Exit Interviews Research Articles

Symptom and Technology Management Intervention Usefulness for Caregivers of Children With Tracheostomies and Feeding Tubes.

Caregivers of children who require medical technology of tracheostomies and feeding tubes provide intensive and specialized care at home. They have extensive training in the hospital prior to their child's discharge; however, there is limited education about their child's care once they are at home. The Creating Opportunities for Personal Empowerment: Symptom and Technology Management Resources intervention focused on commonly experienced symptoms and technology used at home by caregivers. We present the findings from the intervention exit interviews to gain insight about the intervention from caregiver perspectives, notably their perceptions of usefulness, ease of use, and acceptability. A qualitative descriptive design was used to examine caregivers' perceptions of the intervention in exit interviews. These interviews were conducted upon completion of the intervention as part of feasibility testing. Sixteen caregivers completed the study and participated in exit interviews. Caregivers described the themes of the best that you can do, a reminder that I am doing it the right way, and I wish I had these when my child first had the tracheostomy and feeding tube. Caregivers also provided feedback about the intervention's usefulness and suggestions for further refinement and future adaptations of the intervention. Caregivers provided valuable insights about the intervention, describing its usefulness to them, the potential for usefulness for other caregivers of these children, and their experiences with care of their children at home. Future plans include efficacy testing and modifications to enhance the intervention based on caregiver feedback.

Racial Differences in Treatment Intensity at the End of Life Among Older Adults with Heart Failure: Evidence from the Health and Retirement Study.

Background: Black Americans experience the highest prevalence of heart failure (HF) and the worst clinical outcomes of any racial or ethnic group, but little is known about end-of-life care for this population. Objective: Compare treatment intensity between Black and White older adults with HF near the end of life. Design: Negative binomial and logistic regression analyses of pooled, cross-sectional data from the Health and Retirement Study (HRS). Setting/Subjects: A total of 1607 U.S. adults aged 65 years and older with HF who identify as Black or White, and whose proxy informant participated in an HRS exit interview between 2002 and 2016. Measurements: We compared four common measures of treatment intensity at the end of life (number of hospital admissions, receipt of care in an intensive care unit (ICU), utilization of life support, and whether the decedent died in a hospital) between Black and White HF patients, controlling for demographic, social, and health characteristics. Results: Racial identity was not significantly associated with the number of hospital admissions or admission to an ICU in the last 24 months of life. However, Black HF patients were more likely to spend time on life support (odds ratio [OR] = 2.16, confidence interval [CI] = 1.35-3.44, p = 0.00) and more likely to die in a hospital (OR = 1.53, CI = 1.03-2.28, p = 0.04) than White HF patients. Conclusion: Black HF patients were more likely to die in a hospital and to spend time on life support than White HF patients. Thoughtful and consistent engagement with HF patients regarding treatment preferences is an important step in addressing inequities.

Project Building Bridges: A Framework for Preparing Highly Qualified Speech-Language Pathologists to Serve Culturally and Linguistically Diverse Students With Augmentative and Alternative Communication Needs.

Project Building Bridges was funded by the U.S. Department of Education Office of Special Education Programs to address the shortage of speech-language pathologists qualified to serve students with complex communication needs who benefit from augmentative and alternative communication (AAC) and are culturally and linguistically diverse. The purpose was to train future speech-language pathologists in culturally responsive AAC practices through coursework and fieldwork in AAC integrated into the Master of Science degree in Speech, Language and Hearing Sciences. Fifty-seven graduate students completed the project. The scholars' curriculum consisted of two AAC courses, both on-campus and externship AAC clinical practicum experiences to provide services to multicultural and linguistically diverse students, a U.S. or international service-learning opportunity, and cumulative portfolio presentations. Mixed-methods outcome measures consisted of four sets of pre- and postsurveys and qualitative feedback from exit interviews to assess changes in graduate student competencies. Significant differences were demonstrated between scholars' pre- and post-assessments of confidence ratings. Significant differences were also demonstrated in both scholars' and school mentors' pre- and post-assessments of competency ratings. No significant differences were found between evaluations of AAC preparation by Clinical Fellowship (CF) candidates and their CF mentors at 1 year postgraduation. Project Building Bridges provides a framework for preparing highly qualified speech-language pathologists to serve culturally and linguistically diverse students who benefit from AAC as evidenced by pre- and postsurvey results. The project can serve as a model for other university programs in the development of preservice preparation programs focusing on culturally and linguistically diverse students with AAC needs.

