Descriptive Exploratory Study Research Articles

Integrating family caregivers in older adults' hospital stays: a needed cultural shift.

This study aimed to examine perceived barriers and facilitators to caregiver inclusion in the hospital care of older adult family members or friends through the perspectives of (1) hospitalized older adults, (2) caregivers of a hospitalized older adult, (3) healthcare clinicians, and (4) policymakers. This qualitative descriptive exploratory study utilized semi-structured interviews with N = 24 participants and was analyzed using a framework method. Eight codes arose that were categorized into four domains guided by the Social Ecological Model. Individual-level factors were determined both for the caregiver and for the clinician. Relationship-level factors were revealed pertaining to communication style and method. Hospital-level factors included hospital environment and resources. Societal-level factors included healthcare climate and policies. Findings indicated that hospital workflows and policies inadequately support family caregivers. This study highlights potential solutions to caregivers' integration into hospital workflows.

"Current", "heated rods", and "hot vapour": why patients refuse radiotherapy as a treatment modality for cancer in northern Sri Lanka.

Significant proportions of patients either refuse or discontinue radiotherapy, even in the curative setting, leading to poor clinical outcomes. This study explores patient perceptions that underlie decisions to refuse/discontinue radiotherapy at a cancer care facility in northern Sri Lanka. An exploratory descriptive qualitative study was carried out among 14 purposively selected patients with cancer who refused/discontinued radiotherapy. In-depth semi-structured interviews were transcribed in Tamil, translated into English, coded, and thematically analyzed. All participants referred to radiotherapy as "current" with several understanding the procedure to involve electricity, heat, or hot vapour. Many pointed to gaps in information provided by healthcare providers, who were perceived to focus on side effects without explaining the procedure. In the absence of these crucial details, patients relied on family members and acquaintances for information, often based on second or third-hand accounts of experiences with radiotherapy. Many felt pressured by family to refuse radiation, feared radiation, or felt ashamed to ask questions, while for others COVID-19 was an impediment. All but three participants regretted their decision, claiming they would recommend radiation to patients with cancer, especially when it is offered with curative intent. Patients with cancer who refused/discontinued radiation therapy have significant information needs. While human resource deficits need to be addressed in low-resource settings like northern Sri Lanka, providing better supportive cancer care could improve clinical outcomes and save healthcare resources that would otherwise be wasted on patient preparation for radiotherapy.

An investigation into the acceptability, adoption, appropriateness, feasibility, and fidelity of implementation strategies for birth companionship in Tehran: a qualitative inquiry on mitigating mistreatment of women during childbirth

BackgroundA birth companion is a powerful mechanism for preventing mistreatment during childbirth and is a key component of respectful maternity care (RMC). Despite a growing body of evidence supporting the benefits of birth companions in enhancing the quality of care and birth experience, the successful implementation of this practice continues to be a challenge, particularly in developing countries. Our aim was to investigate the acceptability, adoption, appropriateness, feasibility, and fidelity of implementation strategies for birth companions to mitigate the mistreatment of women during childbirth in Tehran.MethodsThis exploratory descriptive qualitative study was conducted between April and August 2023 at Valiasr Hospital in Tehran, Iran. Fifty-two face-to-face in-depth interviews were conducted with a purposive sample of women, birth companions, and maternity healthcare providers. Interviews were audio-recorded, transcribed verbatim, and analyzed using content analysis, with a deductive approach based on the Implementation Outcomes Framework in the MAXQDA 18.ResultsParticipants found the implemented program to be acceptable and beneficial, however the implementation team noticed that some healthcare providers were initially reluctant to support it and perceived it as an additional burden. However, its adoption has increased over time. Healthcare providers felt that the program was appropriate and feasible, and it improved satisfaction with care and the birth experience. Participants, however, highlighted several issues that need to be addressed. These include the need for training birth companions prior to entering the maternity hospital, informing women about the role of birth companions, assigning a dedicated midwife to provide training, and addressing any physical infrastructure concerns.ConclusionDespite some issues raised by the participants, the acceptability, adoption, appropriateness, feasibility, and fidelity of the implementation strategies for birth companions to mitigate the mistreatment of women during childbirth were well received. Future research should explore the sustainability of this program. The findings of this study can be used to support the implementation of birth companions in countries with comparable circumstances.

