Deductive Content Analysis Research Articles

The impact of discharge letter content on unplanned hospital readmissions within 30 and 90 days in older adults with chronic illness – a mixed methods study

BackgroundCare transitions are high-risk processes, especially for people with complex or chronic illness. Discharge letters are an opportunity to provide written information to improve patients’ self-management after discharge. The aim of this study is to determine the impact of discharge letter content on unplanned hospital readmissions and self-rated quality of care transitions among patients 60 years of age or older with chronic illness.MethodsThe study had a convergent mixed methods design. Patients with chronic obstructive pulmonary disease or congestive heart failure were recruited from two hospitals in Region Stockholm if they were living at home and Swedish-speaking. Patients with dementia or cognitive impairment, or a “do not resuscitate” statement in their medical record were excluded. Discharge letters from 136 patients recruited to a randomised controlled trial were coded using an assessment matrix and deductive content analysis. The assessment matrix was based on a literature review performed to identify key elements in discharge letters that facilitate a safe care transition to home. The coded key elements were transformed into a quantitative variable of “SAFE-D score”. Bivariate correlations between SAFE-D score and quality of care transition as well as unplanned readmissions within 30 and 90 days were calculated. Lastly, a multivariable Cox proportional hazards model was used to investigate associations between SAFE-D score and time to readmission.ResultsAll discharge letters contained at least five of eleven key elements. In less than two per cent of the discharge letters, all eleven key elements were present. Neither SAFE-D score, nor single key elements correlated with 30-day or 90-day readmission rate. SAFE-D score was not associated with time to readmission when adjusted for a range of patient characteristics and self-rated quality of care transitions.ConclusionsWhile written summaries play a role, they may not be sufficient on their own to ensure safe care transitions and effective self-care management post-discharge.Trial registrationClinical Trials. giv, NCT02823795, 01/09/2016.

“I'm not very skilled in using gadgets:” A qualitative exploration of the facilitators and barriers to using telepharmacy services among Filipino senior citizens

BackgroundTelepharmacy provides remote care by pharmacists to distant patients via telecommunications. It is a new service used in the Philippines during the COVID-19 pandemic. However, its utilization among vulnerable populations, notably senior citizens, remains relatively unexplored. ObjectiveThis study explored the facilitators and barriers to telepharmacy use among senior citizens in Pasig City, Philippines. Pasig City, a highly urbanized area in Metro Manila, is known for its quality and accessible healthcare services and has a high population of senior citizens. MethodsSix focus groups were conducted: three with telepharmacy users and three with non-users, each with 3–5 participants. Focus groups were concluded upon reaching data saturation, where no new insights emerged. Verbatim transcripts were analyzed using deductive and inductive content analysis, guided by the Health Belief Model. Coding and data management were facilitated by MAXQDA software. ResultsFilipino senior citizens recognize the convenience and reliability of telepharmacy services for healthcare advice. Their use is influenced by social factors (friends, family, social media) and personal relevance, especially for those with chronic conditions. Positive experiences increase their likelihood of continued use and recommendations to peers. However, barriers such as poor service knowledge, low self-efficacy, and limited access (lack of smartphones, unreliable internet) hinder broader adoption. ConclusionsTelepharmacy enhances the health and well-being of Filipino senior citizens by offering convenient and effective pharmaceutical care. However, barriers exist that need to be addressed through a multifaceted approach, including education and training for seniors, improved internet infrastructure, and the design of user-friendly platforms.

Falling short in bariatric surgery: An exploration of key barriers and motivators of attrition

BackgroundIn the United States, obesity-related diseases pose significant healthcare challenges, with bariatric surgery offering a potential solution. However, bariatric surgery completion rates, particularly among Black and Hispanic populations, remain low. ObjectiveThis study applied the Theoretical Domains Framework (TDF) to explore behavioral factors influencing bariatric surgery program attrition among a majority Black participant population to inform interventions for improving attrition. MethodsWe conducted semi-structured interviews with 40 surgical and non-surgical participants and conducted deductive content analysis informed by six TDF constructs to explore factors influencing bariatric surgery program attrition. ResultsParticipants’ decision-making regarding bariatric surgery is influenced by behavioral factors, including knowledge, skills, social roles, beliefs about capabilities, optimism, and beliefs about consequences. ConclusionUnderstanding multifaceted factors influencing bariatric surgery attrition will inform the development of tailored interventions that address knowledge gaps, enhance skills, and consider social role conflicts to improve patient engagement and decision-making in managing obesity, especially for Black populations.

