Development Of Support Services Research Articles

Parents' experiences of living with a child with cancer undergoing hematopoietic stem cell transplantation: a qualitative content analysis study.

Pediatric Hematopoietic Stem Cell Transplant (HSCT) profoundly impacts the physical, psychological, and social aspects of parents' lives. Thus, this study aimed to explore the experiences of parents living with a child with cancer who undergoes HSCT. This qualitative study involved 20 parents of children with cancer who were undergoing HSCT at a referral hospital in Iran. Purposive sampling was used to select the participants from February 2023 to November 2023. In-depth semi-structured interviews, featuring open-ended questions, were utilized for data collection. Data analysis was performed using conventional content analysis. Data analysis revealed two main themes. "Surrounded by hardships" and "Self-actualization." The first theme encompassed participants' experiences of facing difficulties in life after being aware of their child's need for HSCT. This theme consisted of four categories: "uncertainty about the child's future," "exhaustion from the child's treatment process," "worrying about the healthy child(ren)," and "helplessness." The second theme "self-actualization" included with two categories: "transformation in life's philosophy" and "acquisition of new capabilities." These categories highlighted the positive outcomes experienced by the participants following their child's HSCT. Our findings underscore the importance of healthcare providers being attuned to parents' experiences throughout their child's HSCT trajectory. It is crucial for healthcare providers to encourage parents to articulate their concerns and feelings and seek support from healthcare providers, family, and friends. The development of psychological support services in healthcare settings can facilitate tailored interventions to alleviate parents' difficulties.

Development and spatial characteristics of housing support services for individuals with psychiatric disabilities in South Korea

ABSTRACT This study aims to explore the evolution of mental health housing policies and spatial characteristics for individuals with Psychiatric Disabilities (IWPDs) in South Korea. This study utilised qualitative methods, including literature review and case analysis, to investigate changes of housing policies and spatial characteristics of residential facilities and independent housing for IWPDs in South Korea. The findings indicate that current housing services limit privacy, autonomy for IWPDs and have regional differences in resource allocation. Based on the circumstance of less radical deinstitutionalisation, the Korean mental health housing policy needs a gradual approach addressing regional disparities and enhancing the residential conditions.

사회복지종사자의 안전을 위한 보호체계 구축사업의 성과 및 발전방안 연구

The purpose of this study is to evaluate the achievements of the “Establishment of a Protective System for the Safety of Social Welfare Practitioners” project, which has been supported by the Community Chest of Korea from 2019 to 2022, and to propose future development strategies for the project. To do this, a mixed research method was employed. Quantitative research utilized data from 1,235 individuals recorded in the performance management records of the project. Data analysis was conducted using SPSS 29.0, including descriptive statistics and cross-tabulation. Changes in pre-post traumatic growth among social welfare practitioners were analyzed through paired-sample t-tests. Qualitative research involved conducting focus group interviews (FGIs) with 9 project managers to analyze difficulties encountered during project implementation, problem-solving efforts for project execution, project outcomes, and strategies for project sustainability. Data collected through FGIs were analyzed using thematic analysis and N-vivo 9. The results of the quantitative study are as follows: First, among the types of job-related trauma, the proportion of subjects who experienced job-related violence was the highest at 53.2%, followed by 19.8% for other types, 18.5% for vicarious trauma, and 8.6% for loss (death experience). Second, cross-analysis results showed statistically significant differences in gender, age, type of affiliated institution, and type of job-related trauma. Third, as a result of providing various recovery support to social workers who have experienced occupational trauma, positive changes in “post-traumatic growth” were observed when measuring pre- and post-traumatic growth. This change was statistically significant. The qualitative analysis results are as follows : First, there was an improvement in awareness and consciousness among social workers regarding safety and human rights, which had previously not received much attention. There was an increased sense of personal, organizational, and societal responsibility for problem-solving. Second, the framework of protection and safety systems has been established, including the enactment and revision of related regulations and the creation of a safe physical environment in social welfare agencies. Third, the recovery and capacity of social workers have been strengthened. As a development strategy to ensure the sustainability of this project, several tasks have been identified. These include the development of various recovery support services, such as the establishment of safety education and coping training programs, providing continuous education on safety and human rights for social welfare practitioners, fostering relevant professionals, adapting to changes in organizational and community environments, and establishing relevant legal and institutional foundations.

