Descriptive Exploratory Study Research Articles

Perspectives of providing magnesium sulfate to patients with preeclampsia and eclampsia: A qualitative study amongst nurse-midwives in Dar es Salaam, Tanzania.

Preeclampsia and eclampsia are among the leading direct causes of maternal death and morbidity worldwide. Up to 34% of maternal deaths in Tanzania are due to preeclampsia/ eclampsia. Magnesium sulfate is recommended for preventing and treating convulsions in women with Preeclampsia or eclampsia. However, evidence suggests limited knowledge of its dosage and proper toxicity assessment after administration among health care providers. This study explored nurse-midwives' perspectives on providing MgSO4 to patients with preeclampsia or eclampsia in Tanzania. A descriptive exploratory qualitative study using in-depth interviews was conducted to understand nurse-midwives' perspectives on providing magnesium sulfate to patients with PE/E. Nineteen nurse-midwives were interviewed from three hospitals in the Dar es Salaam region. We used a semi-structured interview guide in Kiswahili language to collect data. All interviews were digitally recorded and transcribed verbatim. We analyzed data using inductive content analysis. This study revealed that nurse-midwives provide magnesium sulfate to save the lives of women and their unborn children. Nurse-midwives reasoned that confidence in their skill enhances provision of magnesium sulfate. However, they were concerned about its effect on the progress of labour. Ineffective use of magnesium sulfate emerged from inadequate training, an unsupportive work environment, and underutilization of the existing guidelines. Nurse-midwives have clear drive to provide magnesium sulfate to women with preeclampsia or eclampsia. However, inadequate training, underutilization of guidelines and unsupportive work environment lead to ineffective use of magnesium sulfate. Targeted practical training should be emphasized for nurse-midwives mastery of clinical competencies.

Breaking challenges: queer perspectives on solutions to establish inclusive sexual-reproductive healthcare in Gauteng Province, South Africa

IntroductionIn South Africa’s diverse population, queer voices emerge as change agents, proposing new and critical solutions to reform sexual and reproductive healthcare services in the pursuit of inclusivity and equality. Our research aimed to explore and describe queer individuals’ perceptions and solutions for promoting sexual-reproductive healthcare services and needs (SRHSN) in Gauteng Province, South Africa.MethodologyAn explorative-descriptive study was performed for this research. A total of 22 queer individuals was recruited using respondent-driven sampling (RDS) within a queer-inclusive non-governmental organization (NGO) clinic in Gauteng Province, South Africa. Semi-structured interviews and an interview guide were utilized to collect data using English. Thematic content analysis was applied using NVivo 14.ResultsFour main themes and related sub-themes were revealed from the study including the creation of healthcare equity for queer individuals, empowering and supporting healthcare providers (HCPs) to enhance skills, knowledge, and expertise, raising awareness on queer-related issues, and different stakeholders’ involvement.ConclusionAs we navigate South Africa’s complex landscape of SRHSN for queer individuals, the crucial opinions and solutions offered by queer people not only challenge the status quo but also reveal an approach to a better, more equitable, empathetic, and accommodating healthcare system for everyone. Future studies should ensure the inclusiveness of queer individuals with the interest of improving their health not just for research outputs.

Exploring strategies promoting interprofessional collaborative practice in spinal cord injury rehabilitation at a private South African hospital group

Background. Implementing an interprofessional collaborative practice (IPCP) in hospitals improves health outcomes, enhances patient safety and reduces length of stay by optimising resource utilisation. Although this approach was desired at a private hospital group in South Africa (SA), the specific strategies for clinical guidelines and capacity management pertaining to spinal cord injury (SCI) patients and the implementation of IPCP were unknown. Objective. To explore strategies for implementing clinical guidelines and capacity management for SCI rehabilitation to promote IPCP in a private hospital group in SA. Method. This exploratory descriptive qualitative study included participants who were selected through purposive sampling. The participants comprised 11 staff from various disciplines and management of the private hospital group, one local and one international expert in IPCP. Three online focus groups (n=13) were conducted, involving three to five participants. The transcriptions were analysed thematically using Braun and Clarke’s framework. Results. Interprofessional communication and tools as well as capacity development were three emergent themes from the data. Strategies pertaining to communication methods, digitisation, visual displays, patient care information, educational information and education of healthcare workers were suggested to promote IPCP. Conclusion. These findings from the emergent themes could assist in implementing and integrating an IPCP approach into the rehabilitation service. Further research assessing the efficacy of implementing the IPCP strategies and digital platform would be beneficial.

