Directed Content Analysis Research Articles

Abstract 4112589: Typology of Self-Care in Adults with Type 1 Diabetes and Impaired Awareness of Hypoglycemia

Introduction: Individuals with type 1 diabetes (T1D) complicated by impaired awareness of hypoglycemia (IAH) are at significantly increased risk for severe hypoglycemia: a marker of high risk of CVD. Tailoring interventions to promote hypoglycemia avoidance is difficult due to self-care heterogeneity among those with T1D. Aims: Map self-care heterogeneity among adults with T1D into behavioral phenotypes and identify common barriers to hypoglycemia avoidance within each phenotype. Methods: An explanatory sequential mixed methods study was performed in 200 adults with T1D. Participants reported personal, clinical, and social determinants of health, hypoglycemia awareness, and self-care of diabetes (Self-Care of Diabetes Inventory, scored 0-100, adequate ≥70) . Cluster analysis was performed to identify self-care clusters. Then, directed content analysis was applied to individual, semi-structured interviews performed in a subsample from each cluster with IAH ( n =20). Findings were integrated to develop a typology of self-care and identify barriers to hypoglycemia avoidance within each phenotype. Results: Three self-care phenotypes were identified. Experts ( n =70; mean age: 45±17 years; 24% Black; T1D duration: 25±16 years; HbA 1c : 7.36±1.67%; IAH: 20%) performed all aspects of self-care adequately (Maintenance: 84.9±8.8; Monitoring: 85.1±8.8; Management: 72.5±10). Yet, Experts with IAH reported purposefully delaying treatment of hypoglycemia due to lack of concern. Those with Inconsistent self-care ( n = 112; mean age 37±14 years; 20% Black: T1D duration: 21±13 years; HbA 1c : 7.26±1.16%; IAH: 30%) performed only self-care maintenance adequately (Maintenance: 78.6±8.9; Monitoring: 65.6±9.8; Management: 56.8±10.1). Those with Inconsistent self-care and IAH reported passive self-care monitoring that inhibited effective hypoglycemic management. Novices ( n = 18; mean age 27±7 years; 50% Black: T1D duration: 16±8 years; HbA 1c : 8.97±2.80%; IAH: 28%) reported difficulty performing all aspects of self-care (Maintenance: 51.9±7.7, Monitoring: 56.9±12.9, Management: 44.5±6.3) due to economic and psychosocial barriers. Conclusions: Self-care heterogeneity mapped onto three phenotypes that can be used to better understand patient barriers to hypoglycemia avoidance and hypoglycemia awareness restoration. This typology provides a framework for investigating how best to tailor IAH treatment considerate of self-care.

A Qualitative Assessment of South Africa's Central Chronic Medication Dispensing and Distribution Program for Differentiated Antiretroviral Therapy Delivery in Umlazi Township, South Africa: Client Perspectives after 12 Months of Participation.

South Africa's Central Chronic Medicine Dispensing and Distribution (CCMDD) program provides community-based medication delivery for clinically stable people with HIV (PWH) on antiretroviral therapy (ART). To evaluate CCMDD implementation, we conducted semi-structured interviews with 60 PWH enrolled in CCMDD for at least 12 months. In a directed content analysis based on the Practical, Robust Implementation and Sustainability Model (PRISM) implementation science framework, key themes were compared with qualitative data collected from PWH enrolling in CCMDD at an earlier time-point. Results indicated consistently positive views of CCMDD, primarily attributed to convenient and smooth medication pick-up. At the later (vs. earlier) time-point, participants discussed less clinic crowding, mentioned few medication errors, and noted improved communication around refills. Community HIV stigma was a persistent challenge, as was nurses' judgmental communication style. To ensure CCMDD's success, continued focus is needed on decreasing HIV stigma beyond the clinic context and improving provider-patient relationships.