Perception, attitude and stigma of community pharmacists toward patients with mental disorders: a cross-sectional study

One of the potential barriers to providing pharmaceutical care services to patients with mental disorders is stigma. Therefore, this study aims to explore the perception, attitude and stigma of community pharmacists toward patients with mental disorders in Indonesia. A self-report questionnaire was used including a convenience sample of 1,878 Indonesian community pharmacists from January to March 2023. The regression analyses showed that the perception in confidence level was significantly affected by age (95% CL :0.468-0.851; p-value:0.003) and work experience (95% CL: 1.205-2.284; p-value :0.002). Furthermore, age also affected the attitude of the community pharmacists towards patients with mental disorders (95% CL: 0.705-0.985; p-value: 0.033). Gender and a history of mental illness in a family member or a close friend contributed significantly to social distance (95% CL: 0.584-0.937; p-value: 0.013 and 95% CL: 1.212-1.779; p-value: <0.001, respectively). However, the self-disclosure of pharmacists about mental disorders remained unfavourable. In conclusion, this study found that majority of respondents had good perception and a low level of stigma towards patients with mental disorders. Based on the results, the continuous promotion of mental health awareness and education is recommended. In addition, sharing the personal experiences of individuals with mental disorders is essential for reducing self-stigma. Further studies are required to support service development in this field.

Lessons learnt from developing support services for systematic and scoping reviews in a regional university library

At Federation University Australia, the number of queries received by the library about conducting scoping and systematic reviews from academics and Higher Degree by Research students has increased. In response, Liaison Librarians developed an online subject guide and ran a series of webinars. The webinars were then adapted to a series of longer workshops with more hands-on activities. Currently, an online open textbook with interactive elements is being written to allow people to work through content at their own pace. A further series of activity based digital workshops in an online flipped classroom model is being planned, along with other initiatives such as a Community of Practice. To be successful, this project required librarians to develop their own digital skills and knowledge, as well as the participants’. The digital content and workshops have increased equity for participants as they can access it no matter their location or other commitments. Cross-campus collaboration has increased and the library is continuing to evolve and adapt to meet the needs of academics and students.

Abstract A033: Use of a novel healthtech platform to record patient-reported needs in real time

Abstract Background: Financial toxicity refers to the challenges that a patient faces due to the high costs of medical care. BIPOC (Black, Indigenous, and People of Color), rural, and other vulnerable populations often bear a disproportionate burden when diagnosed with a chronic disease. As a result, these populations often experience financial toxicity at higher rates. The estimated annual costs of health disparities in the U.S. are $1.24 trillion. Financial toxicity and logistical barriers that affect daily life, such as transportation, family care, rent, and home maintenance, can negatively affect a patient’s life. Many clinical trial sponsors and patient advocacy groups focus on providing support to patients around these barriers, but services are often generalized and provided in a ‘one-size-fits-all’ format, which may not be beneficial on an individual level for each patient. In 2023, together with health IT provider The WiTT Group, Tigerlily launched the innovative web-based Resources and AssIstance for Support and Empowerment (RAISE) platform, which brings together the best of wedding registry, crowdsourcing, and digital payment concepts and tools to match patients with the non-clinical services they need in real time as they go through treatment. With RAISE, Tigerlily empowers Black women with breast cancer to specify needs in their registry in real time, delineated by the time and urgency of each need. Our research question is, “What is the relationship between patient informed financial and non- financial stressors and patient's geographical location, age, cancer sub type and staging?"  Methods: Tigerlily captured the “voice of the patient” using user-generated profiles and patient-identified needs on the RAISE platform. Patient-submitted data during the months of May through July 2023 was analyzed. Results: Patients (n=60) documented current financial and non-financial stressors and challenges, as well as other impacted areas of their daily life. Preliminary results indicate that financial costs associated with groceries, insurance copays, and out-of-pocket medication costs were the most requested needs. Additionally, patients reported rent/mortgage, groceries, and childcare as the most financially necessary needs. Conclusions: RAISE allows breast cancer patients from BIPOC, rural, and other vulnerable populations to specify their needs on an individual basis. The most urgent and frequent patient-reported needs were. This approach will be used to inform community-based organizations, advocacy partners, and healthcare providers about patient-reported needs in their communities in order to guide the development of support programs and services. Future research will compare the impact of meeting patient-reported needs on outcomes such as quality of life and the impact of patient-identified stressors. Citation Format: Katherine Cornish, Mary Stober Murray, Maimah Karmo, Jeanne Regnante, Virginia Leach. Use of a novel healthtech platform to record patient-reported needs in real time [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A033.