Use of Melaleuca Essential Oil in Healing Pressure Injuries (LP): Case Series

To monitor and describe the healing process of pressure injuries (PI) grades I, II, III, and IV using tea tree essential oil (TTEO). A descriptive-exploratory study, using a multiple case study approach, was developed by monitoring patients with PI at different stages in a teaching hospital in the interior of Rio Grande do Sul, Brazil, from July to October 2021. The Bates-Jensen Wound Assessment Tool (BWAT) was used to assess wound characteristics. The study included 11 male patients hospitalized in the Intensive Care Unit (ICU) and the COVID-19 and clinical-surgical inpatient unit, with eleven PIs predominantly grade III in the sacral region. Regarding the characteristics evaluated by BWAT, a favorable progression in the lesions was observed in the following items when comparing the first and third days of TTEO use: peripheral skin color, exudate type, granulation tissue, wound edges, exudate amount, and epithelialization. However, an increase in scores was noted for necrotic tissue amount, undermining, necrotic tissue type, size, and depth, indicating regression in these aspects. The pharmaceutical formulations used in this study not only highlighted the benefits of TTEO in the healing process but also reinforced its advantages for being natural and more cost-effective compared to existing commercial formulations on the market.

Preparation & Use of Physical Agent Modalities Among U.S. OT Practitioners: A Mixed-Methods, Exploratory Descriptive Study

Abstract Date Presented 03/22/24 Findings from this study describe a notable shift over the past quarter-century with respect to the preparation and use of physical agent modalities (PAMS) by U.S. OT practitioners. Primary Author and Speaker: Tammy J. LeSage Additional Authors and Speakers: Kenneth Gentry Contributing Authors: Devin Hebble, Lilly Adams, Ashlyn Watts

A Qualitative Exploration of Stroke Survivors' Experiences of Using a Stroke Helpline.

StrokeLine is a stroke-specific helpline used by stroke survivors and their families in Australia to access professional support. There has been little research exploring stroke survivors' experiences of using helplines and their perceived impact on their stroke recovery. The aim of this study is to explore the reasons prompting stroke survivors to call StrokeLine and their experiences and to describe the perceived impact of calling StrokeLine on their recovery. An exploratory descriptive qualitative study was undertaken using thematic analysis of data collected through semi-structured interviews of stroke survivors between December 2020 and May 2022. Participants were recruited using purposive sampling. Interviews were conducted via audio-recorded Zoom conference calling and transcribed verbatim for thematic analysis. A total of eight callers (four men and womenwomen) participated, with the time since stroke ranging from 3.5 months to 5 years. Four major themes were identified, including 17 sub-themes. Key themes included (1) factors prompting use of StrokeLine; (2) experience of using StrokeLine; (3) perceived impact of using StrokeLine; and (4) conceptualising StrokeLine service provision. Participants perceived their experience of contacting StrokeLine as having a positive impact on their stroke recovery, leaving them feeling empowered and motivated to self-manage their condition. Stroke survivors with lived experience influenced the conceptualisation of this study through conversations with consumers and the Stroke Foundation. Eight stroke survivors were involved as participants in the research study.

Barriers and facilitators of evidence-based practice in the Portuguese context: perceptions of formal nursing leaders.

