Directed Content Analysis Research Articles

Barriers, Facilitators, and Preferences for Mental Health Services Among Patients With Systemic Lupus Erythematosus: A Qualitative Study.

Although patients with systemic lupus erythematosus (SLE) experience high levels of depression and anxiety disorders, evidence concerning patient perceptions of facilitators and barriers to effective uptake of mental health services (eg, referral to therapists and psychiatrists, psychoeducational interventions, or support groups) is limited. We conducted semistructured qualitative interviews with 15 adults with SLE to explore patient experiences and perceptions of mental health services to identify facilitators and barriers to accessing mental health care among patients with SLE. Qualitative interviews were conducted via telephone and audio recorded for transcription and directed content analysis using NVivo software by two coders. The median age of the 15 participants was 48 years, 87% were female, 33% identified as Black or African American, and 33% identified as Hispanic or Latino. Qualitative themes were organized into three domains: barriers, facilitators, and preferences for mental health services. Barriers to the use of mental health services include mental health stigma, sociodemographic factors, lack of autonomy, and time commitment. Facilitators to the use of mental health services included strong relationships with their rheumatologists and mental health care clinician experience with patients with SLE. Preferences for mental health services included education-based formats, mental health providers who work with patients with SLE, peer group formats, demographically and disease-matched psychological resources, and an emphasis on non-disease-related activities. In the setting of persistent unmet psychosocial needs of patients living with SLE, data from this qualitative study will inform the development and refinement of mental health interventions that bolster psychological wellbeing in the SLE population.

88 Feasibility of a Home-based Physiotherapy Program to Increase Physical Activity Levels in Older Adults with Diabetes Mellitus

OBJECTIVES/GOALS: The objective of this study is to assess the feasibility and preliminary impact of a physiotherapy protocol for developing an individualized home-based physical activity program to increase physical activity (PA) levels in sedentary older adults with Type II Diabetes Mellitus (T2DM) living in Puerto Rico (PR). METHODS/STUDY POPULATION: This will be a pilot study with two phases. In phase 1, we will design a novel patient-centered home-based PA program protocol for adults ≥65 years with T2DM based on the Information-Motivation-Behavioral Skills model. Its content validity will be assessed through focus groups with 10 experts and 10 older adults and analyzed using a directed content analysis. Phase 2 we will be program implementation using a one-group, repeated measures design with 12 adults ≥65 years with T2DM. PA levels will be assessed by recording active minutes with a Fitbit. Risk of falls, balance, strength, and physical function will be assessed through standardized tests validated for this population. Statistical analysis will include descriptive statistics, comparisons via chi-square/Fisher’s exact test, and non-parametric tests. RESULTS/ANTICIPATED RESULTS: We expect to recruit a minimum of 12 participants and to administer the program for 12 weeks at a frequency of two visits per week. We anticipate that implementing and supervising the home-based PA protocol will be feasible as determined by recruitment and retention rates, patients’ satisfaction, and compliance with the program. We also expect that this protocol will increase physical activity levels, improve general strength, balance, physical function, and reduce the risk of falls in sedentary older adults with T2DM. DISCUSSION/SIGNIFICANCE: As the third cause of death in PR, T2DM represents a public health challenge. An effective home-based PA program may decrease morbidity and mortality rates in older adults by increasing PA and functional health. This study will provide data for planning a randomized controlled trial to assess its effectiveness in the outcomes of interest.

Private practice dietetics workforce: A review of the literature

Private practice is the fastest growing employment sector for dietitians in Australia, including for new graduates(1). There is an anecdotal concern that current graduate cohorts are not adequately prepared for private practice. The present study aims to assess the existing literature relevant to workforce development specific to private practice dietetics, including areas such as workforce size, distribution, competency, practices and global challenges. The secondary aim is to identify gaps in the literature to inform future priority areas and to inform private practice dietetics workforce development research. Five databases were systematically searched from inception to August 2023 and grey-literature was searched using the Google search engine using key search terms to identify studies for inclusion. Of the 2361 peer-reviewed publications and 1800 grey literature, eighty were included. Directed content analysis and qualitative constant comparison technique were used to deductively extract data from eligible private practice literature. Intelligence sources covering the following themes proved to be limited: workforce size, distribution, attributes, demography, supply/preparation, competencies, continued professional development and challenges. However, clear structural issues present workforce challenges for private practice dietitians. There is an overwhelming paucity of comprehensive literature on the private practice dietetics workforce across the world. Private practice dietetics workforce development research is warranted to address current research gaps in a coordinated, collaborative approach to ensure this rapidly expanding workforce is well supported.