Existential distress among family caregivers of patients with advanced cancer: A systematic review and meta-analysis.

Caregiving for a loved one is challenging and requires significant resources. Existential distress in family caregivers may include hopelessness, demoralization, fear of death, pre-loss grief, or a sense of not being emotionally prepared. The aim of this systematic review is to synthesize the quantitative literature on existential distress among family caregivers of patients with advanced cancer, focusing on its prevalence, association with mental disorders, as well as with sociodemographic, disease, and treatment-related factors. We systematically searched electronic databases for quantitative studies of the above-described existential distress concepts in family caregivers of patients with advanced cancer. Two independent reviewers extracted data and evaluated study quality. Data were analyzed using random-effects meta-analysis. We retrieved 17.587 records, of which 31 studies fulfilled inclusion criteria. 63% of the studies (n=20) provided sufficient data for meta-analysis for 5558 patients. We found an overall pooled prevalence of 30.6% for existential distress, 95% CI [24.2-37.0]. For existential distress subconcepts, prevalence rates were 57.0%, 95% CI [37.8-76.2], for death anxiety, 13.9%, 95% CI [10.8-17.0], for demoralization, 24.0%, 95% CI [18.0-30.0], for pre-loss grief, 18.4%, 95% CI [4.0-32.7], for hopelessness, 35.2%, 95% CI [28.2-42.2], for loneliness, and 35.6%, 95% CI [13.0-58.3], for emotional unpreparedness. Approximately one third of the respondents were affected by high levels of existential distress. The review provides evidence for further development of support services that can reduce existential distress, focused on death anxiety, and improve the quality of life for family caregivers of patients with advanced cancer.

A Psychosocial Intervention for Carers of Individuals Diagnosed with Dementia in Social Isolation

Introduction: Growing research has shown the negative impact of social isolation on the health and psychological well-being of individuals with dementia and their carers. This study investigated the effectiveness of a psychosocial intervention for dementia carers during a lockdown period of the COVID-19 pandemic. Methods: Twenty-three family carers of individuals diagnosed with dementia living in the community were recruited and provided with an online psychoeducation toolkit that aims to improve health literacy, management of social and behavioural symptoms in dementia, carer social engagement, and coping skills. Carers were divided into “mild” or “moderate” groups based on the disease severity of the person with dementia they cared for. Outcome measures including distress and severity of neuropsychiatric symptoms, carer self-efficacy and burden, social network, and feelings of loneliness were assessed at baseline and 2 weeks later. Results: Carers in the moderate group reported higher levels of distress (p = 0.001) and severity (p < 0.001) of neuropsychiatric symptoms and greater carer burden (p = 0.003) than carers in the mild group. Following the intervention, both groups reported increased social networks (p = 0.001). In addition, carers in the moderate group reported significantly reduced distress for neuropsychiatric symptoms (p = 0.013), enhanced carer self-efficacy for controlling upsetting thoughts (p = 0.040), and decreased loneliness (p = 0.023). Conclusions: This study demonstrated that psychosocial interventions improve outcomes for carers of individuals with dementia, particularly those caring for individuals with greater disease severity. Findings from this study will inform the development of support services that meet the evolving needs of individuals with dementia and their carers in social isolation, during and in a post-pandemic context.

