Deductive Content Analysis Research Articles

Quality priorities related to the management of type 2 diabetes in primary care: results from the COMPAS + quality improvement collaborative.

This study aims to describe the main type 2 diabetes mellitus (T2DM) quality improvement (QI) challenges identified by primary care teams in the province of Quebec who participated in the COMPAS + QI collaborative. A qualitative descriptive design was used to analyse the results of 8 COMPAS + workshops conducted in 4 regions of the province between 2016 and 2020. Deductive content analysis was performed to classify the reported QI priorities under the Consolidated Framework for Implementation Research domains; and proposed change strategies under the Behavior Change Wheel (BCW) intervention functions. A total of 177 participants attended the T2DM COMPAS + workshops. Three QI priorities were identified: (1) lack of coordination and integration of T2DM care and services; (2) lack of preventive services for pre-diabetes and T2DM; and (3) lack of integration of the patients-as-partners approach to support T2DM self-management. The proposed QI strategies to address those priorities were classified under the education, training, persuasion, habilitation and restructuring BCW intervention functions. This study provides insights on how QI collaboratives can support the identification of QI priorities and strategies to improve T2DM management in primary care.

Biopsychosocial Effects of Donor Traits on Heart Transplant Recipients.

BACKGROUND Psychological function after transplantation has garnered increased attention, and the relationship between recipients and corresponding donors has been investigated in medical research. Here, we investigated potential qualitative and quantitative psychological and lifestyle changes among recipients after heart transplantation and their correlation with donors. MATERIAL AND METHODS Transplant recipients, their families, and the donor's families were interviewed. The interview was semi-structured, featuring open-ended questions related to 5 domains: preference, emotions and temperament, memory, self-identity, and social identity. Qualitative data were analyzed by triangulation and deductive content analysis. Quantitative data were collected using the Big Five Inventory-19 (BFI-19) questionnaire, to complement the domain of emotions and temperament. RESULTS Overall, 20 recipients, 15 recipients' families, and 13 corresponding donors' families were interviewed (5 recipients' families and 7 donors' families refused to participate) between October 2020 and July 2021. The data were matched to 13 groups, each including at least 1 recipient and the corresponding donor. Finally, 13 recipients, 9 corresponding recipients' families, and 13 corresponding donors' families were identified. Similarities between recipients' psychological and lifestyle changes and the corresponding donors' traits were primarily identified in the aspects of diet, emotions and temperament, and special experiences other than dreams. The BFI-19 data showed no significant correlations between recipients and the corresponding donors' families. CONCLUSIONS Our findings indicate significant psychological and lifestyle changes in recipients before and after heart transplantation, with 38% exhibiting characteristics partly similar to those of their donors. Further investigation is needed to explore the psychobiological correlation between recipients and donors.

Towards value‐based rehabilitation: an analysis of South African policies for people with disabilities

AbstractSouth Africa has progressively established good healthcare policies and actively promotes the rights of people with disabilities. However, as the healthcare sector is moving towards value‐based care to achieve universal health coverage, it remains unclear whether South African rehabilitation policies provide sufficient guidance for delivering value‐based rehabilitation services for people with disabilities. This article attempts to ascertain whether the content of South African rehabilitation policies is aligned with value‐based care. Rehabilitation policies were identified through a literature search (including grey literature) and discussions with stakeholders in the health policy field. A framework for value‐based care was created for deductive policy content analysis. A qualitative descriptive approach was used to describe the content that correlates with the framework's components. The National Rehabilitation Policy and the Framework and Strategy for Disability and Rehabilitation Services were included in this study. Both documents aligned with the value‐based framework, however, various barriers in South Africa challenge value‐based rehabilitation services. We conclude that South Africa's rehabilitation policies can guide value‐based rehabilitation services. However, these policies need to be operationalized and supported by empirical data on disability and rehabilitation services. A concerted effort is required from the government to ensure the allocation of resources for the implementation of policy.