Caesarean section on maternal request: a qualitative study of conflicts related to shared decision-making and person-centred care in Sweden

BackgroundToday, person-centred care is seen as a cornerstone of health policy and practice, but accommodating individual patient preferences can be challenging, for example involving caesarean section on maternal request (CSMR). The aim of this study was to explore Swedish health professionals’ perspectives on CSMR and analyse them with regard to potential conflicts that may arise from person-centred care, specifically in relation to shared decision-making.MethodsA qualitative study using both inductive and deductive content analysis was conducted based on semi-structured interviews. It was based on a purposeful sampling of 12 health professionals: seven obstetricians, three midwives and two neonatologists working at different hospitals in southern and central Sweden. The interviews were recorded either in a telephone call or in a video conference call, and audio files were deleted after transcription.ResultsIn the interviews, twelve types of expressions (sub-categories) of five types of conflicts (categories) between shared decision-making and CSMR emerged. Most health professionals agreed in principle that women have the right to decide over their own body, but did not believe this included the right to choose surgery without medical indications (patient autonomy). The health professionals also expressed that they had to consider not only the woman’s current preferences and health but also her future health, which could be negatively impacted by a CSMR (treatment quality and patient safety). Furthermore, the health professionals did not consider costs in the individual decision, but thought CSMR might lead to crowding-out effects (avoiding treatments that harm others). Although the health professionals emphasised that every CSMR request was addressed individually, they referred to different strategies for avoiding arbitrariness (equality and non-discrimination). Lastly, they described that CSMR entailed a multifaceted decision being individual yet collective, and the use of birth contracts in order to increase a woman’s sense of security (an uncomplicated decision-making process). ConclusionsThe complex landscape for handling CSMR in Sweden, arising from a restrictive approach centred on collective and standardised solutions alongside a simultaneous shift towards person-centred care and individual decision-making, was evident in the health professionals’ reasoning. Although most health professionals emphasised that the mode of delivery is ultimately a professional decision, they still strived towards shared decision-making through information and support. Given the different views on CSMR, it is of utmost importance for healthcare professionals and women to reach a consensus on how to address this issue and to discuss what patient autonomy and shared decision-making mean in this specific context.

Family resilience in a crisis: A qualitative study of family resilience in multimember infected families in the context of COVID-19.

This study aimed to understand the family experience and identify family resilience factors to help families adapt to and cope with COVID-19. A purposive sample of 21 patients (from nine families) diagnosed with COVID-19 were recruited for interviews. Participants were interviewed using a semistructured question guide to explore family experiences. Deductive content analysis was used to develop emerging themes. Deductive findings included three main themes: belief systems, family organizational patterns, and communication and problem solving. These themes can be applied to the analysis and conclusions related to family resilience during a crisis such as the COVID-19 pandemic. This study reveals the coping process of families after multiple members were diagnosed with COVID-19, from the establishment and reinforcement of belief systems to the determination of how the family copes with risks and finally their ability to withstand risks. In addition, the study supports the concept that family resilience can be demonstrated during epidemics. Considering that the COVID pandemic might persist for a significant period of time, doctors and nurses must focus not only on individuals but also on the overall recovery of the family and develop interventions aimed at improving family resilience during these challenging times. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Evaluating teacher competencies in Pakistan's public schools: Enhancing the impact of professional development programs

Professional Development (PD) programs in Pakistan typically follow a standardized approach, often overlooking the diverse strengths and weaknesses of various teacher groups, which may not adequately address their specific needs. This study aims to evaluate teacher competencies among different groups from the perspective of school principals in Pakistan's public schools, with the goal of enhancing the effectiveness of PD programs. Initially, the study identifies three key themes of 21st-century teacher competencies through an extensive review of recent literature. An interview guide, based on these competencies, was used to gather data from seven public school principals via structured interviews. The data were analyzed using a deductive content analysis approach, with MAXQDA software employed for theme coding. The findings revealed notable differences in teacher competencies from the principals' perspectives. Female and younger teachers exhibited more competencies compared to their male and senior counterparts. These insights provide crucial information for planning and customizing Teacher Professional Development (TPD) programs, emphasizing an objective evaluation of teachers rather than self-assessment. Tailored PD programs based on these findings can more effectively enhance teachers' professional growth and competence."