Diabetes mellitus in privately insured autistic adults in the United States.

Diabetes is a chronic health condition that is challenging to manage. Estimates of how common diabetes is among non-autistic adults are available, but improved estimates for autistic adults are needed. The purpose of this study was to obtain improved diabetes estimates for autistic adults. We analyzed a large private health insurance claims database to estimate how common diabetes was among autistic adults, and how likely autistic adults were to have diabetes compared to non-autistic adults at 5-year age intervals throughout adulthood (e.g. 18-22, 23-27). We found that diabetes was more common among autistic adults than non-autistic adults and that autistic adults were significantly more likely than non-autistic adults to have diabetes throughout most of adulthood. Our findings suggest that autistic adults may be more likely than non-autistic adults to experience diabetes in adulthood. The development of diabetes support services and programs that accommodate autistic adults' individual needs are important for future study to promote positive diabetes outcomes for autistic adults.

Sustainability practices and challenges in the meat supply chain: a systematic literature review

PurposeThis study comprehensively depicts the state of the art on sustainability research in the meat supply chain to advance the debate on challenges and issues associated with developing sustainable supply chain management practices.Design/methodology/approachThe authors conducted a systematic literature review of 333 articles published in peer-reviewed journals and organized the extant literature into five areas of supply chain management practices: strategic orientation, continuity, collaboration, risk management, and proactivity.FindingsSince 2016, the meat supply chain has received increasing scholarly attention. The literature shows the diffusion of highly heterogeneous sustainability practices related to multiple management areas and levels of analysis (institutional, industry, firm). The need for integrated, multilevel initiatives involving different stakeholders becomes increasingly crucial to the transition towards more sustainable meat supply chains.Practical implicationsThis study highlights the importance of regulatory and stakeholder pressures in the sustainability transition. Beyond setting regulatory requirements, policymakers may facilitate the establishment of collaborations within the meat supply chain and foster the development of support services that help firms to integrate sustainability in their business models. The review also alerts entrepreneurs and managers to the benefits from cooperating with their supply chain partners to navigate the industry transition and thus more effectively respond to the demands of stakeholders and to the increasing customers’ awareness of sustainability issues.Originality/valueThis study is the first to systematize the corpus of knowledge on the sustainability of the meat supply chain by adopting a comprehensive approach to analyze relevant management and agriculture literature.

Towards an ecology of athletes’ career transitions: conceptualization and working models

ABSTRACT In the present paper, we introduce an ecological view of career transitions. We consider an athlete’s development as a journey through various athletic and non-athletic environments that support their striving for career excellence. On this journey, an athlete experiences a multitude of environments and transitions from one environment (e.g., one club, one country or one sport) to another. To develop this understanding, we introduce the concept of a transition environment defined as a dynamic and temporary system that bridges the setting that an athlete is transitioning from and to. We also suggest two working models that in unison can work as a roadmap for transition environment research and practice. The transition environment (TE) model helps to describe the TE and the transition environment success factor (TE-SF) model helps to understand why certain TEs are more successful than others supporting athletes in transition. The models can be used by researchers studying specific transition environments to understand how such environments facilitate or hinder transitions, and by practitioners (coaches, managers, sport psychologists) to support athletes’ transitions by improving their TEs. We hope the idea of an ecology of athlete transitions will find its way into empirical studies of different types of transitions (e.g., to another sport, to another level in sport, to another club or to another country) in multiple cultural contexts and contribute to the development of career-long psychological support services.

