Cross-sectional Mixed Methods Study Research Articles

Endometriosis influencers on Instagram: Who are they and what are they posting?

To examine endometriosis-related content on Instagram, a platform increasingly used for health communication, to understand: 1) the identity of Instagram content creators; 2) themes, tones, and emotions evoked from posts; and 3) accuracy of educational information. The relevance of this study lies in its potential to inform healthcare providers on how to better engage with social media to support individuals with endometriosis. This mixed methods cross-sectional observational study was performed on June 6, 2021. Instagram content was collected via two approaches: 1) searching hashtags related to endometriosis from a list of 30 hashtags and analyzing the top 20 and 10 most recent posts and 2) searching endometriosis-related terms under accounts to examine the first 30 accounts retrieved. Posts were categorized into themes and evaluated for tone and emotion, with educational posts also evaluated for accuracy. Publicly available data on Instagram. None INTERVENTIONS: None MEASUREMENTS AND MAIN RESULTS: The study analyzed 768 Instagram posts and 228 accounts. Of these, 59.9% of posts and 92.1% of accounts contained endometriosis-related content. Most posts (55.4%) and accounts (59.0%) were authored by people with endometriosis. Accounts owned by people with endometriosis were significantly more active and had more followers compared to those who identified as healthcare providers (mean difference of total # of posts=714.4, P<0.001, mean difference of total # of followers = 27,194.7, P<0.001, respectively). Social support was the most common theme (67.2%). Many posts had a negative tone (43.7%) and evoked sadness (57.6%). Objective educational posts contained 85.0% accurate information. Allied healthcare providers were most likely to post accurate educational information compared to all other content creators (P<0.001). Instagram is widely used by people with endometriosis, with posts predominantly centered around social support and personal narratives. Healthcare providers can use this information better understand the experiences of people with endometriosis, and to engage more effectively on Instagram.

A Hospital-Based Survey Assessing Facility-Level Factors Contributing to Late-Stage Cervical Cancer Diagnosis: A Mixed-Methods Approach.

Background In Kenya, cervical cancer is the 2nd commonly diagnosed type of cancer and the top cause of cancer-related deaths among women. Over 50% of cervical cancer cases worldwide are diagnosed at a late stage, with this percentage rising to 80% in developing countries. Poor Health systems are major causes of late-stage diagnosis, leading to low survival rates and increased mortalities among cervical cancer patients. This study focused on determining the facility-level factors that contribute to late-stage diagnosis among cervical cancer patients. Methods An analytical cross-sectional mixed method study was conducted to collect data on hospital and referral systems experiences from 139 cervical cancer patients systematically sampled at Kenyatta National Hospital (KNH), using a semi structured questionnaire. In-depth interviews were conducted on 8 Key Informants. Associations between stage at diagnosis (dependent variable) and independent variables were tested using logistic regression at 95% Confidence Interval. Qualitative data was analyzed using content analysis method. Results Participants mean age was 51 years. 86 (61.9%) were diagnosed at advanced stages III and IV. A higher number of hospital referral instances, facing challenges during the referral process, and prolonged waiting times for diagnostic results were identified as key contributors to late-stage cervical cancer diagnosis. Conclusion Delays in diagnosis for most patients is due to poor health and referral systems. The study recommends improving referral systems and encouraging partnerships to decentralize cancer diagnostic.

Alert design in the real world: a cross-sectional analysis of interruptive alerting at 9 academic pediatric health systems.

To assess the prevalence of recommended design elements in implemented electronic health record (EHR) interruptive alerts across pediatric care settings. We conducted a 3-phase mixed-methods cross-sectional study. Phase 1 involved developing a codebook for alert content classification. Phase 2 identified the most frequently interruptive alerts at participating sites. Phase 3 applied the codebook to classify alerts. Inter-rater reliability (IRR) for the codebook and descriptive statistics for alert design contents were reported. We classified alert content on design elements such as the rationale for the alert's appearance, the hazard of ignoring it, directive versus informational content, administrative purpose, and whether it aligned with one of the Institute of Medicine's (IOM) domains of healthcare quality. Most design elements achieved an IRR above 0.7, with the exceptions for identifying directive content outside of an alert (IRR 0.58) and whether an alert was for administrative purposes only (IRR 0.36). IRR was poor for all IOM domains except equity. Institutions varied widely in the number of unique alerts and their designs. 78% of alerts stated their purpose, over half were directive, and 13% were informational. Only 2%-20% of alerts explained the consequences of inaction. This study raises important questions about the optimal balance of alert functions and desirable features of alert representation. Our study provides the first multi-center analysis of EHR alert design elements in pediatric care settings, revealing substantial variation in content and design. These findings underline the need for future research to experimentally explore EHR alert design best practices to improve efficiency and effectiveness.

