Exploratory Study Research Articles

Innovative Game-Based Teaching Methods for Promoting Nursing Students' Cultural Competence and Attitudes Toward Refugees: An Explanatory Sequential Mixed Study.

Nursing cultural competence is crucial for enhancing the quality of care for refugees. While innovative game-based teaching methods have been used to foster in a wide range of clinical competences, little is known about its use on refugees' care. This study aims to evaluate the effect of these methods on nursing students' cultural competence and attitudes toward refugees. An explanatory sequential mixed design was conducted from March to May 2023. One-hundred forty-one nursing students participated. There were no statistically significant differences in total Outgroup Threat Perception Scale and Cultural Competence Assessment Scale scores between the experimental and control groups, pre- or post-intervention. However, students reported increased awareness and empathy for refugee issues. The study showed that innovative game-based teaching methods effectively increased nursing students' awareness of health-related issues faced by refugees. It recommends incorporating transcultural nursing courses into curricula and professional training, with updated content on migration and refugee issues.

Strategies for Strengthening Network Capacity in the Implementation of Food Security Policies at the Local Level in Indonesia

This study aims to analyze network management strategies in the interactive governance perspective in the implementation of food security policies in North Luwu Regency, Indonesia. The complexity of food security issues requires effective collaboration and interaction among various actors in the policy network. Using a qualitative approach with an explanatory case study design, this research examines seven indicators of network management strategies: network (de-)activating, constitutional reform, (de)coupling games, changing incentives, changing internal structure and position of actors, changing relations, and management by chaos. Data were collected through in-depth interviews, participatory observation, and document analysis, involving relevant stakeholders from government agencies, farmer organizations, and private sector partners. The findings reveal that the application of network management strategies facilitates interaction among network actors and contributes to the success of interactive governance in implementing food security policies. Network (de-)activating involves the engagement of new coalitions and resource mobilization to strengthen cooperation and interaction. Constitutional reform through changes in rules and resources helps develop coordination mechanisms and strengthen policy integration. (De) coupling games demonstrate the separation of strategies carried out by various actors to support a holistic approach in achieving food security. Changing incentives through incentive interventions can increase motivation and active participation of actors in realizing food security. Changing relations indicate changes in cooperative relationships and actor roles to enhance effective collaboration. Management by chaos through the application of principles of flexibility, adaptability, and the ability to manage uncertainty can strengthen interactive governance in facing complex and dynamic challenges. This study recommends strengthening cross-sectoral collaboration, developing a structured incentive system, enhancing the capacity of farmer organizations, and optimizing the use of information technology to improve the success of interactive governance in food security policy implementation.

Exploring Gender Equity in Tanzania- A Comprehensive Study on the Need for Inclusive Practices in Selected Major Media Houses in Tanzania

This study investigates gender equity in Tanzanian print media, particularly focusing on women's leadership. Utilizing a qualitative approach with an interpretivist paradigm, the explanatory case study design includes 12 in-depth interviews. The research unveils the impact of Stereotype Theory on employment promotion policies, emphasizing challenges related to family life and child-rearing in career advancement. Challenges in adhering to maternity leave regulations are identified, hindering the balance between family planning and career progression for female journalists. The study highlights subjective performance evaluations, favoritism concerns, and a lack of transparency in promotion policies, contributing to gender inequity. A glass ceiling is noted at middle and senior management levels. Recommendations include implementing supportive structures for working mothers, revising promotion policies for transparency, and fostering a workplace culture that actively promotes inclusivity. The aim is to create a more equitable and inclusive media industry in Tanzania.

Abstract 4135780: Predictors of Engagement in a Coaching Intervention for Heart Failure Caregivers