Factors impacting positive and negative participation of young people with cerebral palsy: a Delphi study of consumers and health professionals

Purpose To identify specific factors influencing the participation experiences of young people with cerebral palsy (CP) aged 15 to 26 years. Materials and methods A three-round Delphi survey study design was used. Consumers (young people with CP and caregivers) and health professionals were asked to generate and then rate items influencing positive and negative participation experiences. Qualitative content analysis and descriptive statistics were used to classify items across the family of Participation-Related Constructs (fPRC) framework. Results Sixty-eight participants completed Round I (25 consumers, 43 health professionals). Round II resulted in a consensus for all but two items, with Round III not required. The fPRC construct with the most items rated as extremely important for positive participation experiences was Environment–Availability, and for negative participation, experiences were Environment-Acceptability for both adolescents and young adults. Conclusions A consensus was reached on the most important items influencing the positive and negative participation experiences of young people with CP. These items should be prioritised when developing support services and allocating funding to improve the participation experiences of young people with CP.

Prevalence of mental disorders, psychosocial distress, and perceived need for psychosocial support in cancer patients and their relatives stratified by biopsychosocial factors: rationale, study design, and methods of a prospective multi-center observational cohort study (LUPE study).

Despite remarkable progress, cancer remains a life-threatening disease for millions of people worldwide, also resulting in significant psychosocial limitations. High-quality, comprehensive cancer care requires patient and family involvement and the provision of needs-based, targeted psychosocial services. Although progress has been made in understanding the occurrence of mental comorbidity and psychosocial distress in cancer patients, comparatively little is known about the course of psychological comorbidity and psychosocial distress in early survivorship among patients and their families. We therefore aim to estimate the prevalence of mental disorders according to the DSM-5, psychosocial distress, perceived needs for psychosocial support and utilization of psychosocial support offers in newly diagnosed cancer patients and their relatives, taking into account potential contributing biopsychosocial factors for the occurrence of psychological comorbidity. This study follows a prospective multi-center observational cohort design across four measurement time points: within 2 months after cancer diagnosis (t1), and in the follow-up period at 6 months (t2), at 12 months (t3), and at 18 months (t4) after t1. Patients older than 18 years who have a confirmed initial diagnosis of a malignant solid tumor and are scheduled for cancer treatment at one of the participating cancer centers are eligible for study participation. Relatives of eligible patients are also eligible for study participation if they are older than 18 years. Patients are interviewed using the Structured Clinical Interview for DSM-5 Disorders (SCID-5-CV). In addition, patients and relatives receive a set of validated questionnaires at each measurement time point, covering comorbid conditions and functional performance, perceived psychological distress and quality of life, partnership aspects and social relationships, supportive care needs and use of psychosocial support services, health literacy, and health behavior and meaning in life. This prospective multi-center observational cohort study has a major focus on increasing quality of care and quality of life in cancer survivors through providing rigorous longitudinal data for the development and implementation of target group-specific psychosocial support services. NCT04620564, date of registration 9/11/2020; DKG OnkoZert: Registrier-No.: ST-U134, date of registration 5/11/2021.

Understanding the Experiences of Post-Diagnostic Dementia Support for South Asians Living In England: The Need for Co-Production

Background: The increase in the numbers of South Asians in the United Kingdom (UK) is likely to lead to an increased need for dementia services yet; they are currently under-represented in dementia services. Furthermore, little is known about the prevalence, experience and treatment of dementia in the UK South Asian population, including their experiences of post-diagnostic support. Consequently, a project was commissioned by Alzheimer’s Society in the UK to gather insight into the experiences of post-diagnostic dementia support for the South Asian community in England to identify whether their post-diagnostic support needs were being met and what they needed from post-diagnostic support services. Methodology/Methods: As this project sought to understand experiences, a qualitative case-study approach was adopted. Twelve South Asian carers of a person with dementia and one South Asian person living with dementia took part in an on-line in-depth, topic-guided conversation. All conversations were audio recorded with consent and analysed using a thematic analysis. Findings: Analysis revealed that the South Asian community are doubly affected by dementia in relation to post-diagnostic support because 1) they received very little post-diagnostic support and 2) even when they did, it wasn’t culturally appropriate and therefore ineffective. Essentially, the lack of culturally inclusive care compounds the lack of access further. Consequently, people discussed current gaps in service provision, making recommendations that will result in better support, and more positive experiences for South Asians when diagnosed with dementia in England. In order to achieve this, South Asians in need of dementia support should be involved in the planning, development and delivery of post-diagnostic support services. Conclusions: This paper discusses findings that highlight the importance and benefits of co-production whereby people who use services and carers work with professionals in equal partnerships towards shared goals.

