Experiences Of Stakeholders Research Articles

This needs to be a journey that we’re actually on together’—the introduction of integrated care systems for children and young people in England: a qualitative study of the views of local system stakeholders during winter 2021/22

BackgroundIntegrated care has become a central feature of health system reform worldwide. In England, Integrated Care Systems (ICS) are intended to improve integration across public health, the National Health Service (NHS), education and social care. By April 2021, England had been divided into 42 geographical areas, each tasked with developing local ICS provision. However, it was not clear how ICSs would address the specific needs of children and young people (CYP). This study elicited the views of senior professional stakeholders in the first year of the ICS national roll out, to learn how integrated care for CYP was being implemented within the ICSs and future plans for service provision.MethodsA qualitative analysis of in-depth interviews with stakeholders, including healthcare professionals, NHS managers and local authority leaders (n = 25) selected from a diverse sample of ICSs (n = 7) across England, conducted during winter 2021/22. Reflexive thematic analysis involving a collaborative coding approach was used to analyse interview transcripts.ResultsFour themes were identified, indicating challenges and opportunities for ICSs in relation to the health of CYP: 1) Best start in life (a more holistic approach to health afforded by integrated care); 2) Local and national contexts (tensions between local and national settings and priorities); 3) Funding and planning (instituting innovative, long-term plans using limited existing CYP funding streams); 4) Organisational complexities (integrating the work of diverse organisations).ConclusionsThe views of stakeholders, provided at the beginning of the journey towards developing local ICS CYP provision, revealed a common aspiration to change focus from provision of acute, largely adult-orientated services towards one with a broader, population health remit, including prevention and early intervention. This would be delivered by integration of a range of local services, including health, education, housing and social care, to set CYP on a life-long path towards improved health and wellbeing. Yet there was an awareness that change would take place over time within existing national policy and funding frameworks, and would require overcoming organisational barriers through further developing local collaborations and partnerships. As ICSs mature, the experiences of stakeholders should continue to be canvassed to identify practical lessons for successful CYP integrated care.

Mixed-method study on the association between inclusion to conditional cash transfer program and the multiple faces of malnutrition in children and adolescents aged 3 to 19 years: a school-based evidence from Caraga Region, the Philippines

BackgroundThis study aimed to investigate the association between inclusion to Pantawid Pamilyang Pilipino Program (4Ps), a CCT program in the Philippines, and malnutrition in children and adolescents and examine the perceptions and experiences of parents and other stakeholders on how 4Ps influenced child nutrition.MethodsA concurrent mixed-method study was conducted in the Caraga Region, Philippines. Quantitative data from 5541 children and adolescents aged 3 to 19 were analyzed using multilevel mixed-effect logistic models. To allow in-depth understanding of the programmatic components that support the findings from the quantitative study, eight focused group discussions (FGDs) were concurrently conducted, cumulating 33 participants, including 4Ps parents, school coordinators/teachers, and school nurses. A constructivist grounded theory approach was used for analysis, and joint displays were employed to integrate quantitative and qualitative results.ResultsQuantitative findings revealed high rates of malnutrition, with significant rates of stunting (12.0%), wasting/thinness (9.4%), and overweight/obesity (16.4%) among children and adolescents. 4Ps beneficiaries had higher odds of stunting and overweight/obesity compared to non-4Ps beneficiaries (AOR = 1.43, 95%CI: 1.08–1.91; AOR = 1.21, 95%CI: 1.01–1.45, respectively). However, no significant association was observed between inclusion to 4Ps and concurrent stunting and wasting/thinness or overweight/obesity (AOR = 1.05, 95%CI: 0.72–1.55). Geographic variations were observed, with 4Ps children in Agusan del Sur having lower odds of stunting than those in Agusan del Norte (AOR = 0.41, 95%CI: 0.23–0.71). Age and gender also showed significant associations with malnutrition. The qualitative analysis provided insights into the challenges contributing to malnutrition, including child labor, sickness, long distances to school, limited access to healthy food, and larger families. Unintended consequences such as cash card mismanagement, inappropriate cash grant allocation, and falsification of school attendance were identified. However, teachers and parents demonstrated resilience by implementing adaptive approaches to enhance child nutrition.ConclusionsWhile 4Ps beneficiaries exhibit higher odds of stunting and overweight/obesity, the program’s association with malnutrition was significantly influenced by geographic variations. It is crucial for social protection programs to prioritize comprehensive support strategies that effectively counter unintended consequences and challenges faced by beneficiaries and other stakeholders and address malnutrition in children and adolescents.

