of research, we indicate the research gaps and suggest a research agenda introducing areas for future research.

Risk Profiles of Korean Adolescents in Relations With Contextual Factors: Implications for Multi-Tiered Systems of Support.

IntroductionAlthough prior studies have supported the effectiveness of Multi-Tiered Systems of Support (MTSS) on addressing social, emotional, behavioral, and academic challenges faced by youth at-risk, educators using MTSS often do not consider contextual factors which may also influence youth at-risk and the interventions targeting them. This study thus aimed to identify youth at-risk who should be referred to targeted instructions within MTSS by examining the risk profiles of Korean adolescents. Based on the identified risk profiles, we also tried to investigate the effect of contextual factors on deciding youth at-risk and confirm whether and/or what contextual factors should be considered when implementing targeted interventions for them.MethodTo accomplish the research goal, a latent profile analysis on risk factors of Korean adolescents was performed, using the first year data of “Korean Children and Youth Panel Study (KCYPS) 2018.”ResultsFour risk profiles were identified, using low academic motivation, low academic behavior, attention deficit, aggression, social withdrawal, and depression as indicators: the high risk, M-SEB (Moderate-social, emotional, & behavioral) risk, M-ACA (Moderate-academic) risk, and low risk group. The covariates of this study, home and school environmental variables, worked as predictors of adolescents included in the high group.ConclusionThe results of this study suggest students in the high risk group (16.8%) should be given targeted instructions combining academic and SEB support within MTSS so as to prevent negative outcomes in the future among all adolescents. Those instructions need to be planned with consideration of contextual factors accompanied by teacher's careful understanding of social dynamics surrounding each student.

The Association Between Bullying Victimization and Fighting in School Among US High School Students.

In-school fighting often results in severe punishment and compromised learning outcomes, without adequate consideration of contextual factors or student vulnerabilities. In this study, using a large, nationally representative data sample from the 2019 Youth Risk Behavior Survey (N = 13677), we assessed associations between a history of bullying victimization (at school and online) and past year fighting at school among U.S. high school students. Multiple regression models were used, adjusting first for demographics, and then for demographics and emotional-behavioral risks (depressive symptoms, alcohol consumption, and sexual violence victimization), for the total sample and then stratified by gender/sex. Both cyberbullying and in-school bullying were significantly associated with past year in-school fighting for the total sample, with associations retained, but marginally attenuated in fully adjusted models (cyberbullying: AOR: 1.30; 95% CI: 1.01-1.66 and in-school bullying: AOR: 1.96, 95% CI: 1.57-2.45). Gender/sex-stratified models demonstrated retained associations for males (cyberbullying: AOR: 1.93; 1.51-2.46 and in-school bullying: AOR: 2.70, 95% CI: 2.18-3.34) and females (cyberbullying: AOR: 1.89; 1.33-2.68 and in-school bullying: AOR: 1.66, 95% CI: 1.19-2.33) after adjusting for demographics, but only for males after adjusting for demographics and emotional-behavior risk factors (cyberbullying: AOR: 1.43; 95% CI: 1.07-1.93 and in-school bullying: AOR: 2.25; 95% CI: 1.73-2.92). These results demonstrate a significant association between bullying victimization and fighting, which was amplified for male students, and partially explained by social and emotional risks. This suggests that punitive approaches to fighting in school may be resulting in compounded harms for already vulnerable adolescents and that support-oriented approaches emphasizing conflict resolution, social-emotional well-being, positive gender identity development, and bullying prevention may be more appropriate.

The operating conditions framework: Integrating mechanisms and moderators in health behavior interventions.

Efficacious translational research in health psychology relies on specifying why intervention strategies change health behaviors and when, for what behaviors, and for whom, do these strategies promote change. Whereas interventions' mechanism of action (the why question) has attracted considerable attention, there is a need to conceptualize and integrate factors that moderate intervention effectiveness. Intervention effects on health behaviors are a function of 2 change processes: how effectively interventions change mechanisms of action (target engagement), and how effectively those mechanisms change behavior (target validity). We outline the Operating Conditions Framework (OCF) to articulate theoretical linkages between mechanisms and moderators and begin the process of specifying circumstances that promote target engagement and target validity. A review of 46 meta-analyses of behavioral interventions offers impetus for the OCF by revealing that heterogeneity of effect sizes is frequent, substantial, and largely unexplained in traditional moderator analyses. We present an approach to moderation grounded on the distinction between 2 foci-engagement moderation and validity moderation-and reveal that little is known about variation in how interventions change targets and how changing targets promotes behavior change. The OCF addresses this need by maintaining researchers' focus on mechanisms of behavior change but doing so while embracing the conditional nature of these processes. Because the OCF prioritizes consideration of contextual factors at the outset of a research program, early-phase translational research will be critical in specifying operating conditions and, ultimately, generating guidelines regarding why, when, for whom, and for what behaviors are intervention strategies effective. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Role of Layout in Improving Building Thermal Performance in Bangkok

Selecting a building layout is a fundamental task in the early stage of the architectural design process. High thermal mass buildings with well-insulated envelopes are a common solution for colder climates; however, thinner wall construction and lower mass in most tropical architecture means that a well-designed building layout with good consideration of contextual factors is essential to enhance passive cooling and to decrease heat gain by solar radiation. Building layout factors of perimeter and wall surface area are pivotal in long-term energy utilization. This simulation-based research employs Sketchup, Openstudio, and SPSS to investigate the effect of surface solar radiation on indoor air temperature and sensible cooling energy of 17 geometries with and without a self-shading feature under the identical space volume, floor area, and climatic conditions of Bangkok. The simulation conducted in two phases (with and without an active cooling system) revealed that the lower the F/W ratio is, the lower the DBTindoor-annual and operational cost of the A/C system. The circular plan with the highest F/W ratio (0.47) has the lowest annual wall solar heat gain and DBTindoor-annual (29.43°C), and saves approximately 10% of air cooling energy demand compared to the square design (F/W=0.42). The layouts with S/W ratio less than 2.4 are less effective in lowering the DBTindoor-annual and active cooling energy demand than those with S/W greater than 2.4. It is concluded that the self-shading designs (S/W<2.4) may face challenges due to greater wall surface area and receiving more diffuse solar radiation.