‘Coping in practice’: a qualitative exploration of psychological resilience among paediatric physiotherapists

Purpose The importance of improving psychological resilience among healthcare workers to protect individuals, support the delivery of quality patient care, and safeguard health system functioning is well documented. While research has explored many aspects of psychological wellbeing across various healthcare worker populations, it is unclear how physiotherapists view and experience psychological resilience and stress in the workplace. This study aimed to explore how paediatric physiotherapists described resilience, how stress in the workplace affected their ability to provide services, and the methods used to cope with pressures and stress. Methods A cross-sectional, qualitative approach was adopted. Semi-structured interviews were conducted with 22 paediatric physiotherapists working in the Republic of Ireland. The transcripts were analysed using a deductive content analysis approach. Results Five themes arose from the interviews. These were ‘The Nature of Resilience’(summarised many physiotherapist’s perceptions that resilience was ‘coping’ with difficulties in the workplace), ‘Challenges of the Profession’ (described parts of their roles as physiotherapists that contributed to stress)’, Job-Related Gratification’(described the aspects of the role that strengthens resilience), ‘Resilience Strategies (Protective Practices)’(described the actions and activities used by physiotherapists to cope with stressors in the workplace), and ‘Resilience Strategies (Attitudes)’(summarised the attitudes used to safeguard against workplace stress). Conclusions This study evaluated paediatric physiotherapists’ experiences of resilience from a personal and organisational perspective. This study suggests this population shares its understanding of resilience with other healthcare professions. The findings of this research highlights the necessity for additional investigation into methods used by paediatric physiotherapists to cope with workplace stressors.

Exploring the Complexity of Falls in People With Multiple Sclerosis: A Qualitative Study.

The complexity of falls in people with multiple sclerosis (MS) needs further exploration to develop strategies to reduce fall risk. The aim of this study is to explore and describe factors contributing to falls and the complexity of fall situations in people with MS. This longitudinal study used individual interviews shortly after prospective reporting of falls. Manifest analysis was used to describe frequency, place, and time of falls. The International Classification of Functioning, Disability and Health (ICF) was used for deductive content analyses to describe fall-inducing factors. Participants were adults with MS (N = 33) who had experienced falls during the past year and who did not use walking aids. The 25 participants who fell during the study period reported 94 falls, mainly during the day (61%) and outdoors (56%). Fall situations were complex, with interaction between triggering and circumstantial factors related to all domains in the ICF, the impact of preceding factors, and fluctuating symptoms. The complexity of fall situations can be more clearly understood and managed by considering the preceding activities and circumstances in addition to describing single risk factors. This may facilitate discussions of fall risk between health care professionals and people with MS. Individualized fall risk assessments and interventions that strengthen self-management are recommended.

Who gets the bed: Factors influencing the intensive care exit block - A qualitative study

BackgroundPatient flow problems, including discharge delay and after-hours discharge, have been a consistently major issue, especially for intensive care units (ICUs). Evidence suggests that discharge delay and after-hours discharge are associated with increased ICU and hospital length of stay, leading to worsened patient outcomes and increased healthcare costs. They can also increase ICU readmission and post-ICU mortality. The factors influencing discharge processes are not well elucidated. ObjectiveThis study aimed to explore the barriers and facilitators to the ICU patient discharge processes in adult ICUs. MethodsThis qualitative exploratory multisite observational study was conducted in three regional adult ICUs in Queensland, Australia. We used staff interviews, fieldnotes, and document analysis as data collection techniques. Data analysis commenced with a deductive content analysis using the Structure, Process, and Outcomes framework. Following this, an inductive process was taken using the Theoretical Domains Framework. FindingsWe conducted 59 staff interviews and analysed the discharge documents across three sites. Five domains, including context and resources, beliefs about consequences, social/professional role and identity, and behaviour regulation, were strongly related to the factors that influenced the discharge processes. The findings revealed barriers to discharge, including finding the right bed, disconnected and ineffective information systems, ineffective communication and coordination within and across teams and departments, and uncertainty and inconsistency in discharge decision making. Facilitators included clarity on professional roles in ICU discharge, effective communication within the ICU team, and context specific strategies to support the discharge processes. ConclusionsThe findings provide an in-depth understanding of the barriers and facilitators to the ICU discharge processes. Multifaceted strategies should be considered to facilitate and manage ICU discharge safely and efficiently, including the use of clearer discharge criteria and guidelines, digital systems that aid communication and coordination, and early planning of ICU patient discharge.