Factors promoting and hindering resilience in youth with inflammatory bowel disease: A descriptive qualitative study.

To explore factors promoting and hindering resilience in youth with inflammatory bowel disease (IBD) based on Kumpfer's resilience framework. A descriptive qualitative study design with an interpretative approach was used. Participants consisted of 10 youths with IBD from a tertiary hospital in Beijing (China) recruited using the purposive sampling method. Data were collected by semi-structured interviews from December 2020 to March 2021. The directed content analysis was performed for data analysis. Both promoting factors and hindering factors could be divided into personal factors and environmental factors. Thirteen themes were identified. The promoting factors included acceptance of illness, strict self-management, previous treatment experience, life goals, family support, medical support and peer encouragement. Stigma, lack of communication, negative cognition, societal incomprehension, economic pressure and academic and employment pressure were hindering factors. Health care professionals need to develop greater awareness of factors, stemming from both the individual and the outside world, that hinder or promote resilience in order to aid young patients with IBD. Building targeted nursing measures to excavate the internal positive quality of patients, provide external support and promote the development of resilience.

Seeking a “Supportive” Leader: Gendered language in leadership job postings and women’s leadership identification

Evidence suggests that women are underrepresented in leadership positions in Canada (MacDougall et al., 2021). While past research has shown that masculine wording reduces job attractiveness for women, few scholars have examined the effect of gendered language in a leadership context. First, we conducted a directed content analysis to assess the prevalence of gendered language in existing Canadian leadership job postings. This revealed that gendered language exists in job postings at expected levels, with masculine language occurring more frequently, especially in male-dominated industries. Second, we explored how gendered language impacts women’s intentions to apply for leadership positions and the potential roles of stereotype threat and perceived self-efficacy. Results indicated that, for women with lower self-efficacy, feminine language in job advertisements leads to greater application intentions through its effect on leadership identification. These findings suggest that more inclusive, feminine language in leadership job advertisements may encourage more women to apply

Co-design workshops to develop evidence synthesis summary formats for use by clinical guideline development groups

BackgroundEvidence synthesis is used by decision-makers in various ways, such as developing evidence-based recommendations for clinical guidelines. Clinical guideline development groups (GDGs) typically discuss evidence synthesis findings in a multidisciplinary group, including patients, healthcare providers, policymakers, etc. A recent mixed methods systematic review (MMSR) identified no gold standard format for optimally presenting evidence synthesis findings to these groups. However, it provided 94 recommendations to help produce more effective summary formats for general evidence syntheses (e.g., systematic reviews). To refine the MMSR recommendations to create more actionable guidance for summary producers, we aimed to explore these 94 recommendations with participants involved in evidence synthesis and guideline development.MethodsWe conducted a descriptive qualitative study using online focus group workshops in February and March 2023. These groups used a participatory co-design approach with interactive voting activities to identify preferences for a summary format's essential content and style. We created a topic guide focused on recommendations from the MMSR with mixed methods support, ≥ 3 supporting studies, and those prioritized by an expert advisory group via a pragmatic prioritization exercise using the MoSCoW method (Must, Should, Could, and Will not haves). Eligible participants must be/have been involved in GDGs and/or evidence synthesis. Groups were recorded and transcribed. Two independent researchers analyzed transcripts using directed content analysis with 94 pre-defined codes from the MMSR.ResultsThirty individuals participated in six focus groups. We coded 79 of the 94 pre-defined codes. Participants suggested a “less is more” structured approach that minimizes methodological steps and statistical data, promoting accessibility to all audiences by judicious use of links to further information in the full report. They emphasized concise, consistently presented formats that highlight key messages, flag readers to indicators of trust in the producers (i.e., logos, websites, and conflict of interest statements), and highlight the certainty of evidence (without extenuating details).ConclusionsThis study identified guidance based on the preferences of guideline developers and evidence synthesis producers about the format of evidence synthesis summaries to support decision-making. The next steps involve developing and user-testing prototype formats through one-on-one semi-structured interviews to optimize evidence synthesis summaries and support decision-making.