Background: Even the best intervention will not be effective without engagement in the experience. We developed and tested a virtual health coaching intervention ("ViCCY”, Virtual Caregiver Coach for You) for informal caregivers of patients with HF in a RCT. Of the 125 caregivers in the intervention group, completion rates varied (mean 6 ± 4 sessions, median 9; 21% no sessions). The aim of this study was to identify factors associated with intervention engagement defined as receipt of ≥8 of 10 intervention sessions over a 6-month period based on core intervention content. Methods: This explanatory sequential mixed methods study was conducted in two phases. First quantitative data were analyzed with respect to number of completed sessions, sociodemographics, and the Credibility-Expectancy Questionnaire measuring expectations regarding intervention effectiveness. We used multivariable logistic regression to quantitatively identify salient predictors of caregivers’ intervention engagement. Then, based on the number of sessions completed, 24 caregivers assigned to ViCCY were interviewed to explore individual, family, community, and societal factors associated with intervention engagement. Transcribed interviews were coded using content analysis. Results: Each one hour increase in hours caregiving was associated with reduced odds of completing ≥8 sessions. Race other than White and income insufficient to make ends meet were associated with reduced odds of completing ≥8 sessions. Each unit increase in intervention credibility was associated with increased odds of completing ≥8 sessions. Interviews with participants who completed some sessions revealed common challenges such as the patient’s HF progression and life events including caregiver health issues, balancing multiple responsibilities, and interpersonal issues. Reluctance to accept help from an unfamiliar individual through a virtual network and perceiving additional resources as burdensome also hindered participation. Practical issues such as finding a suitable space for virtual meetings and scheduling conflicts interfered. In those who did not complete any sessions, the main reason for non-engagement was misunderstanding of what to expect in the intervention. Conclusions: The daily lives of HF caregivers are influenced by caregiving demands exacerbated by social determinants of health. These issues may reduce the capacity of caregivers to accept help and ultimately act as a barrier to program engagement.

Using School-Based Teleconsultation Services to Make Community Health Services Accessible in Semirural Settings of Pakistan: Sequential Explanatory Mixed Methods Study.

In Pakistan's remote areas, quality health care and experienced professionals are scarce. Telehealth can bridge this gap by offering innovative services like teleconsultations. Schools can serve as effective platforms for introducing these services, significantly improving health service access in semirural communities. This study aims to explore the feasibility of introducing school-based teleconsultation services (TCS) to strengthen community health in a semirural area of Karachi, Pakistan. This study used a mixed methods design. A total of 393 students were enrolled for the quantitative component, while 35 parents, teachers, and community stakeholders participated in the qualitative arm (focused group discussion). Proportional computation for the quantitative data was done using SPSS (version 24; IBM Corp), while qualitative data underwent thematic analysis. A total of 1046 successful teleconsultations were provided for 393 students over 28 months. The demographic data showed that the mean age of the students availing TCS was 9.24 (SD 3.25) years, with the majority being males (59.3%, 233/393). Only 1.24% (13/1046) of cases required referrals. The qualitative analysis yielded three themes: (1) transformation of the health care experience, (2) escalating demands for teleconsultation, and (3) the psychological aspect of care. This study demonstrated the efficacy of integrating TCS in a semiurban school in Karachi to address health care accessibility gaps. Implementing TCS through the school platform improved the overall health status of school children while reducing school absences and financial burdens on families. The study highlighted TCS's cost-effectiveness, time efficiency, and quality, with community support for 24/7 availability, expansion to adults, and a reimbursement model. School health nurse-led TCS offers a scalable solution to health care challenges, enhancing health outcomes for school-going children in Pakistan and globally, particularly in low- and middle-income countries, where accessibility is a major issue.

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

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

Enabling pharmacist prescribing: Lessons learned in Nova Scotia using behaviour change theory.

The COVID-19 pandemic alongside increased patient demand, enablement of scope, and government funding has accelerated the need and demand for pharmacist prescribing in Nova Scotia. A sequential explanatory mixed-methods study was undertaken to understand barriers and facilitators to pharmacist prescribing in Nova Scotia, Canada. This consisted of: 1) a cross-sectional survey and 2) semistructured, qualitative interviews with pharmacists practising in the community. The survey and interviews were designed using the Behaviour Change Wheel that encompasses the Capability Opportunity Motivation Model of Behaviour Change (COM-B) and Theoretical Domains Framework version 2 (TDFv2). Of 190 survey respondents, the percentage who prescribed 15+ times/month increased from 49% before to 80% during the COVID-19 pandemic (P<0.001). Pharmacists identified knowledge, social norms/pressures, and rewards or consequences related to how and when to prescribe as facilitators (Knowledge, Social Influences, and Motivation TDFv2 domains, respectively). Barriers included the environmental context and fear of negative outcomes (Environmental Context and Resources and Beliefs about Consequences, respectively). Through the interviews, the presence of prescribing decision tools (Memory, Attention and Decision Processes) and a supportive organizational culture (Environmental Context and Resources) were facilitators. Worry was expressed about making mistakes (Beliefs about Consequences) and feeling significant pressure to meet patient demand (Social Influences) in a busy setting (Environmental Context and Resources). Supports to better enable pharmacist prescribing are described, with key messages for pharmacists, pharmacy owners/managers, educators, advocacy bodies, regulators, and government identified. Pharmacist prescribing has increased significantly over a short period of time. Environmental supports (e.g., time, space, access to patient records), government funding, peer support, and public awareness are needed to optimize and fully implement these practice changes.