Barriers to and facilitators of employment of persons with disabilities in low- and middle-income countries: A scoping review.

BackgroundUnemployment rates for persons with disabilities in low- and middle-income countries (LMICs) are high. This is despite the call to action by the United Nations Convention on the Rights of Persons with Disabilities and Sustainable Development Goals aimed at improving the economic well-being of the marginalised. To improve the employment outcomes of persons with disabilities in these countries, factors that facilitate and hinder employment should be explored.ObjectivesThis study explored barriers to and facilitators of employment for persons with disabilities in LMICs through a scoping review.MethodsA search strategy included a systematic search of nine databases using specific keywords. The International Classification of Functioning, Disability and Health (ICF) framework was used as a conceptual framework and barriers and facilitators were reported according to the domains of the ICF. Articles published between 2008 and 2020 were reviewed using a predefined criteria.ResultsThirty-two studies were identified in the review. Factors were identified in all domains of the ICF: (1) body function and body structure (12; 39%); (2) activities and participation (13; 42%); (3) personal factors (23; 74%); (4) environmental factors (27; 84%).ConclusionFactors that hinder and facilitate the participation of persons with disabilities in LMICs were mainly found in the environment, with personal factors also influencing participation. The presence of negative attitudes and lack of services mainly in health and transport were major factors within the environment whilst personals factors included the lack of educational qualifications and skills. These results indicate the importance of consideration of contextual factors when developing intervention strategies aimed at facilitating the employment of persons with disabilities in LMICs.

Getting trustworthy guidelines into the hands of decision-makers and supporting their consideration of contextual factors for implementation globally: recommendation mapping of COVID-19 guidelines

Published research on COVID-19 is increasing rapidly and integrated in guidelines. The trustworthiness of guidelines can vary depending on the methods used to assemble and evaluate the evidence, the completeness and transparency of reporting on the process undertaken and how conflicts of interest are addressed.With a global consortium of partners and collaborators, we have created a catalogue of COVID-19 recommendations as our direct response to the increased need for structured access to high quality guidance in the field. The COVID19 map of recommendations and gateway to contextualization (https://covid19.recmap.org) is a living project: emerging guideline literature is added on an ongoing basis, allowing granular access to individual recommendations.Building on prior work on mapping recommendations for the World Health Organization tuberculosis guidelines, a novel feature of this map is the self-directed contextualization of the recommendations using the GRADE-Adolopment approach to adopt, adapt or synthesize de novo recommendations for context specific questions. Through our map, stakeholders access the evidence underpinning a recommendation, select what needs to be contextualized and go through the steps of development of adapted recommendations. This one-stop shop portal of evidence-informed recommendations, built with intuitive functionalities, easy to navigate and with a support team ready to guide users across the maps, represents a long-needed tool for decision-makers, guideline developers and the public at large.

The Immigrant and the Citizen: Out-Group Evaluations and Well-Being of Turkish Immigrants From Bulgaria.

This study examines the postulates of the Rejection Identification Model (RIM) and Rejection Disidentification Model (RDIM) in a sample of 314 ethnic Turks from Bulgaria who migrated to Turkey. We investigate the intervening roles of immigrant and citizen identifications between perceived discrimination and the outcome variables (well-being and out-group evaluations). The results indicate that perceived discrimination predicts negative affect and out-group evaluations. Besides, Turkish citizen identification significantly and positively predicts life satisfaction and satisfaction from living in Turkey, whereas immigrant identification negatively predicts satisfaction in Turkey. Citizen identification predicts positive, and immigrant identification predicts negative out-group evaluations. Immigrant identification plays a mediating role in the link between perceived discrimination and satisfaction in Turkey as well as in that between perceived discrimination and out-group attitudes. The results imply the importance of consideration of contextual factors, including historical and cultural backgrounds, and the meaning of different identities for minority groups in predicting well-being.

Context: a key dimension in midwifery decision making and practice for safe labour care

Background/Aims Research into midwifery decision making to date is limited and, where it exists, theoretical understanding has focused on the cognitive aspects of the process. Understanding the real-life context in which midwives work and how this influences their decision making during labour is important for safer maternity care. This study aimed to explore the contextual factors that influence the decision making of midwives at secondary and tertiary level health facilities during the first stage of labour in the real context of practice. Methods Using a focused ethnographic methodology, data from nine midwives working in two hospital labour ward settings were collected from October 2013 to May 2014. A total of 27 participant observations of midwives supporting women in the first stage of labour, 26 semi-structured interviews with midwives, and a documentary analysis of maternal labour records were conducted. All data were analysed using theme and category formation. Results Four major themes that influenced midwifery decision making for the safe care of women in labour were found: dominance of the medical profession over maternity care, shortage of midwifery staff, limited material resources, and midwifery strategies for maternal and child safety. Conclusions Understanding and improving clinical decision making requires consideration of contextual factors. For safe maternal care during the first stage of labour, midwives need to be supported to manage contextual factors for favourable outcomes for the mother and neonate.