Rural and urban clinician views on COVID-19’s impact on substance use treatment for individuals on community supervision in Kentucky

BackgroundThe COVID-19 pandemic produced system-level changes within the criminal legal system and community-based substance use disorder (SUD) treatment system with impacts on recovery efforts. This study examines rural and urban clinicians’ perspectives of COVID-19 on SUD treatment delivery for people on community supervision.MethodsVirtual qualitative interviews were conducted between April and October 2020 with 25 community supervision clinicians employed by Kentucky’s Department of Corrections (DOC), who conduct assessments and facilitate community-based treatment linkages for individuals on probation or parole. Transcripts were analyzed in NVivo using directed content analysis methods.ResultsClinicians were predominantly white (92%) and female (88%) with an average of over 9 years working in the SUD treatment field and 4.6 years in their current job. Four COVID-19 themes were identified by both rural and urban clinicians including: (1) telehealth increases the modes of communication, but (2) also creates paperwork and technological challenges, (3) telehealth requires more effort for inter/intra-agency collaboration, and (4) it limits client information (e.g., no urine drug screens). Two additional rural-specific themes emerged related to COVID-19: (5) increasing telehealth options removes SUD treatment transportation barriers and (6) requires flexibility with programmatic requirements for rural clients.ConclusionsFindings indicate the need for community-based SUD treatment providers approved or contracted by DOC to support and train clients to access technology and improve information-sharing with community supervision officers. A positive lesson learned from COVID-19 transitions was a reduction in costly travel for rural clients, allowing for greater engagement and treatment adherence. Telehealth should continue to be included within the SUD continuum of care, especially to promote equitable services for individuals from rural areas.

Impact of war on HIV-related healthcare services and health workers in eastern Ukraine: a qualitative study

ABSTRACT The 2022 Russian invasion of Ukraine has caused serious challenges for healthcare workers (HCWs) and HIV-related healthcare services. This study assessed the effects of the invasion on HCWs wellbeing and on continuity of HIV services, using in-depth interviews with HCWs from facilities offering HIV antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) services in the Donetsk region of Eastern Ukraine. A directed content analysis, with both inductive and deductive approaches, was conducted. Ten HCWs (6 [60%] doctors, 4 [40%] nurses; 9 [90%] female) were interviewed. Six respondents were displaced from their homes and worksites, and all described stress and threats to emotional wellbeing. HCWs used online consultations, encrypted mobile communication, and multi-month dispensing to support continuity of ART and PrEP services. They noted immediate needs for psychological and financial support, and access to laptop computers and mobile communications to ensure continuity of HIV services. Priorities for restoration of services include repair of health facilities, restoration of laboratory services and supply chains, and return of personnel and patients. HCWs made innovative, rapid adaptations to HIV services to keep ART and PrEP services running, demonstrating the resolve of Ukrainian HCWs to maintain continuity of HIV services despite the disruptions of war.

Barriers and enabling factors for utilizing physical rehabilitation services by Afghan immigrants and refugees with disabilities in Iran: a qualitative study

IntroductionIndividuals with a migrant background often underutilize physical rehabilitation services (PRS) compared to the host population. This disparity is attributed to various barriers, including limited access to information, language barriers, illiteracy, and cultural factors. To improve PRS utilization by Afghan immigrants and refugees in Iran, it is crucial to identify these barriers and enabling factors. In response, this study explored the barriers and enabling factors for utilizing PRS among Afghan immigrants and refugees with disabilities in Iran.MethodsThis qualitative study was conducted in Iran between January and March 2023. Participants were selected through convenient and snowball sampling. Individual, semi-structured interviews were carried out both in face-to-face and online formats. Data analysis occurred concurrently with data collection, using the directed content analysis approach.ResultsFindings from our research indicate that common barriers to PRS utilization among Afghan immigrants and refugees include insufficient insurance coverage, high service costs, expensive transportation and accommodation, limited knowledge about Iran’s health system, inadequate awareness of available supports, restricted access to PRS in remote areas, impatience among PRS providers, fear of arrest and deportation, a lack of trust in modern treatments, stringent immigration rules, high inflation rates limiting the ability to pay for PRS, and limited social support. On the other hand, several enabling factors were identified, such as strengthening insurance coverage, utilizing the capacities of charities and NGOs, providing information about available services, promoting respectful behavior by healthcare providers towards patients, facilitating cultural integration, and increasing immigrants’ awareness of available services and eligibility criteria.ConclusionThe barriers and enabling factors uncovered in this study offer valuable insights into the complexities surrounding PRS utilization by Afghan immigrants and refugees with disabilities in Iran. Understanding and addressing these factors is essential for developing targeted interventions and policies that can improve access and utilization, ultimately leading to enhanced health outcomes for this vulnerable population.