‘Please, see me’; Informal and professional support of students with relatives with addiction problems: a three-year longitudinal qualitative study

Background and aimAddiction problems also affect the lives of family members. This study aims to examine: (1) young adult family members’ experiences with informal and professional support in coping with the impact of relatives’ addiction problems and (2) how these experiences evolve over time.MethodA three-year longitudinal qualitative study. Four rounds of in-depth, semi-structured individual interviews were conducted. Thirty students aged 18–30 years, participated in the study at baseline. 93% participated in at least two interviews, and 80% participated three or four times. The Stress-Strain-Information-Coping-Support model was used, and Directed Content Analysis was applied.FindingsFive major themes were extracted from the data: (1) Informal support; (2) Educational support; (3) Healthcare support; (4) Resilience factors; and (5) Developments over time. Informal and educational support were more often described as effective than healthcare support, although the number of participants who sought healthcare support increased over time. Effective elements of support included being able to discuss their experiences with people listening without judgment or unsolicited advice and having long-term relationships of trust with people from the social environment and professionals. Participants were mainly treated with Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR). Learning how to distinguish between accurate and inaccurate thoughts, especially about themselves, was considered effective. Body-oriented therapy was remarkably absent. Finding effective healthcare support was often a long and winding road through various therapies and therapists. Participants were not attracted to peer group interventions but needed advice on how to deal with their relatives. They also needed recognition by their relatives for harm done. This recognition was seldom given.ConclusionsIt is recommended to train educational and healthcare professionals to recognize the support needs of young people with relatives with addiction problems, to help them cope, or to refer them adequately. We also suggest broadening the scope of professional support offered to AFMs, including body-oriented and cultural interventions.

Beyond accreditation: unraveling the narrative of public health through a critical race praxis lens

IntroductionRecognizing and addressing health inequities among minority populations are pivotal to public health. Further, public health strives to understand the complexities between race and health without limiting discussions around race as a trivial variable. This commitment toward equity demonstrates considerable similarities to Critical Race Theory (CRT) which led to the creation of the Public Health Critical Race (PHCR) Praxis to instill CRT within public health. However, the literature on how public health education incorporates critical race studies remains limited. The goal of this study was to examine how public health curriculum currently aligns with the PHCR praxis and meets public health's goal of health equity.MethodsThis qualitative study employed document analysis to evaluate academic syllabi from CEPH-accredited MPH programs. Stratified random sampling was applied across two sampling pools, Schools of Public Health (SPH), and Public Health Programs (PHP). Course overviews, course objectives, course curricular information, and course policies were identified and extracted from each syllabus for analysis. A total of 53 syllabi were obtained from a final sample of nine public universities and one private.ResultsThrough inductive and directed content analysis, a priori themes of Structural Determinism, Voice, Critical Approaches, Ordinariness of Racism, Social Construction of Knowledge, Intersectionality, Disciplinary Self-Critique, Primacy of Racialization, Race as a Social Construct, Race Consciousness, and their respective categories arose as salient. Two new themes, Antiracism Practices and Culture of Inclusivity, were also present.DiscussionThis study is the first to explore public health education's current curricular practices concerning CRT and antiracist praxes. The results confirm the interwoven nature of public health education with critical race studies, as all principles of PHCR praxis were present. However, the prevalence of these principles varied, suggesting gaps in the alignment of public health curricula and CRT. It is essential that public health educators ensure that the foundational competencies students are expected to display align with public health's goal of health equity. This work can equip MPH programs and public health educators with the ability to revise or bolster their current curricular and instructional efforts to support the pursuit of health, racial equity, and social justice.

Factors Associated With Colorectal Cancer Screening Behaviors Among Urban Populations in China: A Mixed-Methods Study Using the Health Belief Model.

Adherence to guideline-recommended colorectal cancer screening (CRCS) among average-risk urban populations in China remains significantly suboptimal. This mixed-methods study aimed to investigate screening behaviors and associated factors among average-risk urban populations through a multi-center approach. From February to July 2024, 550 participants were recruited via stratified random sampling in Harbin, China. They completed questionnaires related to health beliefs and knowledge. Additionally, semi-structured interviews were conducted to explore CRCS behaviors, with data analyzed using directed content analysis based on the Health Belief Model (HBM). Five hundred twenty two participants (95.0%) completed the survey. Identified factors influencing screening behavior among average-risk urban populations included perceived severity of colorectal cancer (CRC), benefits of colon cancer surveillance, barriers to surveillance, and knowledge. Twenty-six individuals were engaged in qualitative interviews. Twenty-four themes were identified and categorized by frequency. Both quantitative and qualitative data suggest that CRCS behavior among urban average-risk populations is suboptimal, and the identified factors can be mapped onto the HBM. This mixed-methods study demonstrates that key factors influencing screening behavior among urban average-risk populations align with the HBM. These identified factors should be meticulously considered in future systematic interventions to enhance screening behaviors.