Assessment of Quality of Life and Determinants Among the Elderly Population in Rural Areas of Puducherry: A Mixed Method Study

Background: Elderly people living in rural areas often faces unique challenges that affect their quality of life (QOL), including limited access to healthcare and social support. Understanding the factors influencing their well-being is essential to improve the quality of life. The study aims to assess the QOL and its determinants among the elderly in rural areas of Puducherry. Methods: A community based sequential explanatory mixed method study was conducted among the elderly residing in the rural field practice area of a medical college in Puducherry district. 200 participants were recruited by simple random sampling from the family health records in the Rural Health Training Centre of a medical college. WHO QOL-BREF questionnaire was used to assess the Quality of Life quantitatively and an interview guide to explore its determinants. Data were entered in MS excel and analyzed using SPSS v16.0. Results: The mean age of the participants was 68.8± 2.5 years with majority being females. The environmental domain scored the highest mean QOL and psychological domain the lowest mean QOL. The overall mean QOL was 234.8 ± 65.4. The main determinants of poor QOL are age ≥ 75 years, lower socio-economic class, those who are widow/separated and presence of comorbid conditions. The binary logistic regression predicts the factor for poor QOL was age ≥ 75 years with OR (95% CI) as 6.23 (2.44-15.91). Conclusion: The overall mean QOL was moderate. The factors identified for poor QOL need to be addressed with key intervention strategies. Quality affordable medical services at door step to improve physical domain and targeted health education for family members and the community, who form the immediate environment around the elderly, can play a crucial role in enhancing the social domain.

Navigating Generational Change: The Role of Leadership Skills in Sustaining Family Businesses in Indonesia

A 2014 PwC survey reported that 60% of the next generation is involved in senior executive roles within family businesses, and 27% are present in the company but not as senior executives. The survey also indicated that 37% of family businesses extend up to the second generation, and 33% reach the third generation. This highlights a phenomenon in Indonesia—the lack of sustainability of family businesses across multiple generations. While acknowledging the importance of accounting, management, and internal control, effective leadership in the succeeding generation can further ensure the sustainability of a family business. Therefore, it is crucial for the preceding generation to engage in efforts to acquire or prepare for such leadership. The paradox concerning the importance of the next generation in family businesses is seen as a fundamental phenomenon for developing specific hypotheses with reference to the relationship between leadership, organizational change capability, and the sustainability of family businesses. This enables these businesses to continue thriving and expanding. This study aims to identify and analyze the rules and relationships between skills, the capability of change, and the economic sustainability of family businesses in Indonesia. Utilizing a quantitative approach with an explanatory study design, the research concludes that the impact of leadership skills on the economic sustainability of family businesses, the effect of change capability on economic sustainability, and the moderating role of change capability on the relationship between leadership skills and economic sustainability are all significant, albeit at varying levels of significance. The indirect influence of leadership skills on economic sustainability through change capability is also significant, though minimal. When change capability acts as a moderator, it is proven to strengthen the relationship between economic sustainability and leadership skills.

Predictors of neonatal hypothermia within six hours of birth and exploring preventive practices among post-natal mothers in Kilimanjaro region: Explanatory sequential mixed method protocol.

Neonatal hypothermia is a worldwide problem that can lead to a high impact on neonatal health outcomes if appropriate thermal care measures are not implemented. Tackling neonatal hypothermia from the time of delivery with appropriate thermal care measures will increase neonatal survival and decrease complications related to hypothermia. The study aims to determine the predictors of neonatal hypothermia within six hours of birth and explore its preventive practices among postnatal mothers. This is a mixed-method sequential explanatory study. The first phase will be a quantitative study with a hospital-based analytical cross-sectional design. 325 neonates and their mothers will be randomly selected through a 4-stage sampling technique. The data will be collected using a structured questionnaire, checklist and documentary review. Descriptive and inferential statistics will be used to analyse the data. The second phase will be a descriptive qualitative study involving postnatal mothers who participated in a quantitative study. The data will be collected via in-depth interviews, and thematic analysis will be used to analyse the data. The findings of quantitative and qualitative studies will be triangulated in the discussion. This study will provide a wide understanding of neonatal hypothermia in the region which will help healthcare providers who are caring for neonates to be informed about the current situation, evaluate the care they provide, and find the best way to adhere to thermal care measures. Moreover, the practices of postnatal mothers will be known, which will help to develop tailored interactions to address this problem.