Formal nursing leaders play an important role in promoting and sustaining evidence-based practice (EBP) in the clinical context, particularly by creating a conducive environment for change and increasing clinicians' awareness of the positive results of EBP. However, nursing leaders encounter both barriers and facilitators in their work; therefore, it is important to understand their perceptions on this topic. The objective of this study was to understand the perceptions of formal nursing leaders about barriers and facilitators for EBP. A descriptive exploratory study with a qualitative approach was conducted. A convenience sample was obtained, consisting of formal nursing leaders from three Portuguese health care institutions. Data were collected through semi-structured interviews. Content analysis was conducted using MAXQDA Analytic Pro 2022 software. Seventeen formal nursing leaders were interviewed. Five categories of EBP barriers were identified: (1) scarce resources and inefficient resource management; (2) non-conducive organizational culture; (3) distance between academia and the clinical context; (4) demotivation; and (5) resistance to change. Seven categories of EBP facilitators were identified: (1) availability of resources and efficient resource management; (2) conducive organizational culture; (3) partnerships between academia and the clinical context; (4) motivation and commitment; (5) leadership; (6) organization that regulates professional practice; and (7) multidisciplinary meetings. This study identified barriers and facilitators for EBP through the perceptions of formal nursing leaders. Collaborative multidisciplinary efforts by leaders, direct care professionals, academics, and researchers should be conducted to overcome barriers and strengthen facilitators for EBP. http://links.lww.com/IJEBH/A242.

Breastfeeding mothers' awareness and experience of using the breastfeeding memory aide CHINS: An exploratory descriptive qualitative study

AbstractBackgroundBreastfeeding has immediate and long‐term benefits for both mother and child, but many mothers feel unprepared for the challenges of early breastfeeding. The first letter mnemonic, close, head free, nose to nipllie, in‐line, sustainable (CHINS) was developed as a tool to help practitioners remember retain and recall the principles of positioning for effective breastfeeding and a UK‐wide evaluation shows it is used widely within the UK breastfeeding workforce. This study sought to understand the extent to which breastfeeding mothers were aware of CHINS and their experience of using it to support their breastfeeding.MethodsAn exploratory qualitative research design was used to describe and interpret the findings of individual interviews with 11 breastfeeding mothers from across the United Kingdom who were recruited via a digital flier shared via social media and breastfeeding networks. The interviews were analysed thematically.ResultsAwareness and perception of CHINS, Timing of introduction to CHINS, and Sharing CHINS were the key themes to emerge, with an overarching core theme—The Right Advice at the Right Time. All the participants in the study were aware of CHINS and found it particularly helpful during the early stages of breastfeeding. Some participants reported that others, including fathers and peers, were aware of CHINS and had used it to support breastfeeding mothers. The participants felt support for breastfeeding was variable and that it was important to ensure that the right advice was given at the right time.ConclusionThis study included a small number of breastfeeding mothers from across the United Kingdom and whilst there were high levels of awareness and perceived value of CHINS, a larger study would be warranted to explore the value of CHINS in more depth as well as to understand the role of CHINS in the wider education of peers and significant others, including fathers.

Healthcare workers' views on type 2 diabetes mellitus management at selected clinics in Mthatha.

Diabetes is a non-communicable disease of global public health importance. Healthcare workers play a vital role in the management of this disease. This study aimed to explore healthcare workers' views on managing patients with type 2 diabetes at primary health care facilities. The study was conducted at two primary health care facilities in Mthatha, South Africa. This exploratory descriptive qualitative study included 28 primary health care workers. Data were collected through individual interviews and focus group discussions and analysed using a thematic analysis approach. Study participants' views of poor control of type 2 diabetes mellitus were categorised under patient- and healthcare system-related factors. The patient-related factors included poor adherence to an ideal diabetic diet, poor medication adherence, a lack of personal glucometers, and dearth of support systems. The healthcare system-related factors identified were inadequate patient education, long waiting times at the health facilities, high patient volumes, limited resources, and delayed service provision. Proposed solutions to address poor control of diabetes included improving patient health education, providing diabetic patients with glucometers, multi-stakeholder management of diabetes, allocating designated areas for patients with chronic illnesses, improved resource allocation, and regular staff training. Study participants perceived an improved level of control of diabetes among patients managed at the Community Health Centres. When designing interventions for the management of diabetes, both patient and healthcare system-related factors and the proposed solutions should be considered.Contribution:This study's findings could promote better management of diabetes at the primary health care level.