The intangible costs of living with low back pain from a patient perspective: a scoping review

Purpose Health-related low back pain costs can be direct monetary, indirect monetary, or intangible, non-monetary. The purpose of this review was to identify the intangible, non-monetary costs of low back pain from the perspective of the individual. Materials and methods A scoping review of literature was undertaken. Four databases were searched up to 6th August 2024. Data were charted and coded using deductively derived categories in line with our purpose; additional categories were developed for text that did not fit these categories. Data were analysed using directed content analysis. Results Forty-six studies met the inclusion criteria. Six categories were derived from the data, which express the experience of the person with low back pain: Perceptions of pain, Experience of healthcare, Becoming defined by low back pain, Life on hold, My social self, and Disrupted work life. Each category explored an aspect of life affected by low back pain. Conclusion This review highlights that low back pain profoundly affects many areas, with implications for peoples’ personal, social, and work lives. Our findings suggest that suffering can be reduced when healthcare practitioners show empathy and legitimise the lived experience of low back pain, acknowledging the restrictions it imposes on peoples’ lives.

Suicide attempt survivors’ recovery-related agency in the relational context of services: a qualitative analysis

BackgroundSuicidal persons’ contacts with services present a key opportunity for suicide prevention. However, interventions by services are not always effective. A deeper understanding of suicidal service users’ agency and its implications may facilitate the provision of meaningful responses to help-seeking during suicidal crises. This abductive study explores the recovery-related agency of suicide attempt survivors and the perceived role of interactions with services in facilitating or hindering it.MethodsFourteen Finnish suicide attempt survivors were interviewed in-depth on their experiences of interacting with services during a recent suicidal episode. An operationalization of recovery-related agency as the expressed ability to take (mental or physical) action in a direction perceived as aiding recovery from suicidality (i.e., the coupling of recovery-related intentionality and power) was used to explore transcribed interviews through directed content analysis. Data were further categorized based on whether the service context was perceived as helpful or unhelpful to recovery efforts.ResultsAll participants expressed both agency and non-agency in relation to their recovery process. The relational context provided by services was presented as highly relevant for the achievement and sustainability of recovery-related agency as well as for participants’ experience of safety in instances when agency was lacking. The results are presented as a typology of recovery-related agency in its perceived relational context, with the categories of sustained agency, strained agency, contained non-agency and uncontained non-agency.ConclusionsThe concept of agency helped capture important aspects of suicidal individuals’ recovery-related efforts and the role of services in facilitating or hindering them. The findings illuminate the value of viewing suicidal service users as agents of their own recovery process as well as the potential costs of ignoring this perspective in service delivery and design.

Contextual barriers to infection prevention and control program implementation in hospitals in Latin America: a mixed methods evaluation

BackgroundInfection prevention and control (IPC) programs are essential to prevent and control the spread of multidrug-resistant organisms in healthcare facilities (HCFs). The current implementation of these programs in Latin America remains largely unknown.MethodsWe conducted a mixed-methods evaluation of IPC program implementation in HCFs from Guatemala, Panama, Ecuador, and Argentina, March-July 2022. We used the World Health Organization (WHO) IPC Assessment Framework (IPCAF) survey, a previously validated structured questionnaire with an associated scoring system that evaluates the eight core components of IPC (IPC program; IPC guidelines; IPC education and training; healthcare-associated infection [HAI] surveillance; multimodal strategies; monitoring and audit of IPC practices and feedback; workload, staffing, and bed occupancy; and the built environment and materials and equipment for IPC). Each section generates a score 0–100. According to the final score, the HCF IPC program implementation is categorized into four levels: inadequate (0–200), basic (201–400), intermediate (401–600), or advanced (601–800). Additionally, we conducted semi-structured interviews among IPC personnel and microbiologists using the Systems Engineering Initiative for Patient Safety model to evaluate barriers and facilitators for IPC program implementation. We performed directed content analysis of interview transcripts to identify themes that focused on barriers and facilitators of IPC program implementation which are summarized descriptively.ResultsThirty-seven HCFs (15 for-profit and 22 non-profit) completed the IPCAF survey. The overall median score was 614 (IQR 569, 693) which corresponded to an “advanced” level of IPC implementation (32% [7/22] non-profit vs. 93% [14/15] for-profit HCFs in this category). The lowest scores were in workload, staffing and bed occupancy followed by IPC training and multimodal strategies. Forty individuals from 16 HCFs were interviewed. They perceived inadequate staffing and technical resources, limited leadership support, and cultural determinants as major barriers to effective IPC guideline implementation, while external accreditation and technical support from public health authorities were perceived as facilitators.ConclusionsEfforts to strengthen IPC activities in Latin American HCFs should focus on improving support from hospital leadership and public health authorities to ensure better resource allocation, promoting safety culture, and improving training in quality improvement.