Telehealth in community mental health centers during the COVID-19 pandemic in Peru: A qualitative study with key stakeholders

AimTo describe the perceptions and experiences of key stakeholders to understand the use of telehealth in community mental health centers (CMHCs) during the COVID-19 pandemic in Lima and Callao, Peru. MethodsA qualitative study was carried out in four CMHCs in Lima and Callao, Peru. Forty-nine individual semi-structured interviews were conducted between September 2021 and March 2022, considering CMHCs' users and their relatives, health and administrative workers, directors, as well as local and national policymakers. Data was analyzed using thematic analysis. ResultsRegarding the transition from in-person care to telehealth, CMHCs' directors and workers identified some of the regulations issued by the Government during the pandemic, such as the continuity of care through telehealth, especially for pregnant women and for people with comorbidities related to COVID-19. Regarding benefits, workers and users indicated that it allowed better communication, such as constant follow-ups. Directors and workers recognized that Google Drive facilitated access to user information, since they did not have an electronic medical record. Additionally, workers said they used social media to share educational information on mental health, and explained that some new users began their treatment this way. Regarding difficulties, participants reported a lack of devices and poor internet connection in CMHCs. Users mentioned that scheduling an appointment was difficult because the phone lines were usually saturated, and they could not find available appointments. ConclusionAlthough the pandemic forced an immediate and disruptive change towards telehealth, CMHCs were able to adapt most of their services. This study reports the adaptations made by CMHCs to move from in-person to remote care, identifying the benefits and challenges faced, information that can be used for the nationwide implementation of telehealth in CMHCs. We recommend ensuring technological equipment and internet connection and adapt the telehealth system to make it responsive to the routine practices of CMHCs.

Implementing a Non-Specialist Delivered Psychological Intervention for Young Adolescents in a Protracted Refugee Setting: a Qualitative Process Evaluation in Lebanon

There has been an increase in the evaluation and implementation of non-specialist delivered psychological interventions to address unmet mental health needs in humanitarian emergencies. While randomized controlled trials (RCTs) provide important evidence about intervention impact, complementary qualitative process evaluations are essential to understand key implementation processes and inform future scaling up of the intervention. This study was conducted as part of an RCT of the Early Adolescents Skills for Emotions (EASE) psychological intervention for young adolescents with elevated psychological distress (predominantly with a Syrian refugee background) in Lebanon. Our aims were firstly to conduct a qualitative process evaluation to understand stakeholder experiences and perceived impact of the intervention and identify barriers and facilitators for implementation, and secondly to explore considerations for scaling up. Eleven key informant interviews and seven focus groups were conducted with 39 respondents including adolescent and caregiver participants, trainers, providers, outreach workers, and local stakeholders. Data were analyzed using inductive and deductive thematic analysis. Respondents perceived the intervention to be highly needed and reported improvements in adolescent mental health and wellbeing. Key implementation factors that have potential to influence engagement, adherence, and perceived impact included the socio-economic situation of families, mental health stigma, coordination within and between sectors (particularly for scaling up), embedding the intervention within existing service pathways, having clear quality and accountability processes including training and supervision for non-specialists, and sustainable funding. Our findings provide important context for understanding effectiveness outcomes of the RCT and highlights factors that need to be considered when implementing a mental health intervention on a larger scale in a complex crisis.

Awareness and experiences on core outcome set development and use amongst stakeholders from low- and middle- income countries: An online survey.