Abstract 3408: ‘Survivor mentality’: The meaning of survivorship among Black cancer survivors

Abstract Purpose: To explore how Black adults who have been diagnosed with cancer perceive and interpret the term ‘cancer survivor’. Procedures: This study is a secondary analysis of qualitative data from a project identifying physical activity determinants among Black U.S. residents living past a cancer diagnosis. Semi-structured telephone interviews began with an inquiry into perceptions of the term ‘cancer survivor.’ Eligible participants were age 18 or older, self-identified as Black, and were living beyond a cancer diagnosis. Interviews were audio recorded and transcribed verbatim. Applying directed content analysis, 5 researchers independently applied a codebook generated from the interview guide to a subset of transcripts. The codebook was refined through iterative discussions to address coding discrepancies and achieve replicability. Remaining transcripts were then coded and a report of grouped narrative summaries was generated. Themes and subthemes were organized to present the meaning and significance of ‘cancer survivorship’ among the sample. The partnering community advisory board aided in and reviewed the interpretation of study findings. Results: Participants were 19 survivors of nine different types of cancer. Most participants were women (89.5%), 68.4% held a bachelor’s degree or greater, and the mean age was 56 (SD=12). Emergent themes describing perceptions of ‘cancer survivorship’ included 1) cancer ‘survivor’ terminology preferences, 2) outset of cancer ‘survivorship,’ 3) ‘survivor mentality’ and mental fortitude, and 4) advocacy for those affected by cancer. Many participants identified as ‘cancer survivors’ and preferred this to ‘in remission,’ but some preferred different terms or identities (e.g., warrior or thriver). Many believed survivorship began once an individual completed cancer treatment, but some felt survivorship began at cancer diagnosis. Survivor mentality was raised as a mindset providing some individuals the mental fortitude to complete cancer treatment, especially among those embracing a survivor identity during treatment. Some participants raised advocacy, providing support to others diagnosed with cancer, and sharing cancer information and their experience as part of what it means to be a survivor. Conclusions: Acceptance of the term “cancer survivor” and what it means to be a “survivor” vary among Black individuals living past a cancer diagnosis. The identities held by those diagnosed with cancer may have implications for their cancer experiences and outcomes. Many Black cancer survivors may perceive working to improve the lives of others with cancer as part of what it means to be a survivor. Partnering with Black cancer survivors in cancer prevention and control efforts may be mutually appealing and beneficial to improve the lives of individuals living past a cancer diagnosis. Citation Format: Nathaniel Woodard, Jingle Xu, Deirdre F. Lea, John L. Milner, Paulette Duggins, Karia Coleman, Ashley L. Bryant, Carmina G. Valle, Stephanie B. Wheeler, Jessica Carda-Auten, Tammy A. Triglianos, Rachel Hirschey. ‘Survivor mentality’: The meaning of survivorship among Black cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3408.

Perceived barriers and opportunities to improve working conditions and staff retention in emergency departments: a qualitative study

BackgroundStaff retention in Emergency Medicine (EM) is at crisis level and could be attributed in some part to adverse working conditions. This study aimed to better understand current concerns relating...