Exploring barriers and facilitators to the adoption of regular exercise practice in patients at risk of a recurrence of low back pain (MyBack project): a qualitative study

Purpose This study aimed to explore potential barriers and facilitators to the adoption of regular exercise practice in patients at risk of a recurrence of low back pain (LBP). Materials and Methods Eleven patients, who recovered from a previous episode of LBP, participated in two focus groups. The semi-structured interview schedule was informed by the Behaviour Change Wheel and the Theoretical Domains Framework. Focus groups were held through videoconference, audio and video recorded and transcribed verbatim. A deductive content analysis was performed by two researchers independently. Results Eighteen barriers and 19 facilitators were identified. The most common barriers included “lack of knowledge on how to manage a recurrence of LBP,” “lack of behavioural regulation strategies and having other priorities” and “lack of self-efficacy/confidence to practice exercise autonomously and deal with a new episode of LBP.” “Knowledge on exercise and recurrences,” “regular exercise habits,” “having specific behavioural regulation strategies,” “exercise practice with others,” “willingness to practice exercise and considering it a priority,” and “presence of positive emotions related with exercise practice” were the most common facilitators. Conclusions These findings will inform the development of a behaviour change-informed exercise intervention to promote regular exercise practice among patients at risk of a recurrence of LBP.

Crisis management in community pharmacies during a pandemic

BackgroundAlthough the COVID-19 pandemic required community pharmacies to implement several adaptation strategies to ensure medicines' and services’ availability, related empirical research based on crisis management theory is lacking. ObjectiveThis study sought to holistically depict crisis management in Finnish community pharmacies and explore whether (1) pre-existing crisis plans, (2) crisis teams, (3) shared decision-making or (4) collaboration and communication with external stakeholders can protect staff resilience, pharmacy owners' resilience, organisational cohesion (‘team spirit’) and pharmacies' resources or finances during the pandemic. MethodsA cross-sectional survey was developed based on the crisis management process model and sent to Finnish community pharmacy owners (n = 602) during the pandemic's second wave in October–November 2020. Descriptive statistics were calculated, and logistic regression analysis was performed to explore effects of crisis management efforts. Open-field responses were analysed qualitatively using deductive content analysis. ResultsIn total, 221 (36.7 %) pharmacy owners participated in the study. Pharmacies responded to the pandemic with increased order volumes and new suppliers, home deliveries and remote consultations, hand sanitiser production and additional customer counselling concerning the COVID-19. Shared decision-making with pharmacy colleagues (p = 0.025) and collaboration with peers or stakeholders in the supply chain (p = 0.015) protected pharmacy owners' resilience during the pandemic. Additionally, shared decision-making protected pharmacies' finances (p = 0.040). Crisis teams or collaboration with social and healthcare operators did not provide advantage to pharmacies. However, pre-existing pandemic plans associated with reduction of pharmacies’ resources (p = 0.006). ConclusionsCommunity pharmacies responded to the COVID-19 pandemic with several measures to ensure the continuity of pharmaceutical services and care and the availability of medicines, disinfectants and personal protective equipment. Developing shared decision-making in pharmacies and active collaboration with peers and supply-chain stakeholders could improve pharmacies' finances and their owners’ resilience in future crises.

Antibiotic dispensing practices among informal healthcare providers in low-income and middle-income countries: a scoping review protocol

IntroductionThe rise of antimicrobial resistance represents a critical threat to global health, exacerbated by the excessive and inappropriate dispensing and use of antimicrobial drugs, notably antibiotics, which specifically target bacterial...