Protocol for designing and evaluating an undergraduate public health course on sexual and reproductive health at a public university in California

IntroductionComprehensive sexuality education (CSE) is associated with positive sexual and reproductive health (SRH) outcomes, including increased contraceptive use, lower rates of unintended pregnancy and prevention of sexual violence. However, implementation of and requirements for CSE vary across the United States which can negatively impact students, both during and beyond high school, including among college students. Methodsand Analysis: This paper describes the research protocol for a multi-staged approach for designing, implementing and evaluating an SRH course for up to 60 undergraduate students at a public university in California. Before the class is offered, we will conduct 20 in-depth interviews with current students, educators and course design experts to learn from their experiences and seek their guidance on course design. To evaluate the course, enrolled students will complete a pre-course and a post-course survey before and after class is taught, to assess students’ attitudes and values relevant to educational concepts and the format and delivery of the course and its modules and activities. Approximately 20 students will take part in an in-depth exit interview, after completing the course, to gather perceptions about how the course impacted their knowledge and behavior. The goal is to refine materials for future in-person course offerings and develop a prototype for a fully online version of the course. DiscussionThis study introduces a novel university-level course to provide young adult students comprehensive, evidence-based education on sexual and reproductive health from a public health perspective. The program leverages existing CSE efforts, enhancing them with academic rigor, inclusive content and digital inclusion. This approach, inclusive of diverse sexual orientations, content on pleasure and sexual violence prevention, aims to fill existing gaps in university curricula and also set a new standard in CSE. The project's innovative and multidisciplinary design offers a model for broader impact within a large public university system and beyond.

EHealth-Enhanced Peer Navigation for Substance Use Treatment and HIV Prevention Service Linkage for Young Adults Surveilled by the Criminal Legal System: Protocol for a Pilot Randomized Trial Study.

In the United States, the proportion of criminal legal-involved (CLI) adults with a substance use disorder reaches 72%, and ~150,000 persons with HIV pass through a carceral setting annually, which represents 16% of the HIV-infected population nationally. Despite the high need for substance use treatment and HIV prevention services, few carceral settings successfully link CLI individuals to treatment upon release. Young adults represent 41.9% of the adults incarcerated in the United States and have the highest HIV incidence rates nationally. Peer patient navigation has successfully increased community-based care linkage for people living with HIV leaving jail; yet, peer-led navigation for HIV prevention among HIV-negative CLI populations is undeveloped and untested. eHealth approaches to substance use and HIV prevention services hold promise because they improve access to effective intervention services, particularly for younger people. This paper describes a protocol for a pilot randomized controlled trial that aims to improve linkage to substance use treatment and HIV prevention services using peer navigation and a codeveloped eHealth technology adjunct. The three aims of this study are to (1) adapt an existing evidence-based navigator model and incorporate codeveloped eHealth technology to refer and link young adults (18 to 29 years) surveilled by the criminal legal system to substance use and pre-exposure prophylaxis (PrEP) services; (2) refine and test the intervention with criminal legal-involved young adults (CLI-YAs); and (3) assess the feasibility, acceptability, and impact of the intervention. Data to inform the intervention will be collected via system partner interviews (n=4) and focus groups with CLI-YAs (n=24). Next, an open trial (n=10) will be conducted. The intervention will be refined via interviews with participants and facilitators, and a randomized pilot trial (n=75) will be conducted to assess the feasibility, acceptability, and preliminary impact of the eHealth-enhanced navigation on substance use and PrEP services linkage. Exit interviews conducted with a subsample of intervention participants (n=10), the navigator (n=1), and system partners (n=4) will assess intervention acceptability and suggestions for improvement. A community of practice, a group of system partners with an interest in working toward solutions to common problems, will inform each phase of the study. The project is currently ongoing. The project was funded in September 2022. Internal review board approval was received on March 21, 2022. The first results from early study aims are expected to be published in 2025. This study provides an opportunity to reduce HIV acquisition and improve access to substance use treatment in a systemically marginalized group: young CLI-YAs. The results will contribute to the development and testing of a future multilevel randomized controlled trial. DERR1-10.2196/54815.