How can the Sendai framework be implemented for disaster risk reduction and sustainable development? A qualitative study in Iran

BackgroundThe Sendai Framework is the United Nations’ most significant approach to reducing the risk of disasters from 2015 to 2030. This framework designed for all communities. However, communities should create operational and remedial strategies based on their unique circumstances. Considering the gaps in the implementation of Sendai framework strategies in Iran, as a developing country, the present study was designed.MethodThis study was conducted by using a qualitative direct content analysis method to find out the expert’s opinions on the implementation of the Sendai framework in Iran from 2021 to 2023. 35 experts in the focus group discussion and 9 experts in the interview were the participants of the study.ResultsStudy findings were merged and reported as one main theme entitled Executive actions for implementing the Sendai Framework, four categories, and 37 codes. Eleven codes for the strategy of understanding disaster risk, 11 codes for the strategy of strengthening disaster risk governance to manage disaster risk, eight codes for the strategy of Investing in disaster risk reduction for resilience, and finally, seven codes for the strategy of enhancing disaster preparedness for effective response and to “Build Back Better” in recovery, rehabilitation, and reconstruction were identified as implementation solutions.ConclusionThe Sendai Framework has not provided any detailed implementation solutions because the countries’ economic, social, level of development, etc., are different. The study’s findings can be used as a guide for other developing countries.

Addictive symptoms of mukbang watching: A qualitative interview study using directed content analysis

Mukbang watching (i.e., watching eating broadcasts) is an emerging online behaviour that has recently gained popularity. Although, there are a number of positive impacts of recreational mukbang watching (e.g., helping overcome loneliness), for a minority of individuals, excessive mukbang watching may turn into problematic (i.e., addictive) mukbang watching and lead to negative consequences. The present study investigated the addictive symptoms of mukbang watching using a qualitative design. The study attempted to determine the addictive symptoms of mukbang watching through semi-structured interviews with a sample of eight mukbang viewers who frequently watched mukbang. Directed content analysis was used to analyse the data. Nine key themes were explored comprising preoccupation, withdrawal, tolerance, inability to stop, loss of interest, continuing despite problems, deceiving family/friends, relieving negative mood, and risking relationships. Findings of the present study concur with those of previous survey research suggesting that mukbang watching may be another online addictive behaviour that can result in adverse consequences for individuals’ mental, social, and physical health.

Post-discharge nutritional management for patients with coronary heart disease and frailty: a qualitative study

BackgroundFrail elderly patients experience physiological function and reserve depletion, leading to imbalances in their internal environment, which increases the risk of coronary heart disease recurrence and malnutrition. However, the majority of these patients, who primarily have a low level of education and lack self-management skills, face difficulties actively dealing with obstacles during the transition period after their discharge from hospitalization. Therefore, it is necessary to understand and discuss in depth the nutrition management experience of discharged elderly patients with coronary heart disease and frailty (ages 65-80 years old) and to analyze the promoting and hindering factors that affect scientific diet behavior during the discharge transition period.MethodsFifteen elderly patients with coronary heart disease and frailty who had been discharged from the hospital for 6 months were interviewed using a semistructured method. The directed content analysis approach to descriptive research was used to extract topics from the interview content.ResultsAll participants discussed the problems in health nutrition management experience of discharged. Five topics and ten subtopics were extracted, such as ①Weak perceptions and behaviors towards healthy eating (personal habit solidification, negative attitudes towards nutrition management), ②Lack of objective factors for independently adjusting dietary conditions (reliance on subjective feelings, times of appetite change), ③Personal hindrance factors (memory impairment, deficiencies in self-nutrition management), ④Expected external support (assistance care support, ways to obtain nutritional information), ⑤Lack of continuous nutrition management (interruption of professional guidance, avoidance of medical treatment behavior).ConclusionsNutrition management after discharge places a burden on elderly patients with coronary heart disease and frailty. According to the patients' physical conditions, we should develop a diet support system that is coordinated by individuals, families and society.

Exploring the Experiences of Visiting Veterinary Service Providers in Indigenous Communities in Canada: Proposing Strategies to Support Pre-Clinical Preparation.