ETSI As a case study of organizational resilience in standard setting: strategies that ensure thriving despite organizational challenges

This paper brings forth an empirical study of organizational resilience strategies in standard setting. The selection of ETSI (The European Telecommunications Standards Institute) as a case study for this purpose was motivated by ETSI's legal status as an ESO (European Standardization Organization), global impact, and the history of external criticism directed at the organization. Based on theoretical considerations and author's previous empirical research, it was expected that the organizational resilience strategies used by ETSI differ with regards to two dimensions: anticipation of the disturbance (proactive and reactive strategies); and the locus of the strategic effort (internal or external to the organization). A combination of deductive and inductive content analysis was applied to 12 semi-structured interviews with individuals who participate in standard setting activities within ETSI. The conducted analysis confirmed the expected 2 × 2 type of taxonomy determined by anticipation and locus of strategic effort. The identified 29 categories were thus categorized into four clusters of resilience strategies: proactive external (5), proactive internal (9), reactive external (5) and reactive internal (10) strategies. The discussion reflects on the historical organizational challenges, the resilience strategies reported in response to them, and how they might have contributed to continued thriving of ETSI despite organizational challenges.

Personal Gains and Challenges of Virtual Intergenerational Service-Learning in Health Promotion

ABSTRACT The Coronavirus Disease 2019 (COVID-19) pandemic has disrupted the conventional face-to-face learning since 2020. Face-to-face intergenerational service-learning was switched to online learning. Fifty-six undergraduate students in the health studies program taking the compulsory subject of Practices in Health Promotion were involved in this study which aimed to evaluate the personal gains and challenges of virtual intergenerational service-learning by applying a deductive content analysis on reflective essays submitted by the students. Results indicated that students had gained leadership skills, developed sense of empathy, built a reciprocal relationship with the community, had positive impact on future development and changed in perception of older adults after the virtual intergenerational service-learning. Challenges of the experience consisted of technical issues and support, interruptions during online presentation and effectiveness of services. Recommendations are provided for academic and community settings to achieve successful virtual intergenerational service-learning.

CROSS-CULTURE BRIDGES IN TOURISM: A STUDY ON TRANSLATION STRATEGIES IN INDONESIAN PROMOTIONAL MATERIALS

Tourism promotion is a type of operative text. The text is structured to influence the reader to visit the tourism destination on offer. The same should also appear in the translated version. The language form of promotional texts is dialogic and persuasive. This study generally aims to explain in depth the translation strategies used in the translation of tourism promotional texts and the translation strategies suitable for the translation of appellative genre texts. This research used qualitative method with deductive and comparative content analysis techniques. The research begins with data collection of tourism promotional texts by looking at their lexicogrammatical features. The data sources came from tourism promotional materials in the form of brochures from the tourism offices of Jepara, and Kudus regencies. The data were analyzed with a functional approach. The findings of this study revealed that the dominant translation technique used to translate tourism brochure texts from both Jepara and Kudus is the literal technique at 75%, and the semantic method at 72%. Thus, the dominant translation strategy or ideology applied by the translators is foreignization ideology, 98%. Furthermore, the results of this study also showed that the functional approach is more suitable for translating tourism promotional materials, because the function of promotional texts is to promote tourism.

Investigating the mechanisms linking revenue recycling to increased political acceptability of carbon pricing

AbstractThis paper analyzes the causal relationship between the carbon tax's revenue recycling measures and political acceptability. The Irish carbon tax reform of 2019 forms the basis of the study. The findings are based on deductive content analysis and semi‐structured, elite interviews with key politicians, climate policy advisors, and other influential figures involved in the policy‐making process. Analyzing the extensive Irish revenue recycling scheme, encompassing compensatory measures and various forms of climate spending, provides researchers with the chance to track distinctive causal mechanisms over the course of a politically intense period, leading up to general elections. The results show that relief measures were crucial to alleviate concerns about the negative distributional impact of the policy, which was fiercely attacked by some opposition parties. Additionally, climate spending increased political acceptance by offering low‐carbon alternatives to consumers, even though the policy was initially construed as punitive measure, especially in regions and sectors where switching to low‐carbon options, public transport, or less carbon intense heating, were challenging or even impossible. A unique finding of the study is that revenue recycling facilitates the emergence of cross‐party agreement among ideologically distant parties. Another crucial contribution of this study is the detailed comparison, from the perspective of political acceptability, of two alternative social compensation models, the fee and dividend model, and the integration of targeted social cushioning and climate spending (hypothecation).