Role Of Cities in NCD Prevention and Management: A Qualitative Research Study among Doctors

Background: Noncommunicable diseases (NCDs) such as diabetes, hypertension, and cardiovascular diseases are major global health concerns, surpassing the mortality rates of communicable diseases. These conditions pose significant challenges to global development, particularly in low- and middle-income countries where two-thirds of NCD-related deaths occur. In Pakistan, NCDs account for nearly 25% of all fatalities. The prevention of NCDs requires continuous lifestyle modifications, and evidence suggests that the physical environment and urban design play crucial roles in influencing health behaviors and outcomes. Objective: This study aimed to assess doctors' perspectives on the role of cities in the prevention and management of NCDs in Pakistan, and to identify barriers and enablers to the development of healthy city policies. Methods: This descriptive exploratory study employed a qualitative approach, conducted at various private hospitals in the Twin Cities. A purposive sample of approximately 20 doctors from medical units and outpatient departments participated in focus group discussions (FGDs). Data were collected using a semi-structured interview guide, and the FGDs were audio-recorded with participants' consent. Thematic analysis was performed to identify major themes and subthemes related to the role of urban environments in NCD prevention and management. Results: Participants recognized the importance of physical activity, healthy environments, and lifestyle modifications in preventing NCDs. Key barriers to physical activity included socio-cultural norms, environmental limitations, and political/legislative challenges. Facilitators included individual willpower, health-seeking behavior, supportive policies, and perceived benefits. Poor air quality and the lack of green spaces were significant contributors to the increased prevalence of NCDs. Participants emphasized the need for government intervention to improve urban infrastructure, promote physical activity, and enhance public health initiatives. Conclusion: Well-planned cities can significantly reduce the burden of NCDs by addressing modifiable risk factors. Governments must prioritize the development of infrastructure that promotes physical activity, improves air quality, and increases access to green spaces. Comprehensive multisectoral strategies are essential to combat the rising threat of NCDs, particularly in rapidly urbanizing areas.

Evaluating the new family medicine internship programmes in the Western Cape, South Africa

Background: In 2021, South Africa introduced a new 6-month internship in family medicine and primary care. This study aimed to assess the new rotation at district health facilities in the Western Cape.Methods: A descriptive survey of interns and supervisors, as phase-two of an exploratory sequential mixed methods study. Questionnaires were developed from a descriptive exploratory qualitative study. Data were analysed with the Statistical Package for Social Sciences.Results: Questionnaires were completed by 72 interns (response rate 21%) and 36 supervisors (response rate 90%), across 10 training programmes. Interns felt more independent (97.2%), confident (90.3%) and resilient (91.6%). They learnt to manage undifferentiated and chronic conditions (91.6%), to refer patients (94.3%) and conduct procedures (77.8%). Most interns were not exposed to community-based services (68.0%) and continuity of care (54.1%). Supervision was mostly adequate during the day (79.1%) and afterhours (80.6%). Many interns reported no structured teaching programme (41.7% – 55.6%). Most supervision was from medical officers and registrars. Supervisors saw interns as valuable members of the clinical team (100.0%), who required extra support and administration (42.5%). The majority of interns (75.0%) and supervisors (72.7%) thought the rotation was the right length and the best preparation for community service (67.6%).Conclusion: The rotation met most expectations of the Health Professions Council of South Africa. Programmes need to improve exposure to community-orientated primary care, public health medicine, palliative and ongoing care. Supervision and orientation of interns needs improvement.Contribution: This is the first evaluation of the new family medicine internship programme in South Africa.