Harmonization of outcomes to be measured in clinical trials can reduce research waste and enhance research translation. One of the ways to standardize measurement is through development and use of core outcome sets (COS). There is limited involvement of low- and middle-income country (LMIC) stakeholders in COS development and use. This study explores the level of awareness and experiences of LMIC stakeholders in the development and use of COS. We conducted an online survey of LMIC stakeholders. Three existing COS (pre-eclampsia, COVID-19, palliative care) were presented as case scenarios, and respondents asked to state (with reason(s)) if they would or would not use the COS if they were working in that area. Quantitative data were analyzed descriptively while qualitative data were analyzed thematically. Of 81 respondents, 26 had COS experience, 9 of whom had been involved in COS development. Personal research interests and prevalence of disease are key drivers for initiation/participation in a given COS project. Most respondents would use the COS for pre-eclampsia (18/26) and COVID-19 (19/26) since the development process included key stakeholders. More than half of the respondents were not sure or would not use the palliative care COS as they felt stakeholder engagement was limited and it was developed for a different resource setting. Respondents reported that use of COS can be limited by (i) feasibility of measuring the outcomes in the COS, (ii) knowledge on the usefulness and availability of COS and (iii) lack of wide stakeholder engagement in the COS development process including having patients and carers in the development process. To ensure the development and use of COS in LMICs, collaborations are essential in awareness raising on COS utility, training, and COS development. The COS also needs to be made accessible in locally understandable languages and feasible to measure in LMICs.

Sports venue digital twin technology from a spectator virtual visiting perspective.

The purpose of this article is to adopt a customer-centric perspective the and introduce digital twin technology as a solution for mega-sport event management. This conceptual model article focuses on the potentially drastic role of digital twin technology in modern sports events, explaining in detail different aspects of its impact. The main research question is "How (and why) do sports venue digital twin emerging technologies prospectively impact the sports spectators" customer experiences?" It contributes to understanding how and why sports venue digital twins make events more customer-centred by enhancing fan experiences and engagement. Subsequently, it aims to position digital twin technology as an innovative solution for mega-sport event management across various customer experience touchpoints. By examining the intersection of digital twins and sports events from a customer-centric lens, this article will elucidate the intricacies involved in leveraging this emerging technology to transform stakeholder and fan experiences at major sporting events. Finally, we outline and explain the obstacles, challenges, opportunities, and perspectives of digital twin technology at an intersection with sports events from a customer-centric perspective. The use of digital twins potentially enables the creation of hyper-realistic virtual replicas of sports venues, providing immersive and personalized experiences for spectators. This technology allows event organizers to optimize resource allocation, streamline logistics, and improve operational efficiency.

Improving the Format, Content, and Writing Process of Outpatient Clinic Letters Within a Musculoskeletal Therapy Department.

Outpatient clinic letters are recognized as an important component of patient care. This project aimed to coproduce clinic letters that have meaning and relevance for key stakeholders. This health care improvement project was conducted in one musculoskeletal therapy (physiotherapy and osteopathy) department in southern England using a Lean Six Sigma Define, Measure, Analyze, Improve, and Control-inspired framework. The views and experiences of key stakeholders, including therapists, general practitioners, and patients, were explored using surveys and group meeting methods. New letter designs were coproduced with stakeholders, including patient partners and personalized care lead staff, and were refined through a pilot phase. Qualitative data were analyzed thematically, and quantitative data were analyzed descriptively. Overall, patients and therapists found the clinic letters an important and meaningful part of care. However, therapists reported that they often did not write the letters, and time was identified as the main barrier. The main theme identified from patient feedback was that patients wanted to write the letters in collaboration with the clinician. The pilot phase demonstrated that, on average, the new letters took less time to write. This project has coproduced new clinic letters and operational processes centered on the needs of key stakeholders. This article will help other outpatient departments reflect on their own clinic letters and consider their meaning and relevance for their stakeholders.