Understanding the patient-spouse communication experience during chemotherapy for gastric cancer: A qualitative study

Purpose This study examines how patients with gastric cancer and their spouses communicate about the illness, assessing the impact of positive or negative communication on their psychological adaptation and the intimacy of their relationship as a couple. Method Employing The Relationship Intimacy Model of Couple Adaptation to Cancer, this study used purposive sampling with the principle of maximum variation to select participants. Sixteen pairs of patients with gastric cancer and their spouse caregivers, hospitalized in the oncology department of a tertiary hospital in Jingjiang City, Jiangsu Province, from March to July 2023, were chosen for semi-structured face-to-face interviews. The recorded data were transcribed within 24 h following each interview and supplemented with field notes. Directed content analysis was employed for the qualitative content analysis. Results The interview data revealed three themes and six subthemes. Theme 1: The impact of negative patient-spouse communication, with the subthemes being (i) a decline in couples’ relationship intimacy and (ii) reduced psychological adaptation. Theme 2: The impact of positive patient-spouse communication, with the subthemes being (i) enhanced couples’ relationship intimacy and (ii) increased psychological adaptation. Theme 3: The impact of protective concealment, with the subthemes being (i) declined couples’ relationship intimacy and psychological adaptation, and (ii) increased couples’ relationship intimacy and psychological adaptation. Throughout the chemotherapy period, patients with gastric cancer and their spouses experienced both positive and negative forms of patient-spouse communication. This underscores the significance of acknowledging protective concealment within couples. Moreover, the study highlights how the dynamics of couples’ relationship intimacy and psychological adaptation are influenced by both positive and negative communication patterns surrounding the illness. Conclusions For patients with gastric cancer and their spouses, it is crucial for nurses to emphasize the importance of spousal disease communication during chemotherapy. Efforts should be made to mitigate one-sided, conflictual communication and avoidance behaviors, and to adopt appropriate communication strategies in terms of content and timing to deeply promote couple communication. Additionally, there is a need to focus on the physical and psychological stress of protective concealment in couples.

Perceived risk of death among patients with advanced cancer: a qualitative directed content analysis

BackgroundRisk perception with respect to death is a prerequisite for patients with advanced cancer when the time comes to make medical decisions. However, the nature of death risk perception remains unclear.MethodIn-depth interviews were conducted with 28 patients with advanced cancer who were recruited from two hospitals and one home-based hospice in Fujian, China. Interviews were transcribed and directed content analysis applied. The Tripartite Model of Risk Perception was used as a theoretical framework.ResultsPatients with advanced cancer perceived their risk of death in different ways. Professional communication about death risk and data-driven risk perception were common in clinical settings. Affective influences, inherent cognition, and comparisons to others or oneself also contributed to the subjects’ self-perceived death risk.ConclusionThis theory-informed qualitative study clarifies the nature of the perceived risk of death among patients with advanced cancer. The study findings offer healthcare providers a more nuanced understanding of the perceived risk of death among patients with advanced cancer.