Dedicated financial hardship screening adds value to routine distress screening among gynecologic cancer patients

ObjectivesTo evaluate existing distress screening to identify patients with financial hardship (FH) compared to dedicated FH screening and assess patient attitudes toward FH screening. MethodsWe screened gynecologic cancer patients starting a new line of therapy. Existing screening included: (1) Moderate/severe distress defined as Distress Thermometer score ≥ 4, (2) practical concerns identified from Problem Checklist, and (3) a single question assessing trouble paying for medications. FH screening included: (1) Comprehensive Score for Financial Toxicity (COST) tool and (2) 10-item Financial Needs Checklist to guide referrals. FH was defined as COST score < 26. We calculated sensitivity (patients with moderate/severe distress + FH over total patients with FH) and specificity (patients with no/mild distress + no FH over total patients with no FH) to assess the extent distress screening could capture FH. Surveys and exit interviews assessed patient perspectives toward screening. ResultsOf 364 patients screened for distress, average age was 62 years, 25% were Black, 45% were Medicare beneficiaries, 32% had moderate/severe distress, 15% reported ≥1 practical concern, and 0 reported trouble paying for medications. Most (n = 357, 98%) patients also completed FH screening: of them, 24% screened positive for FH, 32% reported ≥1 financial need. Distress screening had 57% sensitivity and 77% specificity for FH. Based on 79 surveys and 43 exit interviews, FH screening was acceptable with feedback to improve the timing and setting of screening. ConclusionsDedicated FH screening was feasible and acceptable, but sensitivity was low. Importantly, 40% of women with FH would not have been identified with distress screening alone.

A Web-Based Physical Activity Promotion Intervention for Inactive Parent-Child Dyads: Protocol for a Randomized Controlled Trial.

Low levels of physical activity are associated with numerous adverse health outcomes, yet sedentary lifestyles are common among both children and adults. Physical activity levels tend to decline steeply among children aged between 8 and 12 years, even though children's behavioral patterns are largely governed by familial structures. Similarly, parents' activity levels have been generally reported as lower than those of nonparents of comparable age. For this reason, family-based physical activity promotion interventions are a potentially valuable and relatively underresearched method for mitigating physical activity declines as children develop into adolescents and for increasing physical activity in parents. This study aims to assess the efficacy, feasibility, and acceptability of a novel theory-based web-based physical activity promotion intervention among parent-child dyads in Finland who do not meet physical activity recommendations at baseline. Participants (target N=254) will be recruited from the general population using a panel company and advertisements on social media and randomly assigned to either an immediate intervention group or a waitlist control group. The intervention consists of 4 web-based group workshops over the course of 10 weeks, web-based tasks and resources, and a social support chat group. Data on physical activity behavior and constructs from the integrated behavior change model will be collected through self-report surveys assessing physical activity, autonomy support, autonomous motivation, attitude, subjective norm, perceived behavioral control, intention, self-monitoring, habit, and accelerometer measurements at baseline, post intervention, and 3 months post intervention. Exit interviews with participants will assess the feasibility and acceptability of the intervention procedures. This study will reveal whether the intervention changes leisure-time physical activity among intervention participants relative to the control group and will examine the intervention's effects on important theoretical predictors of physical activity. It will also yield data that can be used to refine intervention materials and inform further implementation. Trial recruitment commenced in September 2023, and data collection should be completed by December 2024. The planned intervention has potential implications for both theory and practice. Practically, the use of an entirely web-based intervention may have scalable future uses for improving physical activity in 2 key populations, while also potentially informing on the value of dyadic, family-based strategies for encouraging an active lifestyle as an alternative to strategies that target either parents or children independently. Further, by assessing change in psychological constructs alongside potential change in behavior, the intervention also allows for important tests of theory regarding which constructs are most linked to favorable behavior change outcomes. ClinicalTrials.gov NCT06070038; https://clinicaltrials.gov/study/NCT06070038. DERR1-10.2196/55960.

Health Insurance Navigation Tools Intervention: A Pilot Trial Within the Childhood Cancer Survivor Study.