A Collaboration Between a Public Library and Health Educators to Promote Community Health

ABSTRACT Background Public libraries in the United States are increasingly becoming involved in community health education programs, many of which are designed to reduce the risk of chronic diseases. Purpose The purpose of this article was to explore the collaboration between a public library and health educators to enhance population health. Methods This mixed-methods cross-sectional study included an online and paper survey, key informant interviews, and focus groups with library leadership and personnel. Results A strong base of support for the library to become a key partner in community health education was found. Community members were most interested in nutrition and healthy eating, physical activity, mental health, and programs on finding reliable health information. Key stakeholders and library leadership and personnel perceived the library to be a rich and trusted organization primed to become more involved in community health education Discussion The involvement of public health educators in this study strengthened the library’s capacity to conduct a rigorous needs assessment for the planning of community health education initiatives. Translation to Health Education Practice Health education is often focused on chronic disease prevention programs based on sound needs assessments and engaging stakeholders. This study’s findings directly address NCHEC Area 1 competencies – Assessment of Needs and Capacity and Area II competencies – Engaging priority populations, partners, and stakeholders for participation in the planning process.

Legalization of surrogacy? Opinions from more than 7700 residents in Taiwan.

This study explores Taiwanese' perspectives on the potential legalization of surrogacy, an issue with diverse legal stances globally. Conducted between 17 December 2023 and 1 January 2024, this mixed-methods cross-sectional study employed Knowledge and Attitudes of Legalizing Surrogacy (KALS) questionnaire. This instrument assessed opinions and ethical considerations on various aspects including ethics and children's rights, surrogate health, offspring welfare, and social justice. Responses were quantitatively measured on a 5-point scale (with higher scores indicating more accurate knowledge or stronger perceived impact of surrogacy on society) supplemented by qualitative content analysis of open-ended responses. Out of 7780 predominantly female participants (82.8%), all scores were higher for those did not support the legalization of surrogacy (82.1% of respondents). Noteworthy concerns were raised about potential repercussions of legalizing surrogacy, underscoring the need for broader public education before any legal reforms are implemented. There is significant apprehension about surrogacy legalization in Taiwan, especially regarding its impact on women's health and children's welfare.

Understanding General Practitioner and Patient Perceptions Regarding Integration of Non-Pharmacological Interventions in Chronic Non-Cancer Pain Management—A Cross-Sectional Mixed-Methods Study in the RELIEF Project

Background: Chronic non-cancer-related pain is an independent condition with a multicausal genesis. Guidelines highlight the need for holistic treatment based on the bio-psycho-social model. While prescribing medication is common, it remains unclear how and to what extent non-pharmacological interventions are considered and recommended in general practice pain management. The project RELIEF explored the integration of non-pharmacological interventions in general practices in Germany from both physician and patient perspectives. Methods: A mixed-methods study collected data with patients and general practitioners via semi-structured telephone interviews and self-developed questionnaires. Qualitative data were analyzed in a reflexive thematic analysis. Survey data were analyzed descriptively. Results: N = 383 questionnaires (n = 131 general practitioners, n = 252 patients) and n = 61 interviews (n = 21 general practitioners, n = 40 patients) were analyzed. Patient and physician perceptions regarding the integration of non-pharmacological interventions differed. Patients felt pharmacological therapy was recommended primarily, applied non-pharmacological interventions based on their own initiative, and were aware of bio-psycho-social interrelations. Physicians perceived that they often recommended physiotherapy and psychotherapy alongside analgesics, and asked about non-pharmacological interventions (79.4%), explained the bio-psycho-social chronic pain genesis (55.7%), and provided information on physical (48.9%) and social (35.9%) activity, relaxation techniques (42%), topical applications (31.9%), and support groups (25.2%). Conclusions: The integration of holistic pain management and communication between patients and general practitioners appear to need strengthening.