Mitigating risks of online engagement; considering the contexts and mechanisms of cybercrime among older adults

AbstractBackgroundThis talk will explore how benefits of remote interventions can be realised for older people with cognitive impairments alongside risk mitigation, drawing on a realist review of how and in what circumstances older people become victims of cybercrime. We aimed to identify factors leading to older adults' victimisation, and review theory and evidence for interventions to reduce victimisation risks.MethodWe conducted a realist review synthesising published literature and gathering stakeholder experiences via an online workshop to understand how, why and in what circumstances older adults are at risk of financial cybercrime victimisation. We used the evidence to develop a programme theory and Context, Mechanism, Outcome Configurations (CMOCs) to explain the mechanisms by which older adults become victims of financial cybercrime in different contexts, and to inform the development of interventions to produce desired outcomes of reducing and preventing cybercrime.ResultWe analysed 52 primary and secondary data sources and consulted with 21 stakeholders from across health, social, legal, and financial sectors. Our programme theory comprised 16 CMOCs describing how social isolation, cognitive decline, physical and mental health problems; wealth status, limited cyber security skills or awareness, societal attitudes and content of scams led to increased risk of victimisation. Only evidence for interventions to enhance cyber security awareness and skills of potential older victims was identified. Targeting offender motivation, redesign of security software to increase usability by older people and training programmes for professionals and family members are rational, yet untested interventions. A shift in societal attitudes, conveying positive messages, of older people’s rights to be safely active online, is needed too.ConclusionProtection from cybercrime is instrumental to supporting ageing in a digital world. Incorporating cyber security awareness into future interventions that promote social connectedness, cognition and healthy lifestyles, alongside legal structural protections, and measures to improve societal attitudes towards financial cybercrime victimisation will help older adults navigate online spaces safely. Training programmes targeting older adults, or their supporters should be deliverable by a range of professionals for greatest reach; and be co‐designed with end users to ensure that if they are useful, they are acceptable and used.

The development of an integrated neighborhood approach for health promotion and prevention: a qualitative exploration of stakeholders' views.

Although the promise of integrated neighborhood approaches, including the essential roles of communities and collaboration between the medical and social domains, has been widely acknowledged, the realization of such approaches in practice often remains difficult. To gain insight into the development of integrated neighborhood approaches, this case study describes the experiences of stakeholders involved in such an approach for health promotion and prevention in Rotterdam. Interviews with 18 stakeholders (including health and social care professionals, health insurance employees, and policymakers) were conducted, and stakeholders' statements were analyzed thematically. The results reveal a lack of alignment among the professional, organizational, and system levels. Elements needed for collaboration between health and social care professionals are not supported at the organizational and system levels. The lack of integration at the policy and organizational levels encourages competition and self-interest instead of stimulating collaboration. Intersectoral collaboration and coordination must take place not only between professionals, but also at the organizational and policy levels. As long as integration at the organizational and system levels is lacking, professionals' ability to collaborate and provide coordinated support to neighborhood residents will be compromised.

Heritage Tourism, Retail Revival and City Center Revitalization: A Case Study of Koper, Slovenia

The focus of this paper is the revitalization of a heritage city center and the significance of retail trade and cruise ship tourism within this context. Fundamental concepts are presented in the literature review and the factors contributing to the decline of old city centers explored. The empirical section of the paper comprises a case study that highlights a specific municipality’s efforts to revive its heritage city center. The main attraction in Koper is its well-preserved medieval city center with five-centuries-old Venetian architecture. An analysis of the municipality’s initiatives is performed and a qualitative study that investigates the perceptions and experiences of stakeholders regarding the situation and the municipality’s actions to preserve commercial activity in the city center. The results of the semi-structured interviews conducted with three distinct stakeholder groups are analyzed using the qualitative content analysis method. The findings reveal that the chosen municipality has achieved relative success in revitalizing its heritage city center. Concurrently, stakeholders’ perspectives are utilized to identify potential drawbacks and explore opportunities for mitigating them. This paper concludes by presenting its theoretical and methodological contributions to the field of heritage city center revitalization, not only in the selected municipality but also beyond. These insights can inform the appropriate sustainable policy development and marketing strategy.