Quality medical data management within an open AI architecture – cancer patients case

In contemporary society people constantly are facing situations that influence appearance of serious diseases. For the development of intelligent decision support systems and services in medical and health domains, it is necessary to collect huge amount of patients’ complex data. Patient’s multimodal data must be properly prepared for intelligent processing and obtained results should be presented in a friendly way to the physicians/caregivers to recommend tailored actions that will improve patients’ quality of life. Advanced artificial intelligence approaches like machine/deep learning, federated learning, explainable artificial intelligence open new paths for more quality use of medical and health data in future. In this paper, we will focus on presentation of a part of a novel Open AI Architecture for cancer patients that is devoted to intelligent medical data management. Essential activities are data collection, proper design and preparation of data to be used for training machine learning predictive models. Another key aspect is oriented towards intelligent interpretation and visualisation of results about patient’s quality of life obtained from machine learning models. The Architecture has been developed as a part of complex project in which 15 institutions from 8 European countries have been participated.

Factors affecting health-related quality of life among firefighters during the COVID-19 pandemic: A single-center study.

During the coronavirus disease 2019 (COVID-19) outbreak, firefighters have been working in an environment that is both physically and mentally taxing. This study aimed to investigate factors affecting health-related quality of life (HRQOL) among firefighters in Japan during the COVID-19 pandemic. A total of 227 firefighters from a single firefighting organization were surveyed in June 2021, during the fourth infection spread period of COVID-19 in Japan. Regression analysis was performed to examine factors affecting HRQOL of firefighters measured with the SF-8. In the present study, factors affecting HRQOL among firefighters during the COVID-19 pandemic were lack of sleep, physical abnormalities due to infection control measures, exercise habits, living with family members, and history of suspected COVID-19 infection. The present findings may help develop support services for first responders, including firefighters during the COVID-19 pandemic.

Parental Perceptions of Family-Centred Supports for Children with Developmental Disabilities.

Family-centred interventions have long been advocated in paediatric practice and in public health, but their implementation is rarer with children experiencing developmental disabilities. Moreover, the uptake is lower in families from more socially deprived backgrounds. Yet there is robust evidence that such interventions bring benefits to the family caregivers as well as to the affected children. The present study emerged from a support service that had been located in a rural county in Ireland in which nearly 100 families of children with intellectual and developmental disabilities had participated. Using a qualitative research methodology, interviews were conducted with 16 parents who had taken part in the service with the aim of gaining insights into the ways a family-centred service had been of value to them. The themes identified in their responses were validated in two ways. All parents were given the opportunity to provide their perceptions using a self-completion questionnaire, and nearly 50% responded. In addition, seven health and social care staff who had referred families to the project were asked their views through personal interviews. The core theme to emerge was the focus placed on family engagement by the service, with four subthemes emerging: parental confidence boosted; children developed; community connections were made; and supportive staff. These insights should help existing health and social care services to become more family-centred and inform the development of new support services in response to the high levels of unmet needs among marginalized families in even the most affluent countries.

Use of participatory action research to support Syrian refugee mothers in the resettlement period in Canada: A longitudinal study.