A mixed-methods observational study of strategies for success in implementation science: overcoming emergency departments hurdles

BackgroundHeart failure is a major public health concern, affecting 6.7 million Americans. An estimated 16% of emergency department (ED) patients with acute heart failure (AHF) are discharged home. Our Get with the Guidelines in Emergency Department Patients with Heart Failure (GUIDED-HF) toolkit aims to improve AHF self-care and facilitate safer transitions in care for these patients. We describe implementation barriers and facilitators, and the selection and refinement of implementation strategies, to facilitate future GUIDED-HF implementation.MethodsA mixed-methods cross-sectional observational study was conducted in four United States EDs in two diverse healthcare systems in the Pacific West and Midwest. Data were collected using a survey and interviews with ED providers, nurses, and leaders. The survey assessed the ED context using the context scale of the Organizational Readiness to Change Assessment (ORCA). The Consolidated Framework for Implementation Research informed interviews. Quantitative data were summarized using medians (interquartile ranges) or percentages (frequencies). Wilcoxon rank-sum tests and Kruskal–Wallis tests were used to assess differences in the healthcare system and profession. Qualitative data were analyzed and summarized using rapid qualitative analysis. Convergence of quantitative and qualitative data was used to inform specific refining of implementation strategies to the local context (e.g., who should serve as champions, how best practice alerts should be implemented).ResultsParticipants were predominately white (76%) with median (IQR) age 37.0 (32.0, 41.0). ED leaders/administrators, providers, and nurses comprised 15%, 55%, and 29% of participants, respectively. Sites reported an ORCA context scale score of 3.7 [3.4, 4.0] (scale of 1 = strongly disagree to 5 = strongly agree). Comparison of scores by profession showed a significant difference in the context score among providers (3.9 [3.5, 4.0]), leaders (3.7 [3.5, 4.0]), and nurses (3.6 [3.0, 3.9]) (p = 0.048). Qualitative data indicated implementation barriers (e.g., resource limitations, patient health literacy), facilitators (e.g., GUIDED-HF is patient-centric; site and intervention congruent values, norms, and goals), and site-specific needs due to contextual factors (e.g., education needs, feedback mechanisms, champions).ConclusionsSpecific determinants of implementation exist in ED settings and require the refining of implementation strategies to overcome site-specific barriers and enhance facilitators.Trial registrationn/a.

Experentia Et Progressus: An Experiential Needs Assessment of Military Health care Providers in Treating Pediatric Combat Trauma.

Children are among the most vulnerable populations affected by armed conflicts, yet there is limited data on the preparedness of military medical personnel to care for pediatric combat trauma casualties in austere or large-scale combat operations. This study aimed to assess the confidence, training needs, and resource requirements of military medical providers who have managed pediatric patients during deployment. This IRB-exempt, cross-sectional mixed-methods study used a survey created via a modified Delphi method with input from subject matter experts. The survey was distributed to active duty and reservist physicians, nurses, medics, and corpsmen who had previously deployed to combat environments. Respondents answered Likert-style questions anonymously on the SurveyMonkey platform. Data were analyzed using Welch's t-test, with statistical significance defined as P < .05. Qualitative data were coded into discrete themes and summarized. A total of 84 respondents participated in the survey. Only 27% reported feeling confident or very confident in resuscitating pediatric casualties. Health care providers with prior exposure to pediatric patients reported significantly higher confidence in pediatric trauma resuscitation (P = .02). Key factors contributing to low confidence included difficulty with pediatric medication dosing, anatomical and physiological differences, lack of experience, and insufficient pediatric-specific equipment during deployment. Nearly all respondents with prior pediatric combat trauma experience expressed a desire for additional pediatric-specific predeployment training, with nearly half (47%) advocating for more robust military-civilian trauma center partnerships. Furthermore, 59% of respondents felt they lacked adequate emotional support following negative pediatric events and recommended stronger post-traumatic event debriefing and support mechanisms. Many recently deployed military medical providers reported low confidence in resuscitating pediatric patients in the combat environment, because of drug dosing, anatomic and physiologic differences, and inexperience. Regardless of specialty, almost all providers requested additional pediatric training to improve baseline preparedness. These results can guide future predeployment training and inform policy to reduce unnecessary pediatric mortality on the battlefield.

Consumer experiences of emergency department pre-triage waiting period: A mixed-methods study.