Embedding formal and experiential public and patient involvement training in a structured PhD programme: process and impact evaluation

BackgroundIncorporating Public and Patient Involvement (PPI) into doctoral research is valued by PhD funders and scholars. Providing early career researchers with appropriate training to develop skills to conduct meaningful PPI involvement is important. The Health Research Board (HRB) Collaborative Doctoral Award in MultiMorbidity programme (CDA-MM) embedded formal PPI training in its structured education. The four participating PhD scholars established a PPI panel comprising people living with two or more chronic conditions, presenting an opportunity for experiential PPI training. This study aimed to evaluate the process and impact of embedding PPI training in a structured PhD programme.MethodsThis study was a longitudinal mixed-methods evaluation, conducted over 24 months (June 2020 to June 2022). A process evaluation provided an understanding of how PPI was embedded and explored the experiences of key stakeholders involved. An impact evaluation assessed the impact of embedding PPI training in the programme. Participants included PhD scholars, PPI contributors and PhD supervisors. The data collection and analysis was led by an independent researcher not aligned with the CDA-MM. Data collection methods included five focus groups, individual interviews (n = 6), an impact log, activity logs and group reflections. Qualitative data were analysed using thematic and content analysis and quantitative data analysed using descriptive statistics.ResultsEmbedding formal and experiential PPI training in a structured PhD programme is feasible. Both approaches to training are fundamental to building PPI capacity. Involvement of an experienced and knowledgeable PPI lead throughout is perceived as critical. The PPI panel approach offered a good example of embedded consultation and worked well in a structured PhD programme, providing PhD scholars with ample opportunities for learning about PPI and its implementation. For PPI contributors, culture was the most important indicator of quality and was positively evaluated. Key roles for PhD supervisors were identified. Embedding formal and experiential PPI training impacted positively on many different aspects of individual PhD research projects and on PhD scholars as researchers. There were positive impacts for PPI contributors and PhD supervisors.ConclusionsEmbedding formal and experiential PPI training in a structured PhD programme is a novel approach. The evaluation has identified a number of lessons that can inform future doctoral programmes seeking to embed formal and experiential PPI training.

Stakeholders' views and opinions on existing guidelines on "How to Choose Mental Health Apps".

Mental health Applications (Mhealth Apps) can change how healthcare is delivered. However, very little is known about the efficacy of Mhealth Apps. Currently, only minimum guidance is available in Assessment and Evaluation Tools (AETs). Therefore, this project aims to understand AET developers' perspectives and end users' experiences and opinions on "how to choose a Mhealth App". The primary objectives were: (1) obtaining stakeholder's opinions and experiences of development and use of AETs for Mhealth Apps, their weaknesses and strengths, and barriers in their implementation of Mhealth Apps; (2) the experiences of App users, their analyzation and, obstacles in the use of apps; and (3) to quantify themes related to choosing a Mhealth App. This qualitative study, used a sampling method to recruit six stakeholders (one App developer, two AET developers, an individual with lived experience of mental health illness, and two physicians) who were interviewed using a topic guide. These were examined by researchers (CT, WK, & FN) using thematic content analysis. Additionally, an anonymous online survey of 107 individuals was conducted. Our analyses revealed six main themes: (a) needs and opportunities; (b) views on Mhealth apps; (c) views & opinions on AETs; (d) implementation barriers; (e) system of evaluation and; (f) future directions. The first key concept was, all stakeholders agreed that Apps could significantly impact mental health and that end-users were unaware of mental health AETs and Apps. Secondly, due to commercial interests, end-users reliability of App evaluations requires clear conflict-free guidelines. Thirdly, AETs should be evaluated and developed through a rigorous methodology. Finally, stakeholders shared insights into future developments for AETs and Mhealth Apps. Additionally, online survey respondents chose a "health professional" as their preferred source of guidance in selecting a Mhealth app (84%) and best suited to develop guidelines (70%). The interviews and survey highlight the need for Mhealth Apps to be regulated and the importance of health professionals' engagement in the implementation process. Similarly, without well-defined roles for App evaluations within the health care system, it is unlikely that AETs will have wider spread use and impact without risk.