The many facets of perceived bladder health in women: Absence of symptoms and presence of healthy behaviors across the life course

Purpose:Qualitative studies exploring bladder health are rare compared to research focusing on lower urinary tract symptoms (LUTS). Our aim was to explore adolescent and adult women’s perceptions about what constitutes a healthy bladder. Methods:We conducted a 7-site focus group study of bladder health with adolescent and adult women across six age categories (11–14 to 65+ years). Transcripts were analyzed using transdisciplinary, directed content analysis and an iterative interpretive consensus building approach to identify key constructs, focusing on “healthy bladder” and “unhealthy bladder” codes. Results:Forty-four focus groups with 360 participants were completed. Three thematic categories were identified: (1) concept of a healthy bladder (conceptual abstraction); (2) experience of a healthy bladder (subjective experience); and (3) lifestyle and life course considerations (bladder health in context). Participants struggled to define the unfamiliar concept of healthy bladder and relied on contextualized experiences and behaviors for characterizing bladder health. They described the concept of a healthy bladder as something that you did not need to think about but did require attention to healthy habits to maintain. Other features of a healthy bladder discussed include having bladder control despite urgency and environmental constraints on voiding, normal voiding frequency, and qualities of urine and urination. Participants struggled with lack of information about healthy bladder habits and noted absence of routine bladder health screening. Discussion:Findings identify need to promote public education and information sharing in health care visits about bladder health. Further they can inform bladder health promotion and clinical research on LUTS prevention.

Diagnostic Safety: Needs Assessment and Informed Curriculum at an Academic Children's Hospital.

Diagnostic excellence is central to healthcare quality and safety. Prior literature identified a lack of psychological safety and time as barriers to diagnostic reasoning education. We performed a needs assessment to inform the development of diagnostic safety education. To evaluate existing educational programming and identify opportunities for content delivery, surveys were emailed to 155 interprofessional educational leaders and 627 clinicians at our hospital. Educational leaders and learners were invited to participate in focus groups to further explore beliefs, perceptions, and recommendations about diagnostic reasoning. The study team analyzed data using directed content analysis to identify themes. Of the 57 education leaders who responded to our survey, only 2 (5%) reported having formal training on diagnostic reasoning in their respective departments. The learner survey had a response rate of 47% (293/627). Learners expressed discomfort discussing diagnostic uncertainty and preferred case-based discussions and bedside learning as avenues for learning about the topic. Focus groups, including 7 educators and 16 learners, identified the following as necessary precursors to effective teaching about diagnostic safety: (1) faculty development, (2) institutional culture change, and (3) improved reporting of missed diagnoses. Participants preferred mandatory sessions integrated into existing educational programs. Our needs assessment identified a broad interest in education regarding medical diagnosis and potential barriers to implementation. Respondents highlighted the need to develop communication skills regarding diagnostic errors and uncertainty across professions and care areas. Study findings informed a pilot diagnostic reasoning curriculum for faculty and trainees.

Put at and kept from risk: The sexual risk dilemmas confronting marginalized youth.

The current study examines Bay-Cheng and Ginn's (2024) claim that marginalized youth confront two intertwined sexual risk dilemmas: being put at risk by unjust social forces and structures that threaten their sexual health and safety; and being kept from risk by those same forces and structures, thus compromising their development and dignity. We explored the presence and relevance of these dilemmas using interviews conducted in 2022 with 101 racialized and/or queer (i.e., a sexuality other than exclusively heterosexual) young women and trans or nonbinary youth aged 16-21 and living in Melbourne (Australia), New York City (United States), and Toronto (Canada). We conducted a directed content analysis of the data and examined intersectional group-based comparisons of code frequencies. We found that 80% of participants felt endangered (i.e., put at risk) and/or obstructed (i.e., kept from risk) by social and material conditions. Over half felt put at risk through exposure to hostility and harm, and over one-third of participants described precarious life circumstances as keeping them from taking wanted sexual risks. Group-based and intersectional comparisons indicated that feeling put at risk is associated with marginalized gender and sexuality identities and corresponding discrimination. We also found tentative signs that feeling kept from risk may be more closely linked to race and racism than marginalization by gender and/or sexuality. The findings highlight the diverse implications of interlocked social injustices for youths' sexual lives, particularly the infringement on their rights both to safety and to risk.