Socio-technical transitions towards sustainable development: A proposal for learning assessment in livestock SMEs in the semi-arid Pampas of Argentina

The urgency to achieve the Sustainable Development Goals in the face of climate change has increased interest in studies on innovation niches in food systems. Strategic Niche Management in the framework of the Multi-Level Perspective considers that deep learning must be achieved in experimenting with innovations and demands greater understanding of instrumental aspects to guide the evolution of a niche. This study proposes to assess the progress of innovative performance towards sustainability of small and medium livestock enterprises in the Southwest of Buenos Aires, a fragile region of the Pampas biome of Argentina, as a result of learning generated in rural extension activities of the National Institute of Agricultural Technology (INTA) in order to identify leverage points in the process of technological change towards more sustainable systems. An exploratory-descriptive study was carried out using qualitative-quantitative methods. Ten producers were interviewed and the MESMIS method was proposed for the construction of indicators and assessment of learning goals towards sustainability. A rapprochement of producers from modal practices to more innovative ones was observed, reflecting conditions for the progress and consolidation of the niche. However, they need for greater professionalization and institutional articulation. The study generated a measurement instrument for the self-assessment of the niche enterprises and the planning of INTA's intervention strategies. It sought to broaden empirical research in Latin America, which is still scarce in approaches to socio-technical transitions, and to advance in the evaluation of experiments in transformative innovations on the agenda for the literature.

Practices developed by midwives from territory da Bocaina to assist women in the puerperal pregnancy period

The objective of this study is to describe the cultural practices used by midwives from Traditional Communities in the territory of Bocaina to assist women in the puerperal pregnancy period. It is a descriptive exploratory study with a qualitative approach. Data were collected from April to November 2022, based on semi-structured interviews with midwives in these communities. Data analysis was performed using the Bardin content analysis method. It was observed that the midwives in this territory have different knowledge, but all of them pass through empirical and traditional knowledge. Despite the advancement of science, knowledge, traditions and culture are still practices that they exercise and that are intertwined with mythical-religious affair, especially when it comes to the assistance provided to women in the puerperal pregnancy period. Its cultural practices are the main methods for assisting women in the puerperal pregnancy period, highlighting the use of medicinal plants, sympathies and blessings. It is concluded that midwives, in fulfilling their role, play an important role in health care in their community, especially in women's health.

Application of artificial intelligence in hypertension.

Hypertension is an important modifiable risk factor for morbidity and mortality associated with cardiovascular disease. The incidence of hypertension is increasing not only in Korea but also in many Western countries due to the aging of the population and the increase in unhealthy lifestyles. However, hypertension control rates remain low due to poor adherence to antihypertensive medications, low awareness of hypertension, and numerous factors that contribute to hypertension, including diet, environment, lifestyle, obesity, and genetics. Because artificial intelligence (AI) involves data-driven algorithms, AI is an asset to understanding chronic diseases that are influenced by multiple factors, such as hypertension. Although several hypertension studies using AI have been published recently, most are exploratory descriptive studies that are often difficult for clinicians to understand and have little clinical relevance. This review aims to provide a clinician-centered perspective on AI by showing recent studies on the relevance of AI for patients with hypertension. The review is organized into sections on blood pressure measurement and hypertension diagnosis, prognosis, and management.

Understanding Metaphors: A Study with Portuguese 4-6 Year-old Children

We present the first metaphor comprehension data from 36 Portuguese children aged 4, 5 and 6, using the TCM Júnior, a metaphor comprehension test for young children, in its European Portuguese version. This is an exploratory descriptive study, with a view to collecting data, contributing to the measurement and standardization of the resource used. TCM Júnior is an adaptation of its corresponding Italian acronym, which is in the process of being validated for the Portuguese population in this age group (4 to 6 years old). We describe the resource used, the TCM Junior, Metaphor Comprehension Test for 4-6 years old and the results obtained with a sample. The instrument used is in the process of gauging, or external validation that is, meeting normative data, although it is already subject to adaptation procedures, as it is an original test in Italian. In this study, 36 participants of both sexes participated. Although still incipient, because there are still few data, with groups by age and sex that are not equitable and significant, the results are promising. We will report on the data obtained and analyzed. Although still preliminary and exploratory, with a sample that is still not very representative and significant, the results appear to be not very distant from the averages obtained by their Italian counterparts. Keywords: metalinguistic awareness, understanding, figurative language, metaphors, TCM junior

Nursing Students’ Perceptions about the Effects of Climate Change on Health: A Descriptive Exploratory Study