Childhood cancer survivors are at increased risk for underinsurance and health insurance-related financial burden. Interventions targeting health insurance literacy (HIL) to improve the ability to understand and use health insurance are needed. We codeveloped a four-session health insurance navigation tools (HINT) intervention, delivered synchronously by a patient navigator, and a corresponding booklet. We conducted a randomized pilot trial with survivors from the Childhood Cancer Survivor Study comparing HINT with enhanced usual care (EUC; booklet). We assessed feasibility, acceptability, and preliminary efficacy (HIL, primary outcome; knowledge and confidence with health insurance terms and activity) on a 5-month survey and exit interviews. Among 231 invited, 82 (32.5%) survivors enrolled (53.7% female; median age 39 years, 75.6% had employer-sponsored insurance). Baseline HIL scores were low (mean = 28.5; 16-64; lower scores better); many lacked knowledge of Affordable Care Act (ACA) provisions. 80.5% completed four HINT sessions, and 93.9% completed the follow-up survey. Participants rated HINT's helpfulness a mean of 8.9 (0-10). Exit interviews confirmed HINT's acceptability, specifically its virtual and personalized delivery and helpfulness in building confidence in understanding one's coverage. Compared with EUC, HINT significantly improved HIL (effect size = 0.94. P < .001), ACA provisions knowledge (effect size = 0.73, P = .003), psychological financial hardship (effect size = 0.64, P < .006), and health insurance satisfaction (effect size = 0.55, P = .03). Results support the feasibility and acceptability of a virtual health insurance navigation program targeted for childhood survivors to improve HIL. Randomized trials to assess the efficacy and sustainability of health insurance navigation on HIL and financial burden are needed.

Exit Interviews as Union Prevention Tool

Most seasoned human resources professionals are well versed in the benefits of exit interviews. These interviews provide an opportunity to learn what might be wrong with the workplace and identify potential problems, particularly as soon‐to‐be former employees are more likely to be candid in their responses. An effective exit interview program can also be a valuable tool for maintaining union‐free status. For example, problems underlying high turnover, which is frequently a topic of inquiry, may also uncover problems that commonly lead to interest in union representation.

Caregiver experiences and observations of intrathecal idursulfase-IT treatment in a phase 2/3 trial in pediatric patients with neuronopathic mucopolysaccharidosis II

BackgroundApproximately two-thirds of patients with mucopolysaccharidosis II (MPS II) have a severe, neuronopathic phenotype, characterized by somatic, cognitive, and behavioral issues. Current standard of care for the treatment of MPS II is enzyme replacement therapy with intravenous recombinant human iduronate-2-sulfatase (idursulfase). To target cognitive manifestations of MPS II, idursulfase has been formulated for intrathecal administration into the cerebrospinal fluid (idursulfase-IT). In accordance with recommendations for patient-focused drug development, semi-structured interviews were conducted to assess caregiver experiences and observations in a 52-week phase 2/3 trial of idursulfase-IT, in addition to intravenous idursulfase in pediatric patients with neuronopathic MPS II, or a substudy which enrolled patients younger than 3 years old, all of whom received idursulfase-IT.ResultsOverall, 46 caregivers providing care for 50 children (mean [range] age 7.9 [3–17] years at interview) took part in a single 60-min exit interview; six of these children had participated in the substudy. Qualitative and quantitative data were obtained demonstrating the burden of MPS II experienced by caregivers and their families. Following participation in the trials, 39 (78%) of the children were reported by their caregivers to have experienced improvements in the symptoms and impact of disease. Of those with improvements, 37 (95%) experienced cognitive improvements and 26 (67%) experienced emotional/behavioral improvements. Overall, 43 children (86%) were rated by caregivers as having moderate or severe symptoms before the trials; after the trials, 28 children (56%) were considered to have mild or no symptoms. For the six children who participated in the substudy, these proportions were 83% and 100%, respectively. Caregivers’ qualitative descriptions of trial experiences suggested improvements in children’s verbal and non-verbal functioning and spatial and motor skills, as well as a positive impact on family life.ConclusionsThis study revealed caregiver-reported improvements in children’s MPS II symptoms and the impact of the disease on patients and their families. There was a trend for cognitive improvement and a reduction in severity of MPS II symptoms. After many years of extensive review and regulatory discussions of idursulfase-IT, the clinical trial data were found to be insufficient to meet the evidentiary standard to support regulatory filings.

A Descriptive Study on the Impacts of Hyperbaric Oxygen Therapy on Autistic Individuals Using Parent Testimonies.