Effects and experiences of idiographic patient-reported outcome measures for feedback in psychotherapy: A systematic review and secondary analysis of the empirical literature

Objective: There is a growing interest in idiographic patient-reported outcome measures (I-PROMs) for routine outcome monitoring (ROM) and clinical feedback (CF) in psychotherapy, but to our knowledge, no systematic reviews of the empirical literature. Method: We conducted a systematic literature search for empirical papers investigating effects and experiences of I-PROMs for ROM/CF and found a total of 13 papers. There was only one experimental controlled effectiveness study. Results: We formulated a narrative summary of the data set as a whole. We conducted a secondary analysis of nine papers containing qualitative data on stakeholder experiences with I-PROMs and found three superordinate themes and eight subthemes, summarized as “I-PROMs can facilitate self-reflection for patients, assist in identifying and tracking therapeutic topics, and make patients more committed to therapy by giving them a greater sense of responsibility and empowerment. Formulating goals and problems can be difficult, and lack of progress can be demotivating. Time in therapy is precious and must be spent wisely. Effective use of I-PROMs is facilitated by flexibility and therapists’ use of clinical skills.” Conclusion: We discuss the limitations of the study and provide recommendations for future research and clinical practice.

Nurturing Peaceful Minds: Fostering Peace Education Amid Conflict in Jammu and Kashmir

The basic purpose of the paper is to explore the issues and challenges faced by educational administrators, parents, students, and teachers concerning the effects of armed conflict on educational outcomes. It emphasizes the significance of peace education initiatives in Jammu and Kashmir a region enduring unrest for nearly three decades, profoundly affecting its educational sector. Employing a descriptive qualitative survey method, the study examines the experiences of different stakeholders of education and the factors influencing various stakeholders. The results indicate that academic stress emerges as a dominant risk factor leading to physical and psychological difficulties among the students. The research advocates for integrating peace education into the curriculum, creating a conducive learning environment to empower students in overcoming such challenges. Empirical findings strongly suggest that introducing peace education into the curriculum and peace education as a subject can be instrumental in addressing conflict-related issues.

Understanding the Needs and Lived Experiences of Patients With Graft-Versus-Host Disease: Real-World European Public Social Media Listening Study.

Graft-versus-host disease (GVHD) is the major cause of short- and long-term morbidity and mortality after allogeneic hematopoietic stem cell transplantation. Treatment options beyond corticosteroid therapy remain limited, and prolonged treatment often leads to impaired quality of life (QoL). A better understanding of the needs and experiences of patients with GVHD is required to improve patient care. The aim of this study is to explore different social media (SM) channels for gathering and analyzing the needs and experiences of patients and other stakeholders across 14 European countries. We conducted a retrospective analysis of SM data from the public domain. The Talkwalker social analytics tool collected data from open-access forums, blogs, and various social networking sites using predefined search strings. The raw data set derived from the aggregator tool was automatically screened for the relevancy of posts, generating the curated data set that was manually reviewed to identify posts that fell within the predefined inclusion and exclusion criteria. This final data set was then used for the deep-dive analysis. A total of 9016 posts relating to GVHD were identified between April 2019 and April 2021. Deduplication and relevancy checks resulted in 325 insightful posts, with Twitter contributing 250 (77%) posts; blogs, 49 (15%) posts; forums, 13 (4%) posts; Facebook, 7 (2%) posts; and Instagram and YouTube, 4 (1%) posts. Patients with GVHD were the primary stakeholders, contributing 63% of all SM posts. In 234 posts, treatment was the most discussed stage of the patient journey (68%), followed by symptoms (33%), and diagnosis and tests (21%). Among treatment-related posts (n=159), steroid therapy was most frequently reported (54/159, 34%). Posts relating to treatment features (n=110) identified efficacy (45/110, 41%), side effects (38/110, 35%), and frequency and dosage (32/110, 29%), as the most frequently discussed features. Symptoms associated with GVHD were described in 24% (77/325) of posts, including skin-related conditions (49/77, 64%), dry eyes or vision change (13/77, 17%), pain and cramps (16/77, 21%), and fatigue or muscle weakness (12/77, 16%). The impacts of GVHD on QoL were discussed in 51% (165/325) of all posts, with the emotional, physical and functional, social, and financial impacts mentioned in 69% (114/165), 50% (82/165), 5% (8/165), and 2% (3/165) of these posts, respectively. Unmet needs were reported by patients or caregivers in 24% (77/325) of analyzed conversations, with treatment-related side effects being the most common (35/77, 45%) among these posts. SM listening is a useful tool to identify medical needs. Treatment of GVHD, including treatment-related side effects, as well as its emotional and physical impact on QoL, are the major topics that GVHD stakeholders mention on SM. We encourage a structured discussion of these topics in interactions between health care providers and patients with GVHD. Not applicable.