Research has shown that refugees in a foreign country often experience physical and mental health challenges upon resettlement (Ahmad et al., 2021; Salam et al., 2022). In Canada, refugee women experience a range of physical and mental barriers, including poor access to interpreter services and transportation, and a lack of accessible childcare, all of which can negatively affect their successful integration (Stirling Cameron et al., 2022). Social factors that support Syrian refugees to settle successfully in Canada have been unexplored systematically. This study examines these factors from the perspectives of Syrian refugee mothers living in the province of British Columbia (BC). Framed by principles of intersectionality and community-based participatory action research (PAR), the study draws on Syrian mothers' perspectives of social support in early, middle, and later phases of resettlement. A qualitative longitudinal design consisting of a sociodemographic survey, personal diaries, and in-depth interviews was used to gather information. Descriptive data were coded, and theme categories were assigned. Six themes emerged from data analysis: (1) Steps in the Migration Journey; (2) Pathways to Integrated Care; (3) Social Determinants of Refugee Health; (4) COVID-19 Pandemic Impacts and Ongoing Resettlement; (5) Strength-Based Capabilities of Syrian mothers; (6) Peer Research Assistant's Research (PRAs) Experience. Results from themes 5 and 6 are published separately. Data obtained in this study contribute to the development of support services that are culturally appropriate and accessible to refugee women living in BC. Our objectives are to promote the mental health and improve the quality of life of this female population, and to enable it to access healthcare services and resources in a timely manner.

Supporting engagement and retention of online and blended-learning students: A qualitative study from an Australian University.

Enrolment numbers in online higher education courses have continued to increase over the last decade. The challenges brought about by the COVID-19 pandemic have further accelerated the growth in online and blended course offerings. The development of institutional support services, however, does not reflect this growth. Many students are not equipped with the skills or given adequate support to engage and succeed in their courses, leading to student disengagement and attrition. This study investigated the perceptions of students in online and blended subjects, regarding both the academic and institutional support they were provided. The research team collected interview data from 41 online and blended-learning students and then analysed these data using an iterative thematic analysis approach. This article introduces the key findings with two models: one presenting support strategies at multiple levels within this university; the other presenting three key elements of subject-level teacher support, which were identified by the interviewees as the most significant, effective, and relevant support mechanism in this context. The findings will inform higher education institutions who aim to engage and support online and blended students better, through an improved understanding of how support is perceived by this student cohort. This study was conducted at one Australian university; however, the findings are relevant to higher education institutions in other countries that strive to bring about positive experiences and enhance retention rates for online and blended students.

PrEP uptake and persistence amongst HIV-negative women who exchange sex for money or commodities in Kampala, Uganda: A qualitative inquiry assessing the influence of pregnancy.

Pregnant young women who exchange sex for money or commodities are at elevated biological and social risk for HIV acquisition. PrEP serves as an effective means of HIV prevention, including during pregnancy. This study aimed to explore attitudes, experiences and challenges with PrEP to understand what motivates or limits PrEP uptake and adherence specifically during pregnancy among this population of young women. Semi-structured interviews were conducted with 23 participants, recruited from the Prevention on PrEP (POPPi) study in the Good Health for Women Project clinic in Kampala, Uganda. POPPi's inclusion criteria comprised of HIV-uninfected women, aged 15-24, who exchange sex for money or commodities. Interviews focused on experience with PrEP and pregnancy. Data were analyzed utilizing a framework analysis approach. Key themes were comprised of participant barriers to and facilitators of PrEP uptake and adherence. Reasons for PrEP initiation included desire for autonomy and agency, mistrust of partners, and social support. Participants expressed challenges with initiating or sustaining their use of PrEP, including pregnancy, PrEP access and perceived or felt stigma. During pregnancy, participants' primary motivators for altering PrEP use were either understanding of PrEP safety for their baby or changes in perceptions of their HIV risk. Many of these factors were similar across participants who had experience with pregnancy and those who did not. This study highlights the importance of addressing barriers to and facilitators of PrEP uptake and persistence, especially during pregnancy where risk is elevated, with a multi-level approach. Community-oriented education, stigma reduction activities alongside access to PrEP, can serve as means for adherence. The development of robust PrEP support services and guidelines regarding PrEP use during pregnancy among high-risk women, and strategies for their implementation, are of utmost importance for the control of HIV in key populations and the elimination of mother-to-child transmission of HIV.