Background: Climate change is recognized as an important health concern that the health sector and nurses must prepare for. Adequate preparation and understanding of its effects on health must be exemplified by nurses and nursing students. Previous studies showed that nurses and nursing students have good knowledge of climate change and its effects on health. However, none of these studies were conducted in the Philippines.Purpose: This study explored the perceptions of nursing students about the effects of climate change on health.Methods: The researchers utilized a descriptive qualitative research design. The study was conducted among level three Bachelor of Science in Nursing students selected through purposive sampling using the following criteria: a) students who were enrolled with a full load of units in the BSN course, and b) those who have not taken Disaster Nursing course in the previous semesters. A total of 35 participants were included in the study. Data collection was done through an interview using a researcher-made interview guide. Data analysis was done through content analysis.Results: Two major themes were identified, which describe the perceptions of the nursing students about the effects of climate change on health. The findings revealed that the respondents have an adequate understanding of what climate change is and the factors that cause it. The respondents also mentioned that climate change negatively affects the physiological health of humans. Specifically, climate change increases the risk for non-communicable disease such as cardiovascular and respiratory diseases. It also alters certain characteristics of communicable diseases such as prevalence, seasonal pattern, and geographic distribution.Conclusion: The findings revealed that student nurses know what climate change is and are aware that it negatively affects health. However, their perceptions of the effects of climate change on health are limited to its physiologic effects, specifically on non-communicable and infectious disease, as this reflects their understanding of how environmental factors affect disease pathogenesis or development.

Identifikasi Ektoparasit pada Kelelawar di Gua Kenculit Desa Mekar Sari Kabupaten Lombok Tengah

Identifikasi Ektoparasit pada Kelelawar di Gua Kenculit Desa Mekar Sari Kabupaten Lombok Tengah

Critical care nurses’ experiences of communication- vulnerable patients in the intensive care unit and the influence on rendering compassionate care

Background. Interventions administered to critically ill patients, including mechanical ventilation, sedation or other treatments may hinder communication between patients and nurses. These communication challenges may affect critical care nurses’ ability to provide compassionate, person-centred care. Objective. To identify nurses’ experiences with patients who are communication-vulnerable in the intensive care unit and how they affect nurses’ ability to offer compassionate care. Method. This qualitative explorative descriptive study involved nurses who worked in intensive care units from four private hospitals in Gauteng, South Africa. Focus groups were conducted with 30 critical care nurses in groups of two to six participants each. Thematic analysis was used to identify themes. Results. Five main themes were identified based on nurses’ reports of their experiences with critically ill patients who experience communication difficulties and their impact on rendering compassionate care. Themes were deductively identified based on the social purposes of communication categories. Participants indicated that communication-vulnerable patients influence their ability to provide compassionate care. Generally, the physical, emotional, social and communication difficulties of assisting communication-vulnerable patients caused nurses to feel frustrated and negative towards their work environment, which added to their work stress and sometimes resulted in compassion fatigue. Conclusion. The study shows that various factors could impact the nurses’ ability to provide compassionate care and that they require support to provide person-centred care. These factors can include the physical environment, the patient’s alertness and awareness and institutional barriers. To support nurses in providing compassionate care, communication partner training may be warranted.

Data-Driven Decision Support Tool Co-Development with a Primary Health Care Practice Based Learning Network

Background The Alliance for Healthier Communities is a learning health system that supports Community Health Centres (CHCs) across Ontario, Canada to provide team-based primary health care to people who otherwise experience barriers to care. This case study describes the ongoing process and lessons learned from the first Alliance for Healthier Communities’ Practice Based Learning Network (PBLN) data-driven decision support tool co-development project. Methods We employ an iterative approach to problem identification and methods development for the decision support tool, moving between discussion sessions and case studies with CHC electronic health record (EHR) data. We summarize our work to date in terms of six stages: population-level descriptive-exploratory study, PBLN team engagement, decision support tool problem selection, sandbox case study 1: individual-level risk predictions, sandbox case study 2: population-level planning predictions, project recap and next steps decision. Results The population-level study provided an initial point of engagement to consider how clients are (not) represented in EHR data and to inform problem selection and methodological decisions thereafter. We identified three initial meaningful types of decision support, with target application areas: risk prediction/screening, triaging specialized program referrals, and identifying care access needs. Based on feasibility and expected impact, we started with the goal to support earlier identification of mental health decline after diabetes diagnosis. As discussions deepened around clinical use cases associated with example prediction task set ups, the target problem evolved towards supporting the upstream task of organizational planning and advocacy for adequate mental health care service capacity to meet incoming needs. Conclusions This case study contributes towards a tool to support diabetes and mental health care, as well as lays groundwork for future CHC EHR-based decision support tool initiatives. We share lessons learned and reflections from our process that other primary health care organizations may use to inform their own co-development initiatives.