Preparation and Use of Physical Agent Modalities Among U.S. Occupational Therapists: A Mixed-Methods, Exploratory-Descriptive Study

Preparation and Use of Physical Agent Modalities Among U.S. Occupational Therapists: A Mixed-Methods, Exploratory-Descriptive Study

Standardization of Dental Vulnerability Scale scores (EVO-BR)

BackgroundDental Vulnerability Scale (EVO-BR) is an instrument developed to help identifying oral health-vulnerable individuals. This scale comprises 15 items distributed into 4 dimensions. It is the first instrument with the potential to guide clinical and managerial decisions in the oral health field. The aim is to validate a score to enable using EVO-BR in Primary Health Care (PHC).MethodThe investigated sample included PHC users in five Brazilian regions. Data were collected at two different stages: in 2019 (São Paulo) and in 2022 (Minas Gerais, Mato Grosso, Roraima, Pernambuco e Paraná). Exploratory descriptive study of this scale scores was carried out to create classification ranges. Subsequently, discriminant analysis was performed to assess the accuracy of the established classification. Boosting regression was carried out to check items’ weight for the instrument score.ResultsEVO-BR score ranged from 0 (highest vulnerability) to 15 (lowest vulnerability). Four (4) classification configurations were tested. Score equal to 12 points was the one presenting the best classification of the assessed individuals (100% were correctly classified). Boosting regression has evidenced that items 1 and 2 (Overall health domain) and 14 and 15 (Health Services domain) had the strongest influence on this instrument’s score.ConclusionThe process to standardize the EVO-BR score and, consequently, to develop assessment ranges, is an important step in the fight against health inequalities, since it provides a tool to help planning actions and interventions aimed at meeting specific needs of the population in the Primary Health Care context.

Can you be unique by wearing fast fashion? Exploring South African contemporary female consumers’ creative behaviour towards fast fashion uniqueness

Contemporary female consumers manage their appearance through current fashion trends and styles. The desire to be unique drives consumers to develop appearances that are perceived to differentiate them from others. In a world where fast fashion delivers multiple copies of one fashion item, it is difficult to imagine if fast fashion could deliver a unique appearance. Little research has considered the possibility of achieving fast fashion uniqueness. The behaviour of South African female consumers and their desire for fast fashion uniqueness as proposed in the theory of the need for uniqueness has also not been researched. The purpose of this study was to determine the meaning of fast fashion uniqueness and the behaviour related to the dimensions of uniqueness. An exploratory descriptive qualitative study was used to determine the fast fashion unique experiences of female fashion shoppers in South Africa. Thematic analysis of electronic individual interviews revealed the meaning of uniqueness manifested through mechanisms of self-expression and design creativity. Contribution to uniqueness theory is expressed through a socially acceptable appearance typified by creative choice counter-conformity behaviour. Unpopular choice counter-conformity behaviour was expressed through precautionary and guarding behaviour. Avoidance of similarity behaviour resulted in similarity acceptance behaviour characterized by helplessness and acceptance of fast fashion duplication, due to the inability to avoid similarity experienced during fast-fashion retail purchases. Coping strategies and avoidance behaviour tactics were applied to avoid fashion similarities. Fashion creativity serves as the mechanism through which contemporary fast fashion consumers achieve fast fashion appearance uniqueness. Fast fashion retailers in South Africa may need to improvise fashion offerings and give consumers alternative appearances to accommodate the creative uniqueness that female consumers are compelled to apply to achieve fast fashion uniqueness.