Introduction Hyperbaric oxygen therapy (HBOT) has been influential in treating many physical and psychological ailments, including the symptoms of autism. This current study aims to evaluate HBOT parents' goals and exit interviews describing the positive, negative, or no impacts experienced from the HBOT dives, asking the question, "Are your child's symptoms improving?" Methods Between January 2020 and July 2023, a Class B monoplace hyperbaric chamber (Sechrist 3300H, Sechrist Industries, Inc., Anaheim, California, United States) was used to administer HBOT sessions to patients with autism. Medical-grade oxygen was pressurized to 1.5-2.0 atmospheres absolute at a rate of 1-2 psi/min, with an average oxygen percentage of 100%, for up to five sessions per week. Retrospective descriptive data and patient information through parent testimonials were collected through a chart review of 30 children and one adult with autism who experienced HBOT sessions. Data were presented through exit interviews describing how parents felt about their child's progress toward goals. Four raters rated parent testimonies on a 5-point Likert scale (1 = Much worse, 2 = Somewhat worse, 3 = Stayed the same, 4 = Somewhat improved, and 5 = Much improved), and an inter-rater reliability estimate using interclass correlation (2) (r = 0.831) was derived, indicating excellent agreement between raters. Results Parents/caregivers provided testimony in an exit interview with a registered nurse after the individual with autism received an entire course of HBOT dives. Descriptive statistics resulted in Rater #1 (M = 4.19, median = 4, SD = 0.654): 87.1% of Rater #1 ratings were Somewhat improved and Much improved; Rater #2 (M = 4.23, median = 4, SD = 0.717): 83.9% of Rater #2 ratings were Somewhat improved and Much improved; Rater #3 (M = 4.23, median = 4, SD = 0.560): 93.5% of Rater #3 ratings were Somewhat improved and Much improved; and Rater #4 (M = 4.26, median = 4, SD = 0.631): 90.3% of Rater #4 ratings were Somewhat improved and Much improved. One-way ANOVA resulted in F (3,123) = 0.052, p = 0.984, which indicated a nonstatistically significant mean difference between rater groups. Conclusions The current study assessed HBOT parents'/caregivers' goals and exit interviews, describing the effects experienced from the complete course of HBOT dives on their children/individuals. A majority of parents/caregivers declared that their condition had "Much improved" or "Somewhat improved," based on the 5-point Likert scale. Based on parents'/caregivers' testimonies, HBOT was demonstrated as a safe and effective intervention, and side effects were primarily mild and did not lead to treatment discontinuation. As a result of this analysis, we recommend continued use of HBOT for treatment.

Creating healthy eating and active environments in early learning settings: protocol of the CHEERS eHealth intervention study.

Early childhood educators through their daily interactions with children, play a central role in shaping young children's health behaviors. Given their influential role, early childhood educators are often targeted in interventions aiming at enhancing their nutrition and physical activity practices. This paper presents the design of the CHEERS eHealth program to improve nutrition and physical activity practices within Early Childhood Education and Care (ECEC) centers. The study has a longitudinal quasi-experimental design with recruitment of ECECs across Alberta Canada. ECEC intervention group educators complete 12 weekly online nutrition and physical activity modules and participate in weekly communities of practice sessions to discuss practical applications within their centers. Outcome assessments are scheduled at baseline (T1), mid-point at 5 months (T2), and end of program after 10 months (T3). Outcome measures include the Creating Healthy Eating and Active Environments survey (CHEERS), Mindful Eating Questionnaire (MEQ), Canadian Behavior, Attitude and Nutrition Knowledge Survey (C-BANKS 2.0), Physical Literacy Knowledge, Attitude, Self-Efficacy, and Behavior (PLKASB-ECE), the Environment and Policy Assessment and Observation (EPAO) derived variables, and an objective measure of children's physical activity using ActiGraph GT3X accelerometers. Linear mixed model analyses will be used to evaluate the effectiveness of the intervention. Qualitative assessments comprise exit interviews and open-response questions embedded within the educational modules. Preliminary baseline data from the 2019 cohort indicate no statistically significant differences between the intervention and control groups for the primary outcome variables, except age. Educators' personal nutrition-related knowledge, attitude and behaviors were positively associated with their self-assessments of the nutrition environment and practices in ECECs. A significant correlation was observed between educators' self-reported physical activity practices and observed activity practices. The CHEERS survey Food Served subscale showed a positive correlation with the objective measures of EPAO-Foods Provided and Nutrition Policy subdomains. We propose that this eHealth intervention would be an effective scaling up approach to enhancing the nutrition and physical activity environments of ECECs by fostering improved nutrition and physical activity-related knowledge, attitudes, and adherence to best practices which will potentially lead to improved outcomes for children in their care.