Factors influencing proactive health behaviors in pre-frailty older adults: A qualitative study based on theory of planned behavior

Aimsto explore factors that can influence proactive health behaviors in pre-frailty older adults. Designthis is a qualitative content analysis study. Methodsdata collected through interviews with 20 pre-frailty older adults in a geriatric unit at a general hospital in Guangzhou, China. We used deductive content analysis to categorize codes and calculate their frequency based on the theory of planned behavior. Inductive content analysis was used to analyze data that could not be analyzed according to the theory of planned behavior. Resultsthe data were analyzed and grouped into categories by beliefs similarity, counted from the frequencies. The factors of 6 behavioral beliefs, 6 normative beliefs, and 14 control beliefs were issued. Six themes emerged, including positive attitudes toward proactive health behaviors outcomes, lack of proactive health awareness the negative influence of children on proactive health behaviors, lack of knowledge of proactive health behaviors, spouses play an important role in proactive health behaviors, low resistance to unhealthy behavior. Conclusionthis research will support to the construction of a psychometric scale to measure the intentions of proactive health behaviors in pre-frailty older adults. These influencing factors will also help us to develop measures to improve the ability of pre-frailty older adults to be proactive health in the future. Impactthis research validates and extends the theory of planned behavior. The findings of factors influencing proactive health behaviors help us to develop strategies to enhance proactive health in pre-frailty older adults in the future. These findings also provide content for the construction of the psychometrics of proactive health intentions scales. Reporting Methodthis study follows the COREQ reporting norms.

The Proposal of Integrated Actions in Transport as Part of a Climate Action Plan for UNICAMP

Since 2019, the State University of Campinas (UNICAMP) has been collecting data, preparing, and annually monitoring sustainability indicators submitted to the UI GreenMetric ranking, which guide improvement projects at the university in alignment with the Sustainable Development Goals (SDGs). This article aims to propose sustainable practices for managing urban mobility on its campuses, drawing inspiration from the experiences of national and international universities that ranked highest in the 2023 edition of the aforementioned ranking. The study employed both qualitative and quantitative research methods, using a descriptive approach combined with Deductive Content Analysis (DCA). This analysis was further validated by the Multi-Criteria Decision-Making (MCDM) method known as Fuzzy SWARA. Through this process, the study identified the most commonly adopted actions by universities: promoting the use of electric and/or conventional bicycles on campus (11.8%); projects in partnership with government, state, or municipal entities to develop express cycle paths and encourage bicycle use both on campus and in the city (9.2%); conventional bicycle rental on campus (9.2%); and electric car sharing on campus (9.2%). The proposals suggested for UNICAMP include encouraging carpooling, implementing a public transportation exemption or half-fare program for employees, promoting the use of bicycles while ensuring increased campus security, among other initiatives. This research is part of a proposal for a Climate Action Plan for the university, which aims to effectively integrate sustainability into the university's agenda and support the fight against the climate emergency through necessary adaptations.

Examining high school students' conception of the function concept from a theoretical thinking perspective

This study explores the conceptions of functions among high school students through the lens of theoretical thinking, encompassing three core components: reflective, systemic and analytical thinking. A case study methodology was employed in this research. The data were gathered through interviews with 11 senior high school students and analysed using deductive content analysis techniques. The findings reveal that students needing more reflective thinking tend to resort to practical methods and quickly gave up when facing challenges. Those who showed limited systemic thinking often relied on incorrect or inadequate criteria to determine if an expression constituted a function and struggled to connect the function concept with other concepts. Students needing more analytical thinking faced challenges in employing mathematical language and representations for functions, verifying if an expression is a function or transforming representations and frequently overlooked quantifiers or logical connectors related to variables in definitional properties. In this study, the theoretical thinking framework, mainly used for university-level mathematical concepts, provided a broad perspective in determining high-school students' understanding of the concept of function. Future research should extend this approach to various educational levels and concepts to enhance our understanding of students' conceptions and enrich the theoretical thinking framework.