Emergency department pre-triage waiting periods have received limited attention. We aimed to explore the pre-triage experiences and perspectives of consumers attending emergency departments. This mixed-methods cross-sectional study included 92 participants (patients, carers, and guardians) who attended one of three public hospital emergency departments in metropolitan Melbourne (Victoria, Australia). Quantitative self-report outcomes were waiting time (minutes) and number of previous emergency department visits. Qualitative outcomes (explored through content analysis) were consumer experiences and perspectives of emergency departments in general and the pre-triage waiting period specifically. Participants reported a median (IQR) waiting time since triage of 45 (100) minutes and 65 % (n = 60) experienced a pre-triage waiting time of 3-90 minutes. The most common perception of the pre-triage waiting period was an expectation to wait (n = 16, 17 %), yet 46 % (n = 42) reported difficulties during this period, such as other patients cutting in queue (n = 6, 6.5 %). Few positives were associated with the pre-triage waiting period and suggestions to improve this period tended to focus on facilitating a queuing system (n = 18, 20 %). Consumers expected and understood triage, yet reported various difficulties and few positives during the pre-triage waiting period and suggested improvements to the current system, warranting investigation of interventions to improve queuing.

Exploring pre-exposure prophylaxis (PrEP) modality preferences among black cisgender women attending family planning clinics in Chicago via a cross-sectional mixed-methods study

BackgroundDespite pre-exposure prophylaxis (PrEP) demonstrated effectiveness, black cisgender women continue to be at an elevated risk for HIV acquisition and uptake of daily oral PrEP is low in this population...

Infection prevention and control and water, sanitation, and hygiene status of healthcare facilities in the Greater Kampala Metropolitan region during the COVID-19 pandemic in Uganda

Infection Prevention and Control (IPC) and Water Sanitation and Hygiene (WASH) are critical in preventing the spread of healthcare Associated Infections, including COVID-19. However, there was limited evidence on the status of IPC/WASH in healthcare facilities (HCFs) in Uganda amidst the COVID-19 pandemic which complicated IPC/WASH planning for the COVID-19 response. This study assessed IPC/WASH status for HCFs in the Greater Kampala Metropolitan Area (GKMA), during the COVID-19 pandemic, so as to inform programming and policy. A mixed methods cross-sectional study was conducted in 75 HCFs following the first wave of COVID-19 in Uganda. The mWater tool was used to collect quantitative data which were then analyzed into STATA version 16. A key informants’ guide was used to collect qualitative data, which was analyzed thematically and themes and quotes used to support the quantitative findings. Overall, 86.7% (65/75) of HCFs had an IPC committee and 72.3% (47/65) of these were functional. Besides, 90.7% (68/75) of the HCFs had an IPC focal person, and 49.3% (37/75) had a clear annual IPC activity plan. Unfortunately, only 32.3% (21/65) of the functional IPC committees received budgetary support for their activities. In terms of WASH infrastructure, 96.0% (72/75), 10.7% (8/75), 60.0% (45/75), and 22.7% (17/75) had access to a basic water service, a basic sanitation service, a basic hand hygiene service and a basic environmental cleaning respectively. Our study reveals that while most HCFs have IPC committees and focal persons, functional support remains limited, with half having a clear annual plan and less than a third receiving budgetary support. Nearly all HCFs have basic water services, but there are significant gaps in sanitation and environmental cleanliness domains. These findings highlight the urgent need for improved support and investment in IPC/WASH supplies and infrastructure to enhance infection control and public health outcomes in Uganda.

The MyGuide Web-Based Self-Management Tool for Concussion Rehabilitation: Mixed Methods Cross-Sectional Study.

Web-based concussion self-management education programs for adolescents can improve functional outcomes, reduce concussion symptoms, and increase self-efficacy. However, there are a limited number of studies examining the perceptions and acceptance of these programs and the use of these tools in the adult concussion population. This study aimed to investigate the perceptions and acceptance of clinicians and adults with concussions using MyGuide Concussion (Vancouver Coastal Health), a web-based concussion self-management tool. Using a mixed methods sequential explanatory design, a convenience sample of 8 adults with concussions and 8 clinicians who used MyGuide Concussion over a 2-year period were interviewed, and their responses were analyzed. Participants reported two key benefits of using the web-based self-management tool: (1) the tool's emphasis on the interconnectedness of physical and psychological symptoms, and (2) the ability to provide reassurance that symptom being experienced were a normal part of the concussion experience. Clinicians described the tool as being useful as a supplementary source of information for clients in addition to clinical sessions and believed the content was useful for increasing clients' independence in managing their own recovery. Overall, the evaluation of the MyGuide tool is an acceptable and well-perceived tool for adults with concussions who require a basic understanding of concussion recovery, particularly in the early stages of recovery. Future research may include optimizing MyGuide by targeting promotional strategies and addressing other barriers to use.