Genus Acacia in Mainland Portugal: Knowledge and Experience of Stakeholders in Their Management

The global rise in issues related to the invasion of alien tree species is becoming increasingly prominent. Genus Acacia is one of the most pervasive invaders among the non-native flora introduced to Portugal over the centuries. This research aimed to pinpoint the key players engaged in its management, their expertise, and the methodologies applied to control acacias or decrease affected regions. Data were gathered via an online survey and subjected to diverse statistical analyses. Numerous stakeholders have emerged in recent decades, employing various methods to fight acacia invasion. Mechanical, chemical, and combined methods are the most frequently applied. The findings highlight the need for continued funding for long-term acacia control in the same invaded areas, increased training actions and best practices demonstration in the field and increased public awareness and engagement in local communities and the general public.

Exploring stakeholders’ experiences in co-creation initiatives for clinical nursing education: a qualitative study

BackgroundCo-creation is an emerging approach in nursing education, wherein academics engage in multi-stakeholder collaborations to generate knowledge, ideate solutions, promote sustainability, and enhance educational quality. However, knowledge on stakeholders’ experiences in participation in co-creation initiatives for nursing education is scarce. This study aimed to explore the experiences of student nurses, nurse educators, and e-learning designers in co-creation initiatives to design and develop a digital educational resource for clinical nursing education.MethodsThe study adopted an exploratory qualitative design. Data were collected via three separate semi-structured focus group interviews with student nurses (n = 7), nurse educators (n = 8), and e-learning designers (n = 3) who participated in co-creation workshops. Collected data were then thematically analyzed.ResultsThree themes related to the participants’ experiences emerged: (1) The co-creation workshops were enjoyable, useful, and instructive; (2) power imbalances influenced the students’ engagement; and (3) contextual factors influenced the participants’ overall engagement.ConclusionsThis study shows that co-creation through workshops is a novel, enjoyable, and instructive approach that facilitates knowledge exchange. It also highlights the needs and experiences of stakeholders, especially student nurses. However, the use of co-creation in nursing education presents some challenges. Recognizing and managing power differentials are essential for successful co-creation in clinical nursing education, alongside a mindset of collaboration and mutuality. Future research is required to systematize knowledge about the benefits and impacts of the processes and outcomes of co-creation initiatives, including stakeholders’ motivation, barriers, and facilitators to participation in co-creation, to improve the quality of clinical nursing education.

Implementation of an office-based addiction treatment model for Medicaid enrollees: A mixed methods study