Many Indigenous communities in Canada lack access to veterinary services due to geography, affordability, and acceptability. These barriers negatively affect the health of animals, communities, and human-animal relationships. Canadian veterinary colleges offer veterinary services to Indigenous communities through fourth-year veterinary student rotations. Ensuring that the students and other volunteer veterinary service providers (VSP) are adequately prepared to provide contextually and culturally appropriate care when working with Indigenous peoples has not been explicitly addressed in the literature. We explored the experiences of VSP delivering services in unfamiliar cultural and geographic settings and identified: what pre-clinic training was most helpful, common challenges experienced, and personal and professional impacts on participants. Fifty-two VSP (veterinarians, animal health technicians and veterinary students) who participated in clinical rotations offered by five Canadian veterinary colleges between 2014 and 2022 completed online surveys. Respondents shared their pre-clinic expectations, sense of preparedness to practice in a remote Indigenous community, their clinical and community experiences, and any personal and professional impacts from the experience. Data were analyzed using a directed content analysis approach. Respondents highlighted which pre-clinic training was most valuable and what they felt unprepared for. Community infrastructure and resources were concerns and many felt unprepared for the relational and communication barriers that arose. VSP were uncomfortable practicing along a spectrum of care with limited clinical resources. Many VSP identified positive personal and professional impacts. Our findings suggest that pre-clinic orientations focused on contextual care in limited resource settings could better prepare VSP to serve underserved Indigenous communities.

Patients' perspectives about the role of primary healthcare providers in long-term opioid therapy: a qualitative study in Dutch primary care.

Over the past decade, long-term use of prescription opioids for chronic non-cancer pain has risen globally despite the associated risks. Most opioid users receive their first prescription in primary care. To investigate the perspective of patients who are long-term opioid users in primary care regarding the role of healthcare providers (HCPs) in their prolonged opioid use. Semi-structured interviews in Dutch primary care. We recruited patients who were long-term users of opioids for chronic non-cancer pain from seven community pharmacies in the Netherlands. In-depth, semi-structured interviews focused on patients' experiences with long-term opioid use, access to opioids, and the guidance of their HCPs (primarily their GPs and pharmacists). A directed content analysis was conducted on the transcribed interviews using NVivo. Participants (n = 25) described ways in which HCPs impacted their long-term use of opioids. These encompassed the initiation of treatment, chronic use of opioids, and discontinuation of treatment. Participants stressed the need for risk counselling during initial prescribing, ongoing medication evaluations including tapering conversations, and more support from their HCP during a tapering attempt. Patients' perspectives illustrate the important role of HCPs across the spectrum of opioid use - from initiation to tapering. The results of this study underscore the importance of clear risk counselling starting at initial prescribing, repeated medication assessments throughout treatment, addressing tapering at regular intervals, and strong support during tapering. These insights carry significant implications for clinical practice, emphasising the importance of informed and patient-centred care when it comes to opioid use for chronic non-cancer pain management.

First-hand accounts of structural stigma toward people who use opioids on Reddit

People who use opioids face multilevel stigma that negatively affects their health and well-being and drives opioid-related overdose. Little research has focused on lived experience of the structural levels of stigma toward opioid use. This study identified and qualitatively analyzed Reddit content about structural stigma toward opioid use. Iterative, human-in-the-loop natural language processing methods were used to identify relevant posts and comments from an opioid-related subforum. Ultimately, 273 posts and comments were qualitatively analyzed via directed content analysis guided by a prominent conceptualization of stigma. Redditors described how structures—including governmental programs and policies, the pharmaceutical industry, and healthcare systems—stigmatize people who use opioids. Structures were reported to stigmatize through labeling (i.e., particularly in medical settings), perpetuating negative stereotypes, separating people who use opioids into those who use opioids “legitimately” versus “illegitimately,” and engendering status loss and discrimination (e.g., denial of healthcare, loss of employment). Redditors also posted robust formulations of structural stigma, mostly describing how it manifests in the criminalization of substance use, is often driven by profit motive, and leads to the pervasiveness of fentanyl in the drug supply and the current state of the overdose crisis. Some posts and comments highlighted interpersonal and structural resources (e.g., other people who use opioids, harm reduction programs, telemedicine) leveraged to navigate structural stigma and its effects. These findings reveal key ways by which structural stigma can pervade the lives of people who use opioids and show the value of social media data for investigating complex social processes. Particularly, this study's findings related to structural separation may help encourage efforts to promote solidarity among people who use opioids. Attending to first-hand accounts of structural stigma can help interventions aiming to reduce opioid-related stigma be more responsive to these stigmatizing structural forces and their felt effects.

Patterns and Predictors of Referral for Screening Breast MRI: A Mixed-Methods Study.