Retention strategies are routinely communicated to potential trial participants but often differ from what was planned in the trial protocol: an analysis of adult participant information leaflets and their corresponding protocols

BackgroundRetaining participants in randomised controlled trials (RCTs) is challenging and trial teams are often required to use strategies to ensure retention or improve it. Other than monetary incentives, there is no requirement to disclose the use of retention strategies to the participant. Additionally, not all retention strategies are developed at the planning stage, i.e. post-funding during protocol development, but some protocols include strategies for participant retention as retention is considered and planned for early in the trial planning stage. It is yet unknown if these plans are communicated in the corresponding participant information leaflets (PILs). The purpose of our study was to determine if PILs communicate plans to promote participant retention and, if so, are these outlined in the corresponding trial protocol.MethodsNinety-two adult PILs and their 90 corresponding protocols from Clinical Trial Units (CTUs) in the UK were analysed. Directed (deductive) content analysis was used to analyse the participant retention text from the PILs. Data were presented using a narrative summary and frequencies where appropriate.ResultsPlans to promote participant retention were communicated in 81.5% (n = 75/92) of PILs. Fifty-seven percent (n = 43/75) of PILs communicated plans to use “combined strategies” to promote participant retention. The most common individual retention strategy was telling the participants that data collection for the trial would be scheduled during routine care visits (16%; n = 12/75 PILs). The importance of retention and the impact that missing or deleted data (deleting data collected prior to withdrawal) has on the ability to answer the research question were explained in 6.5% (n = 6/92) and 5.4% (n = 5/92) of PILs respectively. Out of the 59 PILs and 58 matching protocols that both communicated plans to use strategies to promote participant retention, 18.6% (n = 11/59) communicated the same information, the remaining 81.4% (n = 48/59) of PILs either only partially communicated (45.8%; n = 27/59) the same information or did not communicate the same information (35.6%; n = 21/59) as the protocol with regard to the retention strategy(ies).ConclusionRetention strategies are frequently communicated to potential trial participants in PILs; however, the information provided often differs from the content in the corresponding protocol. Participant retention considerations are best done at the planning stage of the trial and we encourage trial teams to be consistent in the communication of these strategies in both the protocol and PIL.

Developing the Potential of Women Foodpreneur by Using the Skill Will Matrix: A Case Study of Dapur Mawar Program

Small and medium-scale entrepreneurs mainly consist of women. Women's small businesses in developing communities can drive the economy for generations. To succeed in the business world, women entrepreneurs need to have high skills and knowledge. Entrepreneurship training and skills are essential, especially for potential entrepreneurs who want to develop and expand a business. Thus, it is essential to identify and evaluate existing and foreseeable skills and abilities. Entrepreneurial skills can be learned, formed, and mastered by an individual through the entrepreneurial education process or experience. The Dapur Mawar project aims to provide training and education for women foodprenuers. Before the training module's implementation, the trainers employed a skill-will matrix to examine the willingness and skills of trainees. This study uses a semi-structured interview method. Twenty-three women foodprenuers have been selected as key informants using purposive sampling. Deductive content analysis for analyzing qualitative data was employed to quantify the frequency of keywords. Pre-existing quadrants are applied to the data through a deductive approach. The findings revealed that critical informants could be categorized into two categories: 1) an entrepreneur with high skill and high motivation and 2) an entrepreneur with low skill and high motivation. The result of the analysis is used to prepare the Dapur Mawar program. The implications of the study and future research suggestions are also justified.

"You want people to listen to you": Patient experiences of women's healthcare within the Veterans Health Administration.