Support Through Remote Observation and Nutrition Guidance (STRONG), a digital health intervention to reduce malnutrition among pancreatic cancer patients: A study protocol for a pilot randomized controlled trial

BackgroundMalnutrition is a common and distressing condition among pancreatic cancer patients. Fewer than a quarter of pancreatic cancer patients receive medical nutrition therapy (MNT), important for improving nutritional status, weight maintenance, quality of life and survival. System, provider, and patient level barriers limit access to MNT. We propose to examine the feasibility of a 12-week multi-level, digital health intervention designed to expand MNT access among pancreatic cancer patients. MethodsIndividuals with advanced pancreatic cancer starting chemotherapy (N = 80) will be 1:1 randomized to the intervention or usual care. The Support Through Remote Observation and Nutrition Guidance (STRONG) intervention includes system-level (e.g., routine malnutrition and screening), provider-level (e.g., dietitian training and web-based dashboard), and patient-level strategies (e.g., individualized nutrition plan, self-monitoring of dietary intake via Fitbit, ongoing goal monitoring and feedback). Individuals receiving usual care will be referred to dietitians based on their oncologists’ discretion. Study assessments will be completed at baseline, 4-, 8-, 12-, and 16-weeks. ResultsPrimary outcomes will be feasibility (e.g., recruitment, retention, assessment completion) and acceptability. We will collect additional implementation outcomes, such as intervention adherence, perceived usability, and feedback on intervention quality via an exit interview. We will collect preliminary data on outcomes that may be associated with the intervention including malnutrition, quality of life, treatment outcomes, and survival. ConclusionThis study will advance our knowledge on the feasibility of a digital health intervention to reduce malnutrition among individuals with advanced pancreatic cancer. Trial registration: NCT05675059, registered on December 9, 2022.

FACTORS INFLUENCING EMPLOYEE’S TURNOVER AND IDENTIFICATION ON THE METHODS OF RETENTION IN BANGLADESH: A CASE STUDY ON EASTERN TUBES LIMITED (ETL)

This study asses the reasons behind turnover at Eastern Tubes Limited with an objective to identify the factors affecting turnover. Data were gathered from both primary and secondary sources. This research contains summary of employee turnover management at Eastern Tubes Limited (ETL), why does it occur and identify the methods of retention. This research briefly covers various areas where employee retention strategies are implemented namely recruitment, training and development, work culture, salary negotiation, compensation management, rewards and recognition and exit interviews and at the end the research finally highlights various aspects which are to be considered for improvement of employee retention strategies.

Measurement of safe and respectful maternity care in exit interviews following facility childbirth at the Lwala Community Health Centre

Background: Respectful maternity care is essential for ensuring positive childbirth experiences for women. It emphasizes moral values and respect for human rights and encourages behavior that considers women's preferences and needs for pregnant women, newborns, and their families. Maternity exit interviews conducted at Lwala Hospital assessed women's experiences during labor and delivery. Methods: A survey tool, Kobo Collect, was used for data collection among women who delivered at Lwala Hospital. 64 women of an age range of 17 and 36 years who delivered between October 1, 2023, and November 30, 2023, were interviewed. All the women had already given birth at least once. Results: Most of the women in the survey felt that they were given sufficient information to make informed decisions and felt comfortable during their delivery process. 86% strongly agreed that they were encouraged to have some light food, warm fluids, or tea during labor and birth. 72% of women said staff members talked to them about the advantages, disadvantages, and alternatives to treatments or procedures. Only 49% received information about caring for their babies. 13% felt they received information about where to get follow-up care. 96% felt the staff always protected their privacy at all stages. 80% said that the staff never scolded, shouted at, insulted, or made disrespectful comments. 91% said they were never touched by a staff member in a way that caused pain or felt inappropriate or non-consensual. 95% of women said all the staff care about what matters to the mother and her family. 85% of women were encouraged to feel confident in their ability to give birth. Despite 86% of the women feeling that the staff were active during labor, only 68% of women felt competence from the staff members during labor. Conclusion: Interviews underscore the importance of maternity exit interviews in assessing and enhancing the quality of maternity care. The outcomes of this research will inform future interventions and reinforce the commitment to providing respectful and equitable maternity care.