Exploring factors of HPV self-sampling acceptance:a qualitative study with hard-to-reach women

Abstract Background Cervical cancer disproportionately affects socially disadvantaged women, who tend to be underscreened and are generally called “hard-to-reach”. HPV DNA testing based on self-sampling test is an alternative strategy to address women’s low screening uptake and reduce inequalities. Psychosocial factors like self-efficacy, ethicality, and testing conditions should be considered when assessing the acceptability of HPV self-sampling. However, research on the acceptability of HPV self-sampling is scarce among hard-to-reach women. Our study aims to explore self-efficacy beliefs, perceptions of how well HPV self-sampling fits participants’ values and their preferred testing conditions and understand how these factors influence the acceptability of HPV self-sampling test among hard-to-reach women. Methods This qualitative study used a semi-structured guide based on three constructs of the Theoretical Framework of Acceptability. Focus group discussions (FGD) were conducted with n = 63 hard-to-reach women in Portugal (2 FGD), Ecuador (4 FGD), and Belgium (3 FGD). Data were analysed using deductive content analysis. Results While some women viewed HPV self-sampling as acceptable, others questioned its compatibility with their ethical views and moral principles, stressing that the test cannot replace the clinical examination. Participants held conflicting views, with some expressing confidence in their sampling abilities while others feared making errors when taking the sample. Cultural disparities in preferred testing conditions emerged: Ecuadorian women preferred solo testing, while those in Europe preferred assistance. Conclusions This study indicated ambivalent attitudes towards self-sampling. Further research on HPV self-sampling acceptability is needed to explore socio-cultural nuances. Our study emphasises the importance of culturally attuned interventions to address these populations’ needs and reduce inequalities. Key messages • Hard-to-reach women harbour conflicting views about self-sampling. • Screening policies may include opportunities for self- and clinician sampling.

A national job profile for infection control nurses in public health: the development and content

Abstract Background The COVID-19 pandemic emphasized the crucial role of infection control nurses (ICNs) in public health. ICNs working in multidisciplinary infection control teams face challenges, such as new infectious disease outbreaks and vaccination hesitancy. Recognizing the complexity in this domain, Dutch ICNs in municipal public health services expressed the need for a national job profile describing their tasks and responsibilities. Methods A mixed methods approach was used to develop a job profile. National and international documents on infection control professionals were studied by desk research. Insights from Dutch infection control professionals and experts were collected through a survey (n = 171), two interactive discussion meetings (18-22 participants) and meetings with an advisory group of stakeholders, including representatives of the Dutch nurses’ association. Descriptive statistics and deductive content analysis were used to analyze the data. Results The diverse methods facilitated the development of a job profile for Dutch ICNs. The profile describes that, within infection control teams, ICNs play a key role in coordinating and monitoring infection control measures. They facilitate collaboration among (at-risk) individuals, the infection control team, and the collaborating partners. Additionally, ICNs identify emerging risks for infection control and coordinate infection prevention activities in collaboration with the infection control team. During large-scale outbreaks, ICNs take a leading role and, where appropriate, delegate tasks such as contact tracing to crisis workers. Conclusions We developed the first job profile that outlines the tasks and responsibilities of ICNs in Dutch public health services. It contributes to strengthening infectious control services to face future challenges. Findings emphasize the ICNs’ pivotal role in coordinating and monitoring infection control efforts, while enhancing collaboration, even during large outbreaks. Key messages • In close collaboration with infection control professionals a robust job profile was developed, describing the tasks and responsibilities of infection control nurses in the Netherlands. • The new job profile contributes to strengthening the position of infection control nurses working in municipal public health services and infection control teams.

A socially interactive communication skills training for competent health educators

Abstract Background Every contact with expectant and new parents can be a “teachable moment” for promoting the health of mother-baby-family; yet, healthcare providers may not effectively perform their educational role. Previous studies have described various setting-specific challenges. Procedural knowledge, resulting in lack of confidence and avoidance, is a universal theme, challenging current communications skills training. Given the evolving role of midwives under the new Cyprus National Healthcare System, there is need for innovative practices. Objectives “Baby Buddy Communicators” designed, implemented and piloted tested a socially interactive digital environment on the Edubreak platform, where practicing (N = 8) and in-training (N = 7) Midwives completed an 8-week iterative hybrid communication skills course along with service-users. Results Four situational-based scenarios were co-created with ‘holders of the experience’ tapping on key priorities (elective caesarean, breastfeeding challenges, baby in NICU, postnatal depression). Participants produced video artefacts of role-play consultations and engaged in peer-to-peer and service-user feedback via the in-built video annotations and blog writing tools. Deductive content analysis of the rich material using the 18-item Health Professionals Communications Skills (HPCS) scale identified recurrent patterns tapping on both informational aspects (e.g. incomplete information gathering, overload without assessing comprehension) as well as social skills (e.g. agenda setting, early reassurance, assertiveness). Conclusions This cross-sectoral transfer of social video from sports training to healthcare is a “proof of concept”. Inverted (i.e. making current practices visible) and experiential learning (e.g. feedforward) with cross-sectoral (service-user involvement) and cross-module dimensions (i.e. communication skills and evidence-based practice) provided the basis for evaluation and a source of shared learning and reflection. Key messages • Several areas of improvement in communication skills of maternal healthcare providers were identified while peer-to-peer and service-user feedback was a source of reflection. • The use of digital technology and social video allowed immersive role-playing, observation and constructive feedback loops providing a new paradigm in health communication skills training.