Perceptions and Experiences of Inequity for Women of Refugee Background Having a Baby during the COVID-19 Pandemic in Melbourne, Australia.

Listening to What Matters is an exploratory descriptive qualitative study that aimed to (1) understand how women of refugee background in Melbourne, Australia experienced access to health information and maternity and/or early parenting care during the COVID-19 pandemic and (2) whether pandemic health directives had an impact on structural inequities for women of refugee background who received maternity and/or early parenting care during the COVID-19 pandemic. Semi-structured interviews were conducted with 41 participants including 17 women of refugee background, who identified as belonging to the Karen, Assyrian Chaldean, Iraqi, Syrian, Afghan, Sudanese, or South Sudanese communities and 24 health and social care professionals who identified as providing pregnancy or early parenting care during the pandemic in the north western suburbs of Melbourne. Interviews with women were conducted in preferred languages by community researchers. Interviews with professionals were conducted in English by researchers. Reflexive thematic data analysis included constructivist positionality and a trauma and violence informed approach. The results reported in this paper include three themes, with four accompanying subthemes, as follows: theme (1), 'Structural inequities and the toll of the pandemic'; theme (2), 'Supportive infrastructure'; and theme (3), 'Cultural safety during the pandemic'. The results demonstrate that cumulative negative impacts such as unequal access to health information, family separation and isolation, inadequate household income, and mental and social health concerns had the potential to amplify pre-existing structural inequities for women of refugee background. Community engagement facilitated by bicultural workers, interpreters, and trusted care providers facilitated fast-paced, two-way communication that built capacity and health literacy for women who were unable to speak English and unfamiliar with the health care system and, improved experiences of care. More research is needed to understand how the intersectional cumulative impacts of structural inequities have affected maternal and neonatal health outcomes for women of refugee background during the pandemic, as well as any differences in maternal and neonatal health outcomes between Australian-born and refugee background women and babies.

Registrars' experience with research in family medicine training programmes in South Africa.

Completion of a research assignment is a requirement for specialist training in South Africa. Difficulty with completion delays graduation and the supply of family physicians. The aim of this study was to explore the experience of registrars with their research in postgraduate family medicine training programmes. An explorative descriptive qualitative study. Extreme case purposive sampling selected registrars who had and had not completed their research on time, from all nine training programmes. Saturation was achieved after 12 semi-structured interviews. The framework method was used for data analysis, assisted by ATLAS.ti software. The assumption of prior learning by teachers and supervisors contributed to a sense of being overwhelmed and stressed. Teaching modules should be more standardised and focussed on the practical tasks and skills, rather than didactic theory. Lengthy provincial and ethics processes, and lack of institutional support, such as scholarly services and financial support, caused delays. The expertise of the supervisor was important, and the registrar-supervisor relationship should be constructive, collaborative and responsive. The individual research experience was dependent on choosing a feasible project and having dedicated time. The balancing of personal, professional and academic responsibilities was challenging. Training programmes should revise the teaching of research and improve institutional processes. Supervisors need to become more responsive, with adequate expertise. Provincial support is needed for streamlined approval and dedicated research time.Contribution:The study highlights ways in which teaching, and completion of research can be improved, to increase the supply of family physicians to the country.

Exploring experiences of HIV care to optimize patient-centred care in Conakry, Guinea: a qualitative study.