High-flow nasal cannula oxygen therapy for mild-moderate acute respiratory failure in patients with blunt chest trauma: An exploratory descriptive study

ObjectiveThe use of high-flow nasal cannula (HFNC) oxygen therapy is gaining popularity for the treatment of acute respiratory failure (ARF). However, limited evidence exists regarding the effectiveness of HFNC for hypoxemic ARF in patients with blunt chest trauma (BCT). MethodsThis retrospective analysis focused on BCT patients with mild-moderate hypoxemic ARF who were treated with either HFNC or non-invasive ventilation (NIV) in the emergency medicine department from January 2021 to December 2022. The primary endpoint was treatment failure, defined as either invasive ventilation, or a switch to the other study treatment (NIV for patients in the NFNC group, and vice-versa). ResultsA total of 157 patients with BCT (72 in the HFNC group and 85 in the NIV group) were included in this study. The treatment failure rate in the HFNC group was 11.1% and 16.5% in the NIV group - risk difference of 5.36% (95% CI, −5.94–16.10%; P = 0.366). The most common cause of failure in the HFNC group was aggravation of respiratory distress. While in the NIV group, the most common reason for failure was treatment intolerance. Treatment intolerance in the HFNC group was significantly lower than that in the NIV group (1.4% vs 9.4%, 95% CI 0.40–16.18; P = 0.039). Univariate logistic regression analysis showed that chronic respiratory disease, abbreviated injury scale score (chest) (≥3), Acute Physiology and Chronic Health Evaluation II score (≥15), partial arterial oxygen tension /fraction of inspired oxygen (≤200) at 1 h of treatment and respiratory rate (≥32 /min) at 1 h of treatment were risk factors associated with HFNC failure. ConclusionIn BCT patients with mild-moderate hypoxemic ARF, the usage of HFNC did not lead to higher rate of treatment failure when compared to NIV. HFNC was found to offer better comfort and tolerance than NIV, suggesting it may be a promising new respiratory support therapy for BCT patients with mild-moderate ARF.

Responsive Complementary Feeding Practices in Rural Muhanga District of Rwanda: A Mixed Methods Study

ABSTRACTBackgroundResponsive feeding among infants and young children (IYC) determines their food acceptance and adequate dietary intake, which enhances growth and developmental opportunities. However, little is known about responsive feeding practices among IYC in Rwanda. This study explored the status and barriers of responsive feeding practices among mothers from rural areas of Muhanga District in Rwanda.MethodThis descriptive longitudinal and exploratory mixed methods study was conducted among 29 mothers from 2 rural health centers in Muhanga District. Mothers were interviewed, and their interactions with children during lunch meals at 6, 9, and 12 months were observed. The interviews were recorded, transcribed, and thematically analyzed using Atlas.ti software.ResultsThe study shows that the number of mothers who reported to verbally encourage their children to eat during feeding increased with the child's age. Less than half of mothers, at all three time points of data collection (at 6, 9, and 12 months), reported and were observed allowing their children to self‐feed, smiling and talking to them during feeding. The perceived major barriers to mother–child interaction during feeding were lack of time due to the burden of other responsibilities, and poverty. In addition, fear of messing up and food waste were barriers to child self‐feeding opportunities.ConclusionFindings indicate that responsive feeding was less practiced among study mothers due to lack of time, poverty, and fear of food waste during child self‐feeding. Nutrition interventions in this community should consider raising awareness of responsive feeding practices through education and encouraging mothers to devote sufficient time to interact with their children during feeding episodes.

Lack of autonomy and professional recognition as major factors for burnout in midwives: A systematic mixed-method review.

The aim of this study was to review the existing evidence on burnout levels in midwives and the main related factors. Mixed studies systematic review. PubMed, Scopus and Web of Science were sourced from 2018 and 2023. Inclusion criteria: quantitative cross-sectional or qualitative articles published in English within the last 5 years. studies with undergraduate or trainee midwives, studies examining the factors in a pandemic setting and those not answering the research question. Potential risk of bias was assessed using the Mixed Methods Assessment Tool (MMAT). A convergent synthesis design was followed through a thematic synthesis using Thomas and Harden's three-step method: inductive coding of the text, development of descriptive themes and generation of analytical themes. Qualitative approaches adopted exploratory descriptive studies and participatory action research. Thirty-six studies were included, with a total of 17,364 participants. There were higher levels of burnout in midwives who were single, under 35-40 years of age, with less than 10 years of experience and those with young children. Stress, anxiety and depression, as well as the emotional impact of traumatic events, have been described as related psychological factors. Although extrinsic work factors such as shifts, workload, pay and interpersonal relationships increase burnout, intrinsic factors such as lack of autonomy and recognition are the main factors related to it. What problem did the study address? Burnout among healthcare workers has been recognized as a global crisis requiring urgent attention, specifically in midwives. What were the main findings? There is a persistent shortage of midwives that is attributed in part to chronic retention difficulties related to job burnout expressed by these professionals. Where and on whom will the research have an impact? We seek to address the paucity of research on burnout in midwives in the current crisis in the profession. Work factors such as lack of autonomy or recognition in the profession carry an associated risk of burnout and job attrition. Understanding the factors that contribute to burnout will enable healthcare organizations to reduce the current problem. PREFERRED: Reporting items for systematic review and meta-analyses (PRISMA). No patient or public contribution.