Mixed-method study of women’s experiences of Respectful-Disrespectful Maternity Care in Cyprus

Abstract Background Since the WHO reports on Disrespect and Abuse (D&A) in childbirth, there was an increase in studies across Europe exploring women’s experiences. Even though contentious, a 2024 EU Committee report adopts the term obstetric violence. With the highest caesarean section (C/S) in the EU, the birth environment in Cyprus raises questions about informed choices. Methods The RESPECT mixed-method study gained insights into the experiences of women in Cyprus with focus groups (N = 6, 28 women) and survey (online and in-person) tapping on Rights for Respectful Maternity Care (RMC), as measured by Person-Centred Maternity Care scale (PCMC), autonomy in decision making (MADM), dignity and respect (MoRi) and mistreatment (MIST). Results Among 516 responses (61% first childbirth, 38.5% vaginal, 15% public sector, consistent with official statistics), the 35-item PCMC (range 0-100%) represents a continuum of quality standards deviations (Med=81, IQR=61-92). Lowest scores were recorded for “Communication & Autonomy”, with 28.5% reporting ‘feeling pushed into a decision’, with associations observed with younger age, first-time birth, mode and place of birth, highlighting social inequity. Based on MADM, 23.8%, 14.1% and 14.7% women were classified as having moderate, low or very low autonomy. For mistreatment, 32.0% reported at least one of 11 indicators, most commonly privacy violations and no freedom of movement. Formula feeding against wishes (13.6%), vaginal examinations (11.6%) and episiotomy (7.8%) where most common among 33.7% reporting procedures without consent. Deductive content analysis of narratives according to RMC triangulate findings of weak shared decision-making processes. Conclusions Given that C/S reduction was identified as a national priority in Cyprus, the RESPECT findings can widen the conversation about quality improvement and form the basis to engage with local stakeholders in an open-dialogue about RMC, guided by participatory action research principles. Key messages • In the medicalized birth environment of Cyprus, women report a range of sub-optimal practices, with ethical implications, primarily affecting the right to autonomy. • Adopting the Respectful Maternity Care framework, the findings can stimulate and shape quality improvement efforts in a participatory and inclusive process with local stakeholders.

Ambiguous Loss Experienced by Georgian Workers Living in Italy

An ambiguous loss describes a loss that lacks closure due to its ambiguity and uncertainty. The study applies to those who have experienced separation from the family and struggle with keeping their family members psychologically present, namely, immigrants. The study aimed to explore the phenomenology of ambiguous loss experienced by Georgian immigrants. Fifteen narratives collected via face-to-face in-depth interviews were analyzed using the deductive content analysis strategy. Participants describe feelings of loss, such as being unable to live together as a family, uncertainty about going back, stress, and worry about family members. While physically absent, the psychological family is evident in their thoughts and concerns. Family boundaries can remain clear as family members reconsider their roles and responsibilities. The main challenge is to remain resilient, which is connected to identity reconstruction.

Individual Resilience among Adult Children of Parents with Bipolar Disorder in Chinese Society: An Inductive and Deductive Content Analysis Approach.

Nurses can help children of parents with mental illness discover their resilience. However, previous studies have focused on their experience in Western settings and have limited understanding of a Chinese cultural context. This study aims to explore individual resilience emerging from adult children's experience of living with parents with bipolar disorder in Chinese society within the framework of character strengths and possible cultural components. A content analysis with both inductive and deductive approaches. Twenty adults participated in this study. Interviews were conducted while the participants' parents were hospitalized in an acute psychiatric hospital ward. The framework of character strengths confirmed five emergent themes of individual resilience in this study: courage, temperance, humanity, knowledge and wisdom, and transcendence. Character strengths are an adequate framework for understanding of individual resilience. Chinese adult children develop resilience by regulating their emotions, respecting their parents, engaging in self-discipline, and positively interpreting adversity.