Studies on the organisation of care and the power dynamic between providers and patients with HIV in sub-Saharan Africa are rare. This study aims to describe the patient-provider relationship and explore the challenges to optimal and patient-centred care for HIV patients. This was a qualitative exploratory descriptive study using in-depth individual interviews and focus group discussions. In total, 17 individual interviews and 5 focus group discussions were conducted. This was conducted in four urban health facilities in Conakry, the capital of Guinea. Three group of participants were included in this study namely patients with HIV; health providers including facilities and services managers; and psychosocial counsellors. Psychosocial counsellors provide emotional and psychosocial support to HIV patients. Their role in the organization care in Guinea is new and they contribute to strengthening adherence of patients with HIV to ARV treatment. Patients with HIV, health providers, and psychosocial counsellors have a positive perception of the patient-provider relationship. This relationship was characterized essentially by maintaining confidentiality of HIV status disclosure, caring attitudes towards patients (being available, adjusting locations for accessing ART, based on patients' preferences), and participating in HIV patient's social life. However, scolding and miscommunication about the interpretation of viral load tests were reported. The shortage of human resources, low salaries of health staff, poor infrastructure, and the financial burden borne by patients with HIV impede the implementation of optimal patient-centred care. Integrating psychosocial counsellors in HIV care organization, improving access to ARV, infrastructure, increasing human resources, and removing the financial burden for HIV patients are needed to optimal patient-centred care in Guinea.

Parental experiences in navigating health services for paediatric residual obstructive sleep apnoea: An exploratory qualitative descriptive study.

To explore parents' experiences and perceptions regarding engagement in health services for managing residual paediatric obstructive sleep apnoea (OSA) across levels of care. Qualitative description guided study design. Data were collected through semi-structured interviews with parents of children diagnosed with residual OSA at a university-based sleep clinic. The relevant literature informed the interview guide and was piloted before data collection. Inductive, manifest content analysis was used to describe parents' perceptions and experiences using data-driven categories and sub-categories. Several strategies were employed to ensure rigour in this study. Eight interviews were conducted. Parents' views were organized into five categories: awareness of the sleep issue, interaction with non-sleep specialists, interaction with sleep specialists, interaction with dental professionals, and further actions and support. Parents reported several engagement issues due to their interactions with different care providers. These issues included having to personally identify and raise the sleep problem, feeling that care providers did not take this problem seriously, waiting for an extended period to be referred for sleep services, and receiving conflicting or insufficient treatment recommendations. Overall, parents perceived that their actions and the services received across levels of care were not effective enough to address paediatric OSA. Based on this exploratory qualitative descriptive research, along with developing evidence-based clinical guidelines for paediatric OSA screening and management tailored to different levels of care, strategies intended to improve the engagement of patients and care providers in addressing paediatric OSA should be developed and empirically tested.

Singapore nurses’ perception of professional identity

Introduction: Nurses’ professional identity is important for their career orientation and clinical practice. This study explored Singaporean nurses’ perceptions of professional identity. The results provide an understanding of how guided learning and reflection could help nurses in their professional identity formation and development. Methods: Using an exploratory descriptive qualitative research study and purposive sampling by researchers teaching in the programme, 64 Registered Nurses with a diploma qualification pursuing a Bachelor of Science degree with Honours in Nursing programme in Singapore were invited to participate. They responded to open ended survey questions online, which were analysed using a thematic analysis. Ethical approval was obtained. Results: All 64 first year students were invited to participate at the start of the module and upon the completion. The response rates were 94% and 81% respectively. Two overarching themes – “nurses as professionals with knowledge and moral character” and “the construction of professional identity” - emerged from the data. Conclusion: The nurses perceived their professional nursing identity as a construct comprised of knowledge and moral characteristics, which is consistent with international literature. A professional nursing identity, relationships with other healthcare professionals, patients and confidence in practice were all interrelated. Guided reflection and discussion on clinical experiences and social interactions helped students become aware of their professional identity and responsibilities. Such purposive educational effort needs to be started early and supported through the students’ educational journey into clinical practice. Keywords: Professional Identity of Nursing, Singapore Nurses, Image of Nursing, Social Perception of Nursing in Singapore, Nurse Education

Audiobooks cabins project )Masmooa( in the Kingdom of Saudi Arabia: An exploratory descriptive study

Audiobooks cabins project )Masmooa( in the Kingdom of Saudi Arabia: An exploratory descriptive study

Community perceptions, beliefs and factors determining family planning uptake among men and women in Ekiti State, Nigeria: finding from a descriptive exploratory study

ObjectivesTo examine family planning through the community’s perception, belief system and cultural impact; in addition to identifying the determining factors for family planning uptake.DesignA descriptive exploratory study.SettingThree communities were selected...