La formación de comunicadores en clave de la inter y transdisciplinariedad para actuar en un mundo digitalizado

Reflection is called for on the institutional use, practices, and formative relations resulting from the implementation of ICT in educational communication processes. Redefining communicative work in terms of inter- and trans-disciplinarity requires revising training objectives and developing competencies and skills mediated by the appropriation of ICT. Transformations in social scenarios and practices can impact mediations, spaces, and forms of cultural goods and resource use. This paper presents an exploratory relational descriptive case study. The study used quantitative elements to calculate repetitive frequencies in the curriculum. These frequencies were then used as input for the qualitative analysis of the structure, contents, and approaches of the curricula of 15 universities. The universities were selected based on their importance in each of the five Colombian regions. The study's main finding is that the curriculum lacks coherence and logical organisation, hindering the development of a model for the use and appropriation of technologies. The convergence of pedagogical and didactic methodologies in the learning environment is only timidly explored. The problem-solving approach is prioritised by social constructivism.

Movement and Pressure Injury Prevention Care for Nursing Home Residents: Addressing the Nescience.

To compare movement associated with position changes among nursing home residents who remain in lying versus upright positions for more than 2 hours and among residents living with obesity, dementia, or neither condition. The authors conducted a descriptive exploratory study using secondary data (N = 934) from the Turn Everyone And Move for Ulcer Prevention (TEAM-UP) clinical trial to examine transient movements (<60 seconds) within prolonged periods of 2 to 5 hours without repositioning. Nursing home residents exhibit significantly more episodic transient movements when upright than lying. Residents with obesity or dementia exhibited similar frequencies of episodic transient movements compared with residents with neither obesity nor dementia. Upright or lying movements were more frequent among residents with obesity than among those with neither obesity nor dementia selectively when prolonged events ranged from 2 to 4 hours. Pairwise comparisons of movement rates among resident subgroups (living with obesity, living with dementia, or neither group) across repositioning intervals showed episodic transient movements were significantly higher across all subgroups for repositioning intervals up to 3 hours when compared with repositioning intervals of greater than 3 hours. Findings challenge assumptions that nursing home residents are inactive and at risk for prolonged sitting. These preliminary findings, along with TEAM-UP findings where no pressure injuries occurred in up to 5 hours in prolonged positions, support establishing a standard 3-hour repositioning interval with use of high-density mattresses without a negative impact on pressure injury occurrence. There should be caution when considering repositioning intervals greater than 3 hours. Further research is indicated to explore protective effect of episodic transient movements of other subgroups.

Increasing measurement accuracy: Scaling effect on academic resilience instrument using Method of Successive Interval (MSI) and Method of Summated Rating Scale (MSRS)

A research instrument is crucial and must meet the requirements to be valid and reliable in content and construction. Not infrequently, various methods are tried to increase the accuracy of research instruments, one of them being a simple method such as the scaling technique. This research aims to improve measurement accuracy by using scaling techniques through the process of successive intervals and summated rating scale in confirmatory factor analysis of the Academic Resilience (ARS) instrument. This research is a descriptive exploratory study using a questionnaire consisting of five answer choices (5-point Likert scale) as the research instrument. Participants in this research were 300 students. Data analysis was conducted using Microsoft Excel and R programs. The research results showed that there was a significant difference in the results of the reliability and validity of the constructs as well as the parameters in the confirmatory factor analysis of the ARS instrument before and after transformation with the method of successive intervals and summated rating scale. This research contributes to implementing quantitative data scaling practices in measurement research, and it has been proven that there was an increase in measurement accuracy after scaling.