Perceived barriers to paediatric palliative care in a Palestinian children's hospital.

This study aimed to identify barriers to paediatric palliative care provision at one Palestinian paediatric hospital, elucidate reasons for the barriers, provide recommendations for enhancing care and identify topics for future research in other low-to middle-income countries. A mixed-method cross-sectional study, employing both quantitative and qualitative methods was conducted, involving 61 healthcare professionals at a paediatric hospital in Palestine. Data collection consisted of 58 participants completing an electronic survey, while three healthcare professionals participated in semi-structured interviews. Ethical approval was obtained prior to data collection. The study identified significant barriers to paediatric palliative care, categorised into patient-family, healthcare professional and organisational domains. Quantitative data from 58 healthcare professionals revealed family resistance to a palliative prognosis and inadequate training for healthcare professionals, with mean barrier scores ranging from 3.09 to 4.00 (maximum=5.00). Qualitative insights from interviews and open-ended survey questions complemented these findings, highlighting the need for effective communication, educational enhancement and organisational support to improve the quality of care. The study identified barriers to the implementation of effective paediatric palliative care, underscoring the need for emotional support, better clinical guidance, more education and training and stronger interdisciplinary collaboration.

Knowledge and occupational practices of beauticians and barbers in the transmission of viral hepatitis: A mixed-methods study in Volta Region of Ghana.

Hepatitis B and C viral (HBV and HCV) infections are endemic in Ghana. Also, the National Policy on Viral Hepatitis stipulates that there is unreliable data, limited knowledge, and a deficiency in research on viral hepatitis, especially among some high-risk workers in the eastern part of the country. This study therefore assessed the knowledge level and occupational practices of street beauticians and barbers in the transmission of HBV and HCV in the Volta Region of Ghana. A cross-sectional mixed methods study was conducted in Volta Ghana from April to June 2021. An in-depth interview was used to collect data from five environmental health officers who were selected as key informants in the qualitative stage. Structured questionnaires/checklists and direct observations were employed to collect data from 340 street beauticians and barbers in the quantitative stage. During the qualitative stage, the process of coding, and mind mapping via thematic analysis was carried out. Furthermore, descriptive and inferential analyses were performed using Stata version 17.0 at a 95% significance level in the quantitative stage. Most street beauticians and barbers reported poor knowledge levels about HBV and HCV (67.0%), although the awareness of this viral hepatitis was high (88.2%). While almost one-third of the participants observed safe occupational practices (31.5%), about 29.0%, 49.4%, and 55.3% of them also followed hand hygiene protocols, wore protective clothes/gloves, and sterilized or disinfected tools after use respectively. Street beauticians and barbers with higher (tertiary) education (AOR = 6.15; 95%CI = 1.26-29.9; p = 0.024), those who had heavy workload of more than 20 customers per day (AOR = 3.93; 95%CI = 1.26-12.3; p = 0.019), and those who had work experience of at least four years (AOR = 1.65; 95%CI = 1.02-2.69; p = 0.040) were more likely to have good knowledge level about viral hepatitis. Additionally, beauticians were more likely to adhere to safe occupational practices as compared to barbers (AOR = 11.2; 95%CI = 3.46-36.3; p<0.001). The key informant interviews revealed that there was a lack of licensing, monitoring, and planned training for street beauticians and barbers, although their services are rampant in the Volta Region. Participants showed high awareness but limited knowledge about HBV and HCV infections. The general safety practices among the participants were poor. Our study results suggest possible viral transmission through the activities of street beauticians and barbers which could be attributed to the lack of regulatory systems and training of these cosmetologists. Policy-makers and regulatory bodies should institute and enforce rigorous policies and guidelines on job-related safety measures and health practices including regular training, monitoring, screening, and vaccination programs for these high-risk community workers in Ghana.

Perceptions and experiences of directly observed treatment in tuberculosis: insights from a mixed-methods cross-sectional study.