To identify constructs that are critical in shaping Veterans' experiences with Veterans Health Administration (VA) women's healthcare, including any which have been underexplored or are not included in current VA surveys of patient experience. From June 2022 to January 2023, we conducted 28 semi-structured interviews with a diverse, national sample of Veterans who use VA women's healthcare. Using VA data, we divided Veteran VA-users identified as female into four groups stratified by age (dichotomized at age 45) and race/ethnicity (non-Hispanic White vs. all other). We enrolled Veterans continuously from each recruitment strata until thematic saturation was reached. For this qualitative study, we asked Veterans about past VA healthcare experiences. Interview questions were guided by a priori domains identified from review of the literature, including trust, safety, respect, privacy, communication and discrimination. Analysis occurred concurrently with interviews, using inductive and deductive content analysis. We identified five themes influencing Veterans' experiences of VA women's healthcare: feeling valued and supported, bodily autonomy, discrimination, past military experiences and trauma, and accessible care. Each emergent theme was associated with multiple of the a priori domains we asked about in the interview guide. Our findings underscore the need for a measure of patient experience tailored to VA women's healthcare. Existing patient experience measures used within VA fail to address several aspects of experience highlighted by our study, including bodily autonomy, the influence of past military experiences and trauma on healthcare, and discrimination. Understanding distinct factors that influence women and gender-diverse Veterans' experiences with VA care is critical to advance efforts by VA to measure and improve the quality and equity of care for all Veterans.

Barriers to exclusive breastfeeding practice among HIV-positive mothers in Tanzania. An exploratory qualitative study.

Ensuring optimal nutrition through early breastfeeding is vital for infant mental development and overall health. HIV infections complicate decisions regarding exclusive breastfeeding, jeopardizing effective infant and young child feeding, which affects nutrition and health outcomes. Recognizing the lack of evidence on barriers to infant feeding in the context of HIV in Tanzania, this study was conducted to explore individual, household, and community obstacles in the Ilala district, Dar es Salaam. A case study design employing a qualitative approach was used. The study was executed at the Reproductive and Child Health (RCH) Clinic within Amana Regional Referral Hospital, Mnazi Mmoja Health Centre, and Buguruni Health Centre. Data collection ensued through the purposive sampling of healthcare providers and HIV-positive mothers, utilizing in-depth interview techniques. The textual data accrued were analyzed using inductive and deductive content analysis strategies, thereby enabling the delineation and formulation of principal thematic constructs. The study involved interviews with twenty-seven key informants, encompassing HIV-positive mothers, nurses, clinicians, and community-based healthcare workers. The analysis of these interviews resulted in the identification of three major themes. Firstly, individual barriers to exclusive breastfeeding were delineated, encompassing sub-themes such as occupation-related hectic schedules, early motherhood-related non-compliance to safe infant feeding directives, postpartum depression, and issues related to breast sores and abscesses. Secondly, household-level barriers were identified, highlighting challenges like food insecurity and inaccessibility to key resources, the influence of male partners and family members on decision-making, and barriers arising from non-disclosure of HIV status affecting Exclusive Breastfeeding (EBF) support. Lastly, community-level barriers were explored, revealing a sub-theme related to the low retentivity of HIV-positive women in the Prevention of Mother-to-Child Transmission (PMTCT) programs. Individual barriers encompass practical, psychological, and physical challenges, while household-level obstacles include food insecurity, limited resources, and family dynamics influencing decisions. At the community level, there's a concern about the low retentivity of HIV-positive women in PMTCT programs, indicating broader societal challenges in supporting exclusive breastfeeding. There is a need for tailored interventions at individual, household, and community levels to promote and support optimal infant feeding practices among HIV-positive women.