Stimulating ambulance specialist nurse students' ethical reflections by high-fidelity simulation.

Introduction: Ethical competence in professional practice can be considered essential among nurses and nurses in ambulance care encounter ethical dilemmas frequently. To enhance ethical competence among students in the ambulance specialist nursing program, high-fidelity simulation scenarios including ethical dilemmas were introduced as a learning activity. Research aim: The research aim was to investigate the usefulness of high-fidelity simulation in ambulance specialist nurse education to teach ethical reasoning when caring for children. Research design: This study was conducted as a qualitative interview study, complemented with observations and using field notes and qualitative interviews for data collection. Data was analysed using deductive qualitative content analysis based on a care ethical model. Participants and research context: Participants (n = 35) were recruited from an ambulance nurse educational program at a Swedish university. Data was collected after the students took part in two high-fidelity simulations involving children in an ambulance care setting. Ethical considerations: The study has been vetted and approved by the ethical council at the University of Borås, Sweden. The study follows the Helsinki Declaration's advice on ethical principles. Results: The results showed that most of the students expressed some form of ethical reasoning during the simulation sessions, which were elaborated and reflected upon during the debriefing part of the sessions. The simulation design seemed to have a great impact on the outcome of the student's ethical reasoning, where increased immersion led to deeper emotional engagement among the students which increased awareness of their personal preconceptions. Conclusions: This study aimed to investigate whether high-fidelity simulations could be useful to stimulate ethical reflections and contribute to increased ethical competence among students. In conclusion, a well-designed high-fidelity simulation can be useful as an educational tool to learn and enhance ethical competence among specialist ambulance nursing students.

Capitalizing on Dementia Care Mapping in an Evaluation of a Montessori-Based Intervention for Individuals Living with Dementia.

Montessori-based interventions (MBIs) promote quality of life among older adults living with dementia. We used Dementia Care Mapping (DCM) to evaluate the impact of a small-scale MBI. DCM is a systematic observation tool that records the behavior and mood/engagement of individuals living with dementia and can be used to improve quality of care and well-being. Pre- and post-intervention data from 15 care community residents compared: 1) residents' range and types of behaviors, 2) their mood/engagement and 3) staff behaviors that facilitated and impeded residents' personhood. In this mixed-methods study, deductive qualitative content analysis of DCM field notes further explored staff behaviors. Post-intervention, a significantly higher proportion of residents' behaviors had the potential to promote their well-being, although there was little change in mood/engagement while engaging in those behaviors. Post-intervention, there was also a significant increase in staff behaviors that facilitated, and a decrease in staff behaviors that impeded, residents' personhood. Further, post-intervention, staff interactions with residents were more open-ended and inclusive. Although some staff behaviors still excluded residents, the exclusion was more benign than pre-intervention. DCM documented incremental changes toward person-centered care, and DCM field notes provided insight into missed opportunities for effective staff interactions with residents. Taken together, findings provide additional support for the use of MBIs and highlights the usefulness of DCM, especially its associated field notes, to help researchers and practitioners create environments that promote the personhood that individuals living with dementia deserve.

The Effectiveness of an Intervention Based on the Information, Motivation, and Behavioral Skills Model on Treatment Adherence and Self-Efficacy in Patients with Coronary Artery Diseases: An Explanatory Mixed Method Study