The demanding nature and psychosocial burdens of directly observed treatment (DOT) have opened a path to alternative strategies such as video-observed therapy (VOT), which offers comparable treatment outcomes and patient satisfaction while potentially saving time and reducing costs. The objective of this study was to evaluate the perceptions and experiences of patients and health care professionals regarding DOT and other treatment strategies implemented in Portugal. Patients with a confirmed diagnosis of tuberculosis, treated at the Vila Nova de Gaia Outpatient Tuberculosis Centre in the last two years, were asked to complete a brief questionnaire, as were health care professionals working in the northern region of Portugal. Differences were analysed with chi-square tests, complemented by thematic analysis. A total of 62 individuals completed the questionnaire: 29 health care professionals and 33 patients. There were significant differences between the two groups in their views regarding the impact of DOT on treatment outcomes, with health care professionals perceiving a higher degree of negative effects and patients expressing greater satisfaction. Long travel distances, transportation issues and high costs were some of the challenges mentioned by the patients. Significant differences were also found regarding the role DOT plays in ensuring treatment adherence, with patients emphasising personal responsibility and its importance in preventing loss to follow-up and strengthening relationships with health care professionals. Dose dispensing was favoured for its convenience in specific situations, and VOT was generally preferred to reduce constant travelling. Both parties raised some concerns. Existing discrepancies suggest a misalignment between patient experiences and health care provider perceptions, underscoring the need for enhanced communication and a more nuanced understanding of patient perspectives when designing and implementing different tuberculosis treatment adherence strategies.

The Role of Family Planning in Enhancing Community Resilience: Insights from Drought-Affected Youths and Women in Ethiopia.

This study assesses the role of family planning (FP) in resilience building among youths and women in Ethiopia's drought-affected and food-insecure regions. A mixed-method comparative cross-sectional study design with a total of 1712 study participants with an equal 1:1 ratio of the intervention and control groups was used. Binary logistic regression analysis was carried out to identify factors associated with community resilience. More participants in the intervention districts (58.3%) than in the control districts (49%) were currently using FP services. Approximately 54.1% of the intervention group and 43.6% of the control group were able to pay for food and shelter. Two-thirds of the intervention respondents and half of the control respondents had good social cohesion. The food consumption scores for the intervention and control districts were 26.2 and 24.9, respectively. Additionally, 62.5% of the intervention and 53.5% of the control respondents were found to have a good level of community level resilience. FP use (AOR = 3.4, 95% CI: 1.78-6.49), good social cohesion (AOR = 7.9, 95% CI: 6.09-10.23) and productive assets (AOR = 1.4, 95% CI: 1.07-1.92) were significantly associated with community resilience. To enhance community resilience comprehensively, expanding FP services should empower women in decision-making processes, cultivate ties and promote collaborative efforts across different sectors.

Perceptions of stakeholders on the use of a simplified, combined protocol for treatment of acute malnutrition in Central African Republic.

Treatment of acute malnutrition requires novel approaches to improve coverage, reduce costs and improve the efficiency of standard protocols that separate the management of moderate acute malnutrition (MAM) and severe acute malnutrition (SAM). The use of simplified, combined protocols to treat both MAM and SAM has drawn research and policy interest among global, regional and national stakeholders. However, the perspectives of local communities and health care workers regarding the use of protocols to treat acute malnutrition in a routine health care system are generally lacking. This was a cross-sectional mixed-methods study aimed at assessing the perceptions of different stakeholders on the use of a simplified, combined protocol in two districts in the Central African Republic. Most of the respondents preferred the simplified, combined protocol over the standard protocol. They generally agreed that the protocol was easy to understand, allowed more children to receive treatment and was effective in treating acute malnutrition. The protocol modifications were well received, including the expanded admission criteria, use of mid-upper arm circumference (MUAC) only for admission and discharge criteria and reduced and simplified ready-to-use therapeutic food quantity to treat MAM and SAM. Some caregivers expressed concern with the use of MUAC only to declare recovery, flagging that underlying illnesses could still be present. The caregivers recommended the provision of other food basket interventions to improve the treatment. The support by caregivers and health care workers on the idea of training community health volunteers to treat acute malnutrition points to the potential of scaling up decentralized treatment to increase coverage in remote areas.