Production Arrangement of Cachaça: Comparative Study Between Morretes in the Paraná Coast and Luiz Alves in Itajaí Valley - Santa Catarina

Objective: The research sought to promote a characterization of the cachaça LPA in Morretes, Paraná in comparison to an LPA in another Brazilian region, whose production is similar and is classified as one of the most developed in Brazil. Theoretical Framework: Studies about Local Productive Arrangements have been relevant to proposals and regional development, so the basis of the research was inserted in the introductory phase. Method: Between May 2022 and February 2023, an exploratory descriptive study was carried out with leaders of two cachaça production arrangements located in the south of Brazil, one consolidated in Santa Catarina and the other one under development in Paraná. Results and Discussion: The results obtained revealed that despite the similar number of producers, the Morretes LPA has a production capacity equivalent to 35% of what is produced in the Luiz Alves LPA. The difference in productivity is not linked to factors such as proximity to the consumer market, distribution logistics, labor or even geoclimatic characteristics. The main factors limiting the easier development of LPAs were the degree of difficulty in regularizing production, the lack of technical assistance and the almost non-existence of public policies, with the Morretes LPA on the coast of Paraná being most impacted. It is concluded that the insertion of tourism associated with beverage consumption, investment in marketing actions and public policies that facilitate the regularization of informal producers can strengthen the Morretes LPA and promote its consolidation as an economic activity that generates regional development. Research Implications: The Morretes LPA has all the favorable and synergistic conditions for the development of the cachaça LPA, and in this context the offer of new services and products arising from production and trade activities can generate a set of entertainment offered as a new experience for tourists, in addition from visits to stills and the creation of parties and fairs with the drink theme. Originality/Value: Comparative studies between local productive arrangements are still little explored in scientific literature and may guide regional development in a more organized way.

Personal Health Record implementation in rural primary care: A descriptive exploratory study using RE-AIM framework.

Demand is emerging for personal health records (PHRs), a patient-centric digital tool for engaging in shared decision-making and healthcare data management. This study uses a RE-AIM framework to explore rural patients and providers' perceptions prior to and following implementation of a PHR. Health care providers and their patients were recruited from early-adopter patient medical home clinics and a local patient advisory group. Focus groups were used to explore patient and provider pre-implementation perceptions of PHRs and post-implementation provider perspectives. Patients were invited through participating clinics to use the PHR. An implementation process evaluation was conducted. Multiple methods and data sources were used and included pre-/post-intervention patient surveys, provider interviews, and PHR/EHR administrative data. Both patient and provider focus groups described PHRs as providing a comprehensive health story and enhanced communication. Patients prioritized collection of health promotion data while providers endorsed health-related, clinical data. Both groups expressed the need for managing expectations and setting boundaries on PHR use. The evaluation indicated Reach: 16% of targeted patients participated and an additional 127 patients used the PHR as a tool during the COVID-19 pandemic. Effectiveness: Patient satisfaction with use was neutral, with no significant changes to quality of life, self-efficacy, or patients' activation. Adoption: 44% of eligible clinics participated, primarily those operated publicly versus privately, in smaller communities, and farther from a regional hospital. Implementation: Despite system interoperability expectations, at time of roll out, information exchange standards had not been reached. Additional implementation complications arose from the onset of the pandemic. One clinic on-boarded additional patients resulting in a rapid spike in PHR use. Maintenance: All clinics discontinued PHR within the study period, citing several key barriers to use. RE-AIM offers a valuable process evaluation framework for a comprehensive depiction of impact, and how to drive future success. Interoperability, patient agency and control, and provider training and support are critical obstacles to overcome in PHR implementation.