Background: Promoting adherence to treatment and self-efficacy in patients with coronary artery diseases helps to improve patient outcomes. The present study was conducted to explain the effectiveness of interventions based on information, motivation, and behavioral skills model on treatment adherence and self-efficacy in patients with coronary artery diseases. Methods: This explanatory-sequential study was conducted on patients with coronary artery diseases in Shiraz, Iran. First, a quasi-experimental study was conducted on 112 patients who were randomly assigned to two intervention and control groups. The intervention consisted of ten motivational training sessions that were designed based on Information, Motivation, and Behavioral Skills (IMBS) model and continued with six months of telephone follow-up and counseling. Data were collected before, three months, and six months after the end of the intervention. Then, in the second phase, a qualitative study including 20 in-depth interviews with 18 participants from the intervention group was conducted. The data were analyzed by deductive and inductive qualitative content analysis. Finally, quantitative findings were explained with the help of qualitative findings. Results: The findings showed that the mean score of treatment adherence, medication adherence, and self-efficacy in the intervention group was significantly higher than the control group 3 and 6 months after the intervention (p<0.001). The results of the qualitative phase of the study also showed that the four main categories include receiving targeted information, encouragement to care, gained self-efficacy/doubt in care, and improvement/non-improvement of treatment adherence behaviors can explain quantitative phase results. Conclusion: The results showed that receiving training with effective methods, strengthening the support system, self-confidence and positive attitudes about care, and promoting self-management and proper management of emotional distress contributed to the effectiveness of the interventions. However, receiving conflicting information, limited financial resources, and the inability to face challenges were among the obstacles to strengthening self-efficacy and adherence to treatment.

Physician-reported barriers and facilitators to thyroid hormone deprescribing in older adults.

Thyroid hormone is one of the most commonly prescribed medications in the United States. Misuse of and overtreatment with thyroid hormone is common in older adults and can lead to cardiovascular and skeletal adverse events. Even though deprescribing can reduce inappropriate care, no studies have yet explored specific barriers and facilitators to guide thyroid hormone deprescribing in older adults (defined as discontinuation of thyroid hormone when initiated without an appropriate indication or dose reduction in those overtreated). We conducted semi-structured interviews with 19 endocrinologists, geriatricians, and primary care physicians who prescribe thyroid hormone. Interviews were completed between July 2020 and December 2021 via two-way video conferencing. We used both an inductive and deductive content analysis guided by the Theoretical Domains Framework to evaluate transcribed and coded participant responses. Thematic analysis characterized themes related to barriers and facilitators to thyroid hormone deprescribing practices in older adults. The most commonly reported barriers to thyroid hormone deprescribing were related to patient-level factors, followed by physician- and system-level factors. Patient factors included patients' perceived need for thyroid hormone use and patient anxiety/concerns about potential side effects related to thyroid hormone dose reduction, patient lack of knowledge, and misinformation regarding deprescribing. Physician- and system-level barriers included clinic visit time constraints, physician inertia, physician lack of knowledge about deprescribing, perceived lack of sufficient patient follow-up, and electronic health record limitations. The most prominent physician-reported facilitators to thyroid hormone deprescribing were effective physician-to-patient communication, and positive physician-patient relationship, including patients' trust in their treating physician. Barriers and facilitators to thyroid hormone deprescribing in older adults were reported at multiple levels including patient-, physician-, and system-level factors. Interventions to improve thyroid hormone deprescribing in older adults should aim to improve patient education and expectations, increase multidisciplinary physician awareness, and overcome physician inertia.

Narratives of resilience: Understanding Iranian breast cancer survivors through health belief model and stress-coping theory for enhanced interventions

Breast cancer poses a significant global health challenge, with Iran experiencing particularly high incidence and mortality rates. Understanding the adaptation process of Iranian breast cancer survivors’ post-treatment is crucial. This study explores the health perceptions, barriers, and coping mechanisms of Iranian survivors by integrating Stress-Coping Theory (SCT) and the Health Belief Model (HBM). Semi-structured interviews were conducted with 17 survivors, and a grounded theory approach guided the deductive content analysis of the data. The findings reveal key themes, including perceived susceptibility, benefits, barriers to care, cues to action, self-efficacy, and appraisal of action. Perceived susceptibility highlights diagnostic challenges stemming from practitioner errors and symptom misconceptions. Perceived benefits underscore the importance of early detection and support from healthcare providers and families. Barriers include cultural and financial obstacles, while cues to action reflect the influence of media, family, and personal experiences on healthcare-seeking behavior. The study also examines coping strategies, such as problem-focused and emotion-focused approaches, along with family support and external stressors. To address these barriers and enhance support systems, the study suggests specific strategies for healthcare providers, including targeted training to improve diagnostic accuracy and patient communication. Culturally sensitive awareness campaigns can correct symptom misconceptions, while financial counseling can mitigate economic barriers. Establishing community-based support groups and involving family members in care plans can enhance emotional and psychological support. These strategies aim to overcome the identified barriers and improve support systems for Iranian breast cancer survivors, ultimately fostering better recovery outcomes.