Refreshed implementation strategy for respectful maternity care through policy dialog in Kenya

Background: Kenya’s Ministry of Health (MOH) has demonstrated its commitment to quality, respectful health care through the development of national RMNC/PCC policies embedded in existing RMNCAH policies. However, the MOH has identified a gap in the implementation of RMNC policies. Methods: MCGL conducted global and Kenya-specific literature reviews on topics including mistreatment, respectful newborn care, and best practices for RMNC interventions. In addition, qualitative data were obtained through three focused group discussions, and 15 key informant interviews (KIIs) at various levels. Results: Most studies have assessed manifestations, prevalence, and to, to a lesser extent, drivers of disrespect and abuse or mistreatment in facility childbirth. Respondents from the KIIs described cases of mistreatment including harassment, rudeness, denial of services, lack of privacy, and violence. In a 2017 qualitative study, participants described a lack of leadership, stewardship, and accountability toward existing RMNC policies, leading to a lack of implementation. The Kenya Free Maternity Policy recommended that despite this policy, women may still not attend health facilities for maternity care. Newborn experience has largely been excluded from the conversation of RMNC, which has an impact on women and providers with long-lasting effects on their mental health and future care seeking. KIIs were familiar with qualitative methods of measuring mistreatment through exit interviews. Conclusion: Counties are at different stages of advancing respectful care for mothers and newborns and integrating RMNC into existing primary healthcare systems. SA provides evidence regarding the development and implementation of effective RMNC policies and programs both globally and in Kenya.

Behavioural change for Parkinson's Disease: A randomised controlled feasibility study to promote physical activity and exercise adherence among people with Parkinson's: study protocol.

Parkinson's is a common progressive neurological condition characterized by motor and non-motor deficits. Physical activity and exercise can improve health, but many people with Parkinson's (PwP) have trouble reaching the recommended dosage. Our recent literature review found improvements in exercise adherence with behavioural change interventions, but it remains unclear which are most effective. Further qualitative research and patient and public involvement has informed a novel behavioural change intervention to be tested alongside an existing exercise program. To examine the feasibility of behavioural change techniques delivered alongside an exercise programme to improve physical activity, function, and self-efficacy in PwP (and study procedures) to inform a future pilot RCT trial. A parallel-arm single blinded randomised feasibility study. Twenty participants with Parkinson's (Hoehn and Yahr stage 1-3) will be recruited from a physiotherapy primary-care waiting list. Following written consent, and baseline assessment, the participants will be randomly allocated to the intervention (n=10) or the control group (n=10). Both groups will receive usual care, which includes a weekly program of a multidisciplinary education, a supervised exercise class and a prescribed home exercise program. The intervention group will receive additional behavioural change techniques, targeting behaviour regulation, belief about capabilities and social influences. Class and home exercise adherence, behavioural component uptake and adherence, and negative events will be recorded. Outcomes will include enrolment and maintenance rates, physical function, falls, physical activity, and exercise self-efficacy measured pre- and post- the 12-week program (in-person). Surveys will be used to compare experiences and satisfaction between groups. Exit interviews will be completed with the intervention group only, exploring their experience of the behavioural change techniques. The results will help inform a future pilot RCT, based on the intervention acceptability, consent rate, maintenance, and protocol integrity. ClincialTrials.gov NCT06192628.

Using contextual problems to develop preservice mathematics teachers’ understanding of exponential and logarithmic concepts

Understanding a mathematical concept in real-world situations is of practical importance and would be helpful to learn the concept in depth. One potential way to help students learn mathematical concepts in real-world situations would be to engage them with contextual problems. Exponential and logarithmic concepts are essential topics in higher secondary and university curricula, and most students seem to have a procedural understanding of them, and their interpretation in real-world situations has less attention. We examined preservice teachers’ understanding in designing contextual problems for exponential and logarithmic statements. We conducted the study in two countries: Czech Republic and Iran. The process of this study included an initial interview, implementing a set of activities, and an exit interview. The results of the initial interview showed that the preservice teachers did not have enough understanding of exponential and logarithmic statements in real-world situations, but the class activities helped them to develop their understanding of these concepts in real-world situations. Indeed, the results of the exit interview showed that the preservice teachers came to a conceptual understanding in addition to their previous procedural understanding. We report characteristics of preservice teachers’ understanding that would be productive in teaching and learning exponential and logarithmic topics through contextual problems.