Development of a Work Systems Stress Questionnaire to predict Job Burnout: A mixed methods study based on a macroergonomics approach

Job burnout is a stress-related phenomenon that is a significant threat to the health and performance of organizations and employees. Interventions to ameliorate potentials for burnout have been limited by the lack of a comprehensive tool that considers work system stressors. Thus, the aim of this study was to develop a questionnaire for predicting job burnout based on the macroergonomics work system approach. The setting was a petrochemical company in South Iran. In the qualitative phase of this sequential exploratory mixed methods research, 971 meaning codes were extracted from fourteen one-to-one and seven focus group interviews (n=59). The codes were subject to Directed Content Analysis, which yielded three themes and 15 dimensions, which were used to inform the development of reliable and valid questionnaire. Items for each of the dimensions were sourced from exiting scales. To test the developed Work System Stress Questionnaire (WSSQ) in terms of its ability to predict burnout, a survey which included demographic items, the WSSQ, and the Maslach Burnout Inventory was completed by 359 employees. Hierarchical linear regression modelling of the data indicated that Task Significance, Job Demands, Work-Life Conflict, and Work Schedule predicted Emotional Exhaustion, and altogether explained 58% variance. Task Significance, Violence and Harassment, Work-Life Conflict, and Job Insecurity predicted the Depersonalization and explained 29% variance. Decision Latitude, Welfare and Financial Facilities, Task Significance, and Structural Problems predicted Personal Accomplishment and explained 26% variance. All 15 dimensions were valid (CVI range 0.73-0.90) and reliable (Cronbach’s alpha range 0.71- 0.93). The results confirm the ability of the WSSQ to explain more variance regarding job burnout than previous studies. In turn, the WSSQ will enable remedial actions to be put into place. It may also be useful for understanding the consequences associated with other organizational ergonomic variables that are related to job stress.

"Another tool for the sexual health toolkit": U.S. health care provider knowledge and attitudes about doxycycline post-exposure prophylaxis (doxy-PEP) to prevent bacterial sexually transmitted infections among men who have sex with men.

Doxycycline post-exposure prophylaxis (doxy-PEP) reduces chlamydia, gonorrhea, and syphilis infections among men who have sex with men (MSM) and transwomen (TW). Perspectives of health care providers (HCPs) regarding doxy-PEP can inform implementation efforts. From August 2022 to January 2023, HCPs were recruited from 13 cities with high sexually transmitted infection (STI) rates for semi-structured, in-depth interviews about their awareness of and attitudes towards doxy-PEP for STI prevention. HCPs were purposively sampled to include people with experience prescribing PrEP and provision of care to MSM. Interviews were conducted virtually via Zoom. Transcripts and debrief reports were analyzed using a directed content analysis approach to explore knowledge, attitudes, and beliefs about doxy-PEP. Among 30 HCPs, almost half (47%) were between 31-40 years of age, 53% identified as male, and 47% reported their sexual orientation as gay or queer. Half (53%) of participants practiced in the South, 43% had >100 MSM in their clinic panel, and 17% had previously prescribed doxy-PEP. We identified four overarching themes: 1) HCPs expressed positive attitudes towards doxy-PEP; 2) antimicrobial resistance concerns limit enthusiasm for some HCPs; 3) additional data about the long-term safety of doxy-PEP would improve their confidence; and 4) development of guidelines would facilitate the prescription of doxy-PEP, including eligibility, dosing instructions, and treatment management. HCPs were motivated to prescribe doxy-PEP with almost 20% already having prescribed it. Guidelines and data about long-term safety, especially antimicrobial resistance, would facilitate introduction of doxy-PEP into clinical practice.