PROJECT RESPECT: EXPERIENCES OF SERIOUSLY ILL LGBTQ+ PATIENTS AND PARTNERS WITH THEIR HEALTH CARE PROVIDERS

Abstract Discrimination against LGBTQ+ persons in healthcare creates barriers to serious illness care, including patients avoiding or delaying necessary care, providers disrespecting wishes of surrogates, and adverse outcomes for patients and families. A cross-sectional mixed methods study using an online survey was used to determine the extent to which LGBTQ+ patients and spouses, partners, and widows experienced disrespectful or inadequate care due to sexual orientation or gender identity. A total of 290 LGBTQ+ patients and partners reported high levels of disrespectful and inadequate care. Patients reported these discriminatory actions from healthcare providers: insensitive to me as an LGBTQ+ person (35.2%); not aware of LGBTQ+ health needs (30%); made me feel judged for being LGBTQ+ (23.1%); were rude to me (20.7%); didn’t use my correct pronouns (20.3%); and disregarded my treatment decisions (19.7%). Partners reported they were denied access to their loved one in intensive care or emergency room (12.4%); were treated badly (12.1%); and that their decisions were not followed (10%). Black and Hispanic patients were two to four times more likely than non-Hispanic white patients to report discrimination. This study demonstrated high levels of disrespectful and inadequate care towards patients and partners due to being LGBTQ+, especially problematic for Black and Hispanic patients and those living in politically conservative regions. Recommendations include federal and state civil rights laws to prohibit LGBTQ+ discrimination, and institutional practices to address discrimination, including cultural sensitivity training for staff.

A Pilot Study on the Freelisting Method Among Adolescents with Chronic Musculoskeletal Pain: Feasibility, Acceptability and Study Findings.

Background/Objectives: To assess the feasibility and acceptability of freelisting for adolescents with chronic musculoskeletal pain (CMP) and use freelisting to identify how adolescents with CMP cope with pain. Methods: This was a mixed-methods cross-sectional single-center study of patients 12-18 years old, diagnosed with CMP. Twenty-seven subjects participated in an interview which included the freelisting exercise, probing questions, Connor-Davidson Resilience Scale 10-item, and semi-structured interview. Feasibility was pre-defined as ≥85% completion. A list of 'standardized' freelisting terms was created, and we calculated Smith's salience index. Freelisting terms were grouped into individual, family, friends, school, and medical domains. Results: In this predominantly female population, resilience levels were low to moderate, and on average, participants had moderate pain intensity and functional disability. The freelisting exercise was feasible and acceptable among females, with low recruitment of males. Salient words to describe adolescents' pain included frustrating, upsetting, annoying, and painful. Participants identified family, friends, teachers, guidance counselors, and health professionals as key sources of support. Many participants reported difficulties communicating their pain. Helpful coping strategies included rest, distraction, relaxation, endurance, and extracurricular participation. Conclusions: Freelisting was well perceived among female adolescents with CMP. Supportive relationships with community members play an important role for this population. However, perceived stigma may deter female adolescents from talking about their pain. Purposive sampling of male participants and recruitment strategies ensuring diverse patient representation are necessary to ensure generalizability of future results when using the freelisting method for adolescents with CMP.

Decision-making in feminizing genital gender-affirming surgery – the effect of the introduction of the GenderAid decision-aid

Introduction Transgender individuals considering feminizing genital gender-affirming surgery (gGAS) face multiple options and potential decisional conflict (DC). Shared decision-making (SDM) between patients and healthcare professionals (HCPs) can support personalized care and improve outcomes. To aid trans women during the decision-making process for gGAS, a decision aid, the GenderAid (GA), was developed. Methods This study aimed to investigate the effect of the GA on SDM and DC levels during the decision-making process for feminizing gGAS. An observational cross-sectional mixed methods study was conducted at the departments of Psychology and Plastic Surgery at the Center of Expertise on Gender Dysphoria of the Amsterdam UMC between 2020 and 2023. Questionnaires administered before and after implementing the GA included the validated translations of the SDM-Q-doc and SDM-Q-9 and the Decisional Conflict Scale. Qualitative data from interviews explored trans women’s perceptions of the concepts of SDM and DC when deciding on feminizing gGAS. Results Significantly higher levels of SDM experienced by trans women were observed after the introduction of the GA, while no such difference was observed for HCPs. The GA facilitated more thorough discussions with HCPs, and trans women felt well prepared for consultations by the decision-aid. DC was low before and after introduction of the GA; however, both quantitative as qualitative data revealed trans women experienced uncertainties during the process, due to new information on (non-)surgical options for gGAS. Discussion This study suggests that the GA enhanced SDM in individuals seeking feminizing gGAS and had limited impact on DC by offering extensive information on all (non-)surgical options. However, the improved information overview regarding surgical options also resulted in increased decision uncertainty among trans women. Future controlled research should further explore optimizing information provision throughout the care process, managing uncertainties, and implementing the use of decision-aids by HCPs.