Mindful self-compassion for veteran women with a history of military sexual trauma: feasibility, acceptability, potential benefits, and considerations

ABSTRACT Background: Military sexual trauma (MST) is reported by up to 74% of women veterans in the United States and is a driver of poor behavioural and physical health. Self-compassion is a transdiagnostic, protective factor linked with improved posttraumatic stress disorder (PTSD), depression, and health behaviours. Thus, Mindful Self-Compassion training (MSC) may help ameliorate MST-related impacts. However, MSC can also temporarily increase distress (i.e. backdraft). Delivering it with elective trauma-informed yoga (TIY), which regulates acute distress, may help address this issue. Objective: This VA quality improvement project examined feasibility, acceptability, and reported benefits and challenges of a manualized 8-week MSC including within non-randomized subgroups: MSC (n = 4) and MSC+ elective TIY classes (MSC+; n = 4). Methods: Nine women veterans with a history of MST at a Vet Center in the Northeastern U.S.A. enrolled; eight completed, excluding one MSC+ participant. Measures included attrition (n = 9), attendance (n = 8), weekly (n = 8) and posttreatment acceptability (n = 6), validated symptom severity assessments (n = 7), and an exit interview (n = 8). Results: Among completers, MSC attendance was excellent (89%) and higher among in MSC+ vs. MSC (94% vs. 84% sessions completed). On average across the two groups, depressive and PTSD symptom severity decreased by 21% and 30%, respectively. In exit interviews, participants across groups described improved coping with distress and psychiatric symptoms, reduced stress, and improved self-care and health behaviours. Although women in both groups reported backdraft during the programme, MSC+ also reported healthier coping and improved emotional processing. Conclusion: The results of this programme evaluation infer MSC may be feasible, acceptable, and beneficial for women survivors of MST in one Vet Center in the Northeastern USA. Further, temporary elevations in MSC-related distress may be ameliorated with adjunctive TIY. Given requests of women veterans in the USA. for additional complementary and integrative health treatment options, formal research on these approaches is warranted.

Provider and female client economic costs of integrated sexual and reproductive health and HIV services in Zimbabwe.

A retrospective facility-based costing study was undertaken to estimate the comparative cost per visit of five integrated sexual and reproductive health and HIV (human immuno-deficiency virus) services (provider perspective) within five clinic sites. These five clinics were part of four service delivery models: Non-governmental-organisation (NGO) directly managed model (Chitungwiza and New Africa House sites), NGO partner managed site (Mutare site), private-public-partnership (PPP) model (Chitungwiza Profam Clinic), and NGO directly managed outreach (operating from New Africa House site. In addition client cost exit interviews (client perspective) were conducted among 856 female clients exiting integrated services at three of the sites. Our costing approach involved first a facility bottom-up costing exercise (February to April 2015), conducted to quantify and value each resource input required to provide individual SRH and HIV services. Secondly overhead financial expenditures were allocated top-down from central office to sites and then respective integrated service based on pre-defined allocation factors derived from both the site facility observations and programme data for the prior 12 months. Costs were assessed in 2015 United States dollars (USD). Costs were assessed for HIV testing and counselling, screening and treatment of sexually transmitted infections, tuberculosis screening with smear microscopy, family planning, and cervical cancer screening and treatment employing visual inspection with acetic acid and cervicography and cryotherapy. Variability in costs per visit was evident across the models being highest for cervical cancer screening and cryotherapy (range: US$6.98-US$49.66). HIV testing and counselling showed least variability (range; US$10.96-US$16.28). In general the PPP model offered integrated services at the lowest unit costs whereas the partner managed site was highest. Significant client costs remain despite availability of integrated sexual and reproductive health and HIV services free of charge in our Zimbabwe study setting. Situating services closer to communities, incentives, transport reimbursements, reducing waiting times and co-location of sexual and reproductive health and HIV services may help minimise impact of client costs.