Health policy analysis for stewardship of rehabilitation services

Background and aimThere have been a growing interest in investigating the effect of stewardship on other functions of rehabilitation service delivery. Effective stewardship of rehabilitation services can ensure that these services are of high quality, accessible, affordable, and sustainable, and can help achieve the goals of universal health coverage. The purpose of this study was to identify and analyze the policies adopted in the field of rehabilitation services in Iran and in the international arena, and finally to identify policy gaps, areas for improvement, and areas that have been overlooked.MethodThis research is a policy analysis, carried out through document analysis and Dalglish et al.’s READ approach. Data were analyzed and interpreted using qualitative methodology and directed content analysis. For this purpose, Veillard et al.‘s health system stewardship framework was used to analyze the stewardship of rehabilitation services. The dimensions of the stewardship framework, were: Defining the vision for health and strategies and policies to achieve better health; influencing all sectors and advocating for better health; ensuring good governance in line with prevailing values; ensuring the alignment of system design with health system goals; improving existing legal and regulatory instruments; and compiling, disseminating, and applying information. Scott’s four criteria were used to assess the authenticity, credibility, representativeness, and meaning of the documents. Those that did not meet even one of the Scott’s criteria were excluded from content analysis.FindingsA total of 16 documents were identified, all of which met Scott’s criteria and none were excluded from the study. A total of six themes and 56 subthemes were extracted. The contents of all the documents were extracted under six themes of Veillard et al.‘s health system stewardship framework. Overall, the results show that national documents place greater emphasis on the development of preventive healthcare and health promotion. Documents often focus on engaging NGOs and the families of people with disabilities and on intersectoral collaboration for knowledge production and the development of intersectoral knowledge networks. In terms of health system governance in line with prevailing values, documents are mainly focused on health system stewardship by the Ministry of Health and on evidence-based decision-making with the participation of target groups. Also, documents place more emphasis on upgrading the national infrastructure and increasing access to rehabilitation services.ConclusionIn some areas of rehabilitation services, there is a gap between national documents, which reflects differences in priorities, approaches, resources, and instruments available to strengthen rehabilitation services at the national and international levels.

In Search of Best Practices for Improving the Operational Efficiency of the Primary Healthcare Hospitals in Thailand through Benchmarking

Background: Thailand's public health policy emphasizes equitable access to healthcare services, leading to a rapid increase in primary healthcare demands. Enhancing efficiency has become a crucial solution to address this challenge, especially amidst the constraints of limited resources. Aims: To measure the operational efficiency of sub-district or tambon health-promoting hospitals (THPHs) in the Eastern Economic Corridor (EEC) by applying the mathematical technique of Data Envelopment Analysis (DEA) and to identify best practices from efficient THPHs that can be applied to improve the operational efficiency of other THPHs. Methods: First, the operational efficiency of 104 THPHs in Chachoengsao, a province in EEC, was measured using the DEA method. Second, 13 efficient THPHs were selected as benchmarks for operational best practices. In-depth interviews were conducted with five individuals from each selected THPH, including the director and four key stakeholders. The interview data were analyzed and synthesized using directed content analysis to formulate a list of best practices. Finally, the identified best practices were evaluated using the Delphi technique to produce a final list of best practices to improve the operational efficiency of THPHs. Results: 76 best practices were initially generated from the content analysis of the benchmark interviews. However, after the Delphi experts' evaluation, 66 best practices met the required criteria (Mdn > 3.50 and IQR < 1.50) and were ultimately accepted as potential general strategies for improving the efficiency of THPHs. Of these, 35 best practices were related to input management, and 31 were related to output management.

Exploring Stakeholder Perspectives on the Implementation of WHO iSupport for Dementia Program: A Qualitative Study.

To explore the stakeholders' perspectives and develop a conceptual framework for promotion strategies to implement the iSupport-based intervention for family caregivers of people with dementia. A descriptive qualitative design was adopted. Semi-structured interviews were conducted with 49 stakeholders of people with dementia from July to December 2023. The Consolidated Framework for Implementation Research was applied to guide the development of the interview guide, data collection and analysis. Directed content analysis was employed to identify facilitators and barriers, with data analysed based on the framework and the established its codebook. These findings were then summarised into a conceptual framework of critical components. The identified 16 barriers and 28 facilitators were distributed across all Consolidated Framework for Implementation Research domains. All facilitators and barriers were integrated into a conceptual framework guiding the implementation of iSupport. This four-tier, eight-component conceptual framework guides the global promotion of the web-based dementia care model, covering state, society, hospitals, individuals and strategies. The components included comprehensive and balanced national medical guidelines, a friendly social culture, adequate hospital collaboration, cooperative healthcare workers, responsible family caregivers, a comprehensive intervention system, appropriate learning content and digital health support. The 'iSupport for Dementia' program is seen positively for its potential to improve dementia care by providing mental and technical support to family caregivers. Successful implementation requires addressing barriers, enhancing facilitators and adapting to China's conditions and policies. Mobilising local healthcare resources and gaining stakeholder recognition is crucial. This approach may help develop a localised version of iSupport that suits the needs and habits of Chinese family caregivers, with the potential for broader dissemination. The 'iSupport for Dementia' program could greatly improve dementia care in China by addressing barriers and utilising facilitators. This study offers critical insights for future policy development and effective implementation strategies. Adherence to the COREQ guidelines for reporting qualitative research was maintained. No patient or public contribution.