Introduction: Women with ≥20% lifetime breast cancer risk can receive supplemental breast cancer screening with MRI. We examined factors associated with recommendation for screening breast MRI among primary care providers (PCPs), gynecologists (GYNs), and radiologists. Methods: We conducted a sequential mixed-methods study. Quantitative: Participants (N = 72) reported recommendations for mammogram and breast MRI via clinical vignettes describing hypothetical patients with moderate, high, and very high breast cancer risk. Logistic regressions assessed the relationships of clinician-level factors (gender, specialty, years practicing) and practice-level factors (practice type, imaging facilities available) with screening recommendations. Qualitative: We interviewed a subset of survey participants (n = 17, 17/72 = 24%) regarding their decision-making about breast cancer screening recommendations. Interviews were audio-recorded, transcribed, and analyzed with directed content analysis. Results: Compared with PCPs, GYNs and radiologists were significantly more likely to recommend breast MRI for high-risk (ORs = 4.09 and 4.09, respectively) and very-high-risk patients (ORs = 8.56 and 18.33, respectively). Qualitative analysis identified two key phases along the clinical pathway for high-risk women. Phase 1 was "identifying high-risk women," which included three subthemes (systems for risk assessment, barriers to risk assessment, scope of practice issues). Phase 2 was "referral for screening," which included three subthemes (conflicting guidelines, scope of practice issues, legal implications). Frequency of themes differed between specialties, potentially explaining findings from the quantitative phase. Conclusions: There are significant differences between specialties in supplemental breast cancer screening recommendations. Multilevel interventions are needed to support identification and management of women with high breast cancer risk, particularly for PCPs.

Exploring childhood cancer survivor, parent, healthcare and community professionals' experiences of, and priorities for, using digital health to engage in physical activity: a mixed methods study.

Digital health interventions provide an innovative way to engage childhood cancer survivors in physical activity, yet few studies have explored the priorities of key stakeholders regarding using digital health. We aimed to investigate survivor, parent, and healthcare and community professional (HCP) experiences, priorities, and perceived importance of using digital health to promote physical activity behaviours for survivors. Participants rated the importance of digital health features to promote physical activity in a survey. Guided by survey responses, we facilitated online focus groups or semi-structured interviews to discuss participants' experiences, priorities, and suggestions in-depth. We transcribed the data verbatim and conducted directed content analysis. Forty participants took part in focus groups or interviews (including 9 childhood cancer survivors aged 8-21 years, 13 parents, and 18 HCP). Four key priorities were identified: health behaviour education, peer and parent involvement, goalsetting, and support from an HCP. There was a strong preference for digital mediums to facilitate physical activity due to its accessibility and convenience. Common intervention suggestions included earlier intervention (before the survivorship period), tailored and age-appropriate programs, a combined diet and exercise approach, and concise education delivery. This study identified key priorities that may help to promote physical activity behaviours among childhood cancer survivors. Further research is needed to integrate these priorities into health behaviour interventions and evaluate their feasibility and efficacy. Incorporating these multi-perspective priorities into future interventions will help to ensure their sustainability, acceptability, and uptake. This will in turn support childhood cancer survivors to develop a healthy lifestyle into adulthood.

Gerontological educational interventions for student nurses: a systematic review of qualitative findings.

This systematic review of qualitative studies explored interventions to improve student nurses' knowledge, attitudes or willingness to work with older people. Student nurses are likely to encounter older people in all health and aged care settings, however, research demonstrates that few have career aspirations in gerontological nursing. Qualitative systematic review method based on the Cochrane Handbook for Systematic Reviews of Interventions. Search of Medline, Embase, PsycINFO, EBSCOhost and Scopus yielded 1841 articles which were screenedto include primary research about educational interventions to improve student nurses' knowledge, attitudes and/or willingness to work with older people. Data extraction was performed on the 14 included studies,and data were analysed using directed content analysis. The Mixed Methods Appraisal Tool (MMAT) was used the assess the quality of the studies. Educational interventions included theory or practice courses, or a combination of theory and practice. While most interventions changed nursing students' negative attitudes towards older people, few increased their willingness to work with them. Practice courses had the most significant impact on willingness to work with older people. Quality assessment revealed methodical limitations. More research is needed to better understand the elements of practice interventions that enhance student nurses' knowledge, attitudes, and willingness to work with older people, so that they can be replicated.