IntroductionMedications for opioid use disorder (MOUD) are the most effective treatment for opioid use disorder (OUD) but remain underutilized. To reduce barriers to MOUD prescribing and increase treatment access, New Jersey's Medicaid program implemented the Office-Based Addiction Treatment (OBAT) Program in 2019, which increased reimbursement for office-based buprenorphine prescribing and established newly reimbursable patient navigation services in OBAT clinics. Using a mixed-methods design, this study aimed to describe stakeholder experiences with the OBAT program and to assess implementation and uptake of the program. MethodsThis study used a concurrent, triangulated mixed-methods design, which integrated complementary qualitative (semi-structured interviews) and quantitative (Medicaid claims) data to gain an in-depth understanding of the implementation of the OBAT program. We elicited stakeholder perspectives through interviews with 22 NJ Medicaid MOUD providers and 8 policy key informants, and examined trends in OBAT program utilization using 2019–2020 NJ Medicaid claims for 5380 Medicaid enrollees who used OBAT services. We used cross-case analysis (provider interviews) and a case study approach (key informant interviews) in analyzing qualitative data, and calculated descriptive statistics and trends for quantitative data. ResultsProvider enrollment and utilization of OBAT services increased steadily during the first two years of program implementation. Interviewees reported that enhanced reimbursements for office-based MOUD incentivized greater MOUD prescribing, while coverage of patient navigation services improved patient care. Despite increasing enrollment in the OBAT program, the proportion of primary care physicians in the state who enrolled in the program remained limited. Key barriers to enrollment included: requirements for a patient navigator; concerns about administrative burdens and reimbursement delays from Medicaid; lack of awareness of the program; and beliefs that patients with OUD were better served in comprehensive care settings. Patient navigation was highlighted as a critical and valuable element of the program, but navigator enrollment and reimbursement challenges may have prevented greater uptake of this service. ConclusionsImplementation of an OBAT model that enhanced reimbursement and provided coverage for patient navigation likely expanded access to MOUD in NJ. Results support initiatives like the OBAT program in improving access to MOUD, but program adaptations, where feasible, could improve uptake and utilization.

Exploring social justice in marine spatial planning: planner and stakeholder perspectives and experiences in the Baltic Sea Region

This article contributes to the increasing traction of social justice in marine spatial planning (MSP) by exploring perceptions and experiences of social justice from the viewpoint of planners and different social groups who were included and (self)excluded in MSP processes. The study builds on empirical material from Poland, Latvia, and Germany consisting of interviews, MSP legislation, and documents that were analysed through the lens of a multidimensional social justice framework centring on recognition, representation, distribution, and capabilities. Results indicate that MSP institutional arrangements constrain possibilities for marginalised and less consolidated actor groups (residents, coastal tourism, and small-scale fisheries) to enjoy the same degree of recognition that is given to groups representing strategic national interests (renewable energy and shipping). We also highlight the role of planners’ self-reflectivity in enhancing/depriving capabilities of vulnerable social groups whose wellbeing and multidimensional relationships with the sea call for institutional responses adaptive to specific planning contexts.

Barriers to Accessing Effective Treatment and Support for Menopausal Symptoms: A Qualitative Study Capturing the Behaviours, Beliefs and Experiences of Key Stakeholders.

Historically, menopausal symptoms have been hugely under-treated and under-reported, with many women struggling to manage intrusive, bothersome symptoms which can significantly affect quality of life. In the past couple of years, awareness of the impact of the menopause has risen in the public health agenda but many women are still not receiving adequate information and support. To gain an in-depth understanding of the barriers that impact women's access to treatment and uptake of hormone replacement therapy (HRT). Qualitative study with perimenopausal and menopausal women, general practitioners (GPs) and gynaecologists in the UK. Sixty-minute in-depth interviews conducted with 20 menopausal women, 30 GPs and 10 gynaecologists. Data from the interviews were analysed thematically. Barriers to seeking help for menopausal symptoms include: a lack of knowledge of the full range of symptoms, stigma, embarrassment and the belief that it is part of normal ageing. Previous negative experience in accessing advice or treatment discouraged women from pursuing help. There are substantial differences in the beliefs and attitudes towards the menopause amongst GPs and often a lack of confidence in prescribing HRT. Secondary care services can consequently be overwhelmed by an explosion in uncomplicated referrals which could be effectively managed in primary care. There are barriers at each point in the management pathway: from women not feeling empowered to seek medical advice, to some women feeling their symptoms are dismissed by healthcare professionals (HCP); or HCPs not recognising some of the less common menopausal symptoms, not offering options for treatment, both hormonal and non-hormonal, or offering onward specialist referral for complex issues outside their expertise. There are multiple opportunities to address these gaps in knowledge, including the use of HCP education and culturally appropriate leaflets to reach a wider range of perimenopausal and menopausal women.