The Contribution of Sesotho Literature Books Read in Lesotho Secondary Schools in Perpetuating and Reinforcing Gender Stereotypes

Purpose: The overarching purpose of this research was to investigate the presence of gender stereotypes in the books used for teaching of Sesotho Literature in Lesotho secondary schools with a view towards recommending corrective interventions to the challenge. The study examined how physical attributes, character traits, gender roles within households and communities, and occupational roles were assigned to males and females in these books. Additionally, the research explored the power dynamics between male and female genders as depicted in these books. These categories served as the basis for coding and analysing the data. The study selected a purposive sample of four literary genres namely novels, dramas, poetry, and short stories. Methodology: Given the nature of the study, qualitative deductive content analysis was employed to gather and analyse the data from the chapters, stories, and poems within each of the genres. Findings: The findings indicated a significant prevalence of culturally constructed gender stereotypes within the examined works. The most important finding was that literature books perpetuate negative stereotypes which makes education a key contributor to some of the gender related problems. Unique contribution to theory, policy and practice: This research contributes to promotion of gender parity, reduction of gender-based violence and homicides which are problems ravaging the nation today.

'We did everything by phone': a qualitative study of mothers' experience of smartphone-aided screening of cerebral palsy in Kathmandu, Nepal.

International guidelines recommend early intervention to all children at risk of cerebral palsy, but targeted screening programs are often lacking in low- and middle-income settings with the highest burden of disease. Smartphone applications have the potential to improve access to early diagnostics by empowering parents to film their children at home followed by centralized evaluation of videos with General Movements Assessment. We explored mothers' perceptions about participating in a smartphone aided cerebral palsy screening program in Kathmandu, Nepal. This is an explorative qualitative study that used focus group discussions (n = 2) and individual interviews (n = 4) with mothers of term-born infants surviving birth asphyxia or neonatal seizures. Parents used the NeuroMotion™ smartphone app to film their children at home and the videos were analysed using Precthl's General Movements Assessment. Sekhon et al.'s framework on the acceptability of health care interventions guided the design of the group discussions and interviews, and the deductive qualitative content analysis. Mothers were interested in engaging with the programme and expressed hope it would benefit their children. Most felt using the app was intuitive. They were, however, unclear about the way the analysis was performed. Support from the research team was often needed to overcome an initial lack of self-confidence in using the technology, and to reduce anxiety related to the follow-up. The intervention was overall perceived as recommendable but should be supplemented by a face-to-face consultation. Smartphone aided remote screening of cerebral palsy is acceptable in a lower middle-income population but requires additional technical support.

How do labour market conditions explain the development of mental health over the life-course? A conceptual integration of the ecological model with life-course epidemiology in an integrative review of results from the Northern Swedish Cohort

BackgroundThe aim of this study was to contribute to the theoretical development within the field of labour market effects on mental health during life by integrating Bronfenbrenner’s ecological model with mainly earlier theoretical work on life-course theory.MethodsAn integrative review was performed of all 52 publications about labour market conditions in relation to mental health from the longitudinal Northern Swedish Cohort study. Inductive and deductive qualitative content analysis were performed in relation to Bronfenbrenner’s ecological framework combined with life-course theories.ResultsThe following nine themes were identified: 1. Macroeconomic recession impairs mental health among young people. 2. The mental health effects on individuals of youth unemployment seem rather insensitive to recession. 3. Small but consistent negative effect of neighbourhood unemployment and other work-related disadvantaged on individuals’ mental health over life. 4. Youth unemployment becomes embodied as scars of mental ill-health over life. 5. Weak labour market attachment impairs mental health over life. 6. Bidirectional relations between health and weak labour market attachment over life. 7. Macrolevel structures are of importance for how labour market position cause poor health. 8. Unequal gender relations at work impacts negatively on mental health. 9. The agency to improve health over life in dyadic relations. Unemployment in society permeates from the macrolevel into the exolevel, defined by Bronfenbrenner as for example the labour market of parents or partners or the neighbourhood into the settings closest to the individual (the micro- and mesolevel) and affects the relations between the work, family, and leisure spheres of the individual. Neighbourhood unemployment leads to poor health among those who live there, independent of their employment status. Individuals’ exposure to unemployment and temporary employment leads to poorer mental health over the life-course. Temporal dimensions were identified and combined with Bronfenbrenner levels into a contextual life-course modelConclusionCombining the ecosocial theory with life-course theories provides a framework for understanding the embodiment of work-related mental health over life. The labour market conditions surrounding the individual are of crucial importance for the embodiment of mental health over life, at the same time as individual agency can be health promoting. Mental health can be improved by societal efforts in regulations of the labour market.