Cancer Prevention in People Experiencing Mental Ill-Health: A co-designed Patient Navigation Concept

Abstract Introduction People experiencing mental ill-health have greater disparities in cancer specific morbidity and mortality. Factors influencing cancer prevention include increased risk behaviours and frequent encounters with barriers to health care utilization. The Patient Navigation Model (PNM) has been proven to reduce barriers in accessing cancer preventive care in vulnerable populations. To facilitate successful implementation, the conceptual features of the PNM were co-designed with patients and other relevant stakeholders. Methods Twelve focus groups were conducted in January 2024 at four pilot sites in Austria, Greece, Poland, and Spain. Iterative focus group discussions were carried out following key considerations for the PNM as outlined by DeGroff et al., audio recorded and transcribed verbatim. Transcripts were analysed deductively using a directed content analysis while allowing for potential inductive emergence of codes and topics. A total of 50 participants attended, representing five groups (individuals with mental ill-health, care givers, care team members, representatives of mental health organizations, and representatives of service managers). Results The co-design focus groups allowed for the PNM to be contextually adapted to each pilot site, but similarities in the approach emerged within the following four themes: 1) the requirement for a person-centred approach, 2) consideration of both person-specific and context-specific needs, 3) flexibility and competencies of navigators and 4) variation of navigation services (e.g., improving health literacy, promoting a healthy lifestyle, and providing practical support). Conclusions Participatory approaches in co-designing interventions allow for context specific development of interventions to meet the requirements of people with complex needs. Co-designing the PNM is part of activities of the CO-CAPTAIN project funded by the European Union’s Horizon Europe Programme (GA 101104784). Key messages • The Patient Navigation Model for Primary Cancer Prevention is a tailored intervention aiming to meet the needs of individuals experiencing mental ill-health. • The conceptual features of the Patient Navigation Model for Primary Cancer Prevention were co-designed with patients and other relevant stakeholders.

School teachers’ perceptions of intersectoral working with health in the COVID-19 pandemic

Abstract Background The COVID-19 pandemic highlighted the challenge for teachers to integrate protective health measures into their academic daily responsibilities. The aim of this abstract is to analyse how school teachers’ views on intersectoral collaboration with health professionals during COVID-19 vary by country, seeking insights for future directions. Methods In 2021, an online survey was conducted in 6 languages with education and health professionals, followed by optional online semi-structured interviews. We explored the: 1-effect of the pandemic on schools/pupils/teachers; 2-reorganisation of schools; 3-experience of implementing infection control measures in schools; 4-intersectoral working; 5-important resources for keeping schools open. Interviews were transcribed verbatim and translated into English. Analysis of a survey question seeking professionals’ rating of intersectoral working led to a directed content analysis of transcripts and free-text survey responses regarding intersectoral working experiences. Results Data were analysed from 1046 school teacher survey responses from 6 countries/territories and 21 follow-up interviews. Ratings varied considerably across countries. A large majority of teachers in Taipei (83%) reported excellent or good collaboration with health professionals, about half in China (53%) and Portugal (51%), and far fewer in Brazil (38%), Morocco (29%) and France (15%). Taipei respondents cited the key role of school nurses as a positive factor; others added clear national guidelines and local protocols. Negative ratings related to health professionals’ rare visits or absence. Conclusions The direct support of health professionals in schools was offered as explanation for teachers’ positive ratings of intersectoral working in the pandemic. Policy and practice varied geographically; thus, understanding contextual factors that influence the effectiveness of intersectoral working in schools is crucial to orient future public health strategies. Key messages • This highlights the importance of understanding contextual factors that influence the effectiveness of intersectoral working in implementing protective health measures in schools. • This suggests that policy support and the presence of dedicated health personnel within schools play a pivotal role in ensuring effective collaboration between the education and health sectors.