Females wanna-be entrepreneurs need empathic heroes

PurposeDespite the well-documented importance of empathy and mentoring in entrepreneurship, there is a need for a deeper understanding of how empathy influences individuals’ “willingness to be mentored”.Design/methodology/approachThis paper investigates gender differences in “Willingness to be mentored” based on the mentor’s types of empathy (cognitive vs affective) and entrepreneurship (social vs for-profit). Drawing on the personal identification and the entrepreneurship literature, we measured the respondents’ “Willingness to be mentored” by manipulating the type of empathy and entrepreneurship and comparing its effect between male and female respondents. Primary survey data were collected from master’s degree students in entrepreneurship from diverse business schools. An explanatory qualitative study on female start-uppers complemented the findings.FindingsThe results from the quantitative study show that female respondents prefer to be mentored by an entrepreneur who exhibits some affective empathy rather than only cognitive empathy, with a preference for a social entrepreneur. The qualitative study confirms the evidence. This research contributes to the discussion on developing social capabilities to succeed in new ventures. It extends our understanding of the importance of empathic entrepreneurs as mentors to foster entrepreneurship among women.Originality/valueTheoretically, we demonstrate the existence of a gender difference in “Willingness to be mentored” based on the type of empathy displayed by the entrepreneur. Additionally, we introduce a new construct in the entrepreneurship literature, “Willingness to be mentored”, and differentiate it from “Attitude toward entrepreneurship”.

The Duties of Sangging in the Implementation of the Hindu Religious Ceremony of Manusa Yadnya Metatah Mass in Bali: A Study of Occupational Health Science

Occupational Health and Safety (K3) is our effort to create a healthy and safe working environment, so that it can reduce the probability of work accidents / diseases due to negligence that result in demotivation and deficiencies in work productivity. According to the Basic Health Law of the Republic of Indonesia No. 9 of 1960 Chapter I Article II, Occupational Health is a health condition that aims for workers to obtain the highest level of health, both physical, spiritual and social, with prevention and treatment efforts for diseases or health disorders caused by work and the work environment or general diseases. in all work activities in human social and religious life such as research on mass metatah ceremonies that are often carried out by Hindus in Bali, in this case the position of the sangging is the key in this metatah ceremony. Sangging is a person who is tasked with cutting teeth during the metatah ceremony. The duties of the sangging in carrying out metatah are to sharpen the two canine teeth and four incisors in the upper jaw with a file. Providing toothpaste made from turmeric, betel lime and sandalwood rubbing. Following up on the Yama Pati Tatwa palm leaf, a sangging needs to understand the structure of tooth tissue and occupational health science to maintain the sanctity of the ceremony. The metatah ceremony or 'mepandes', 'mesangih' or 'metah ceremony' (Balinese) is a Hindu religious ceremony that must be carried out by all Hindus in Bali. The metatah ceremony contains meaning for life, namely changing behavior to become a true human being who can control himself from the temptation of lust, and fulfilling the obligations of parents to children in order to find the true nature of humanity. This study aims to analyze the nature of the implementation of the mass metatah ceremony in Bali Province in the study of occupational health science. The research design uses a case study based on its type, namely an explanatory case study, which focuses on the mass metatah ceremony. Data is analyzed descriptively and carefully until complete. The results of the study indicate that: 1) occupational health knowledge for the sangging in the mass metatah ceremony has the nature to achieve the maximum goal of the yadnya metatah ceremony, namely suppressing bad thoughts, words, and behavior by controlling themselves from the temptation of lust; 2) the process of implementing the metatah ceremony carried out by a sangging is done by filing both canine teeth and four jaw incisors. However, the process is carried out carefully according to health science and the impact of mass metatah, namely social, psychological, health and economic impacts. The implications of the research results, namely the implementation of the 'manusia yadnya' metatah must be carried out carefully by paying attention to health risks when the metatah ceremony is carried out, internence and application of occupational health science need to be carried out so that religious ceremonies become pure physically and mentally according to the purpose of the metatah ceremony.

A sequential explanatory mixed method study of maternal and fetal outcome in gestational diabetes mellitus using Diabetes in Pregnancy Study Group India (DIPSI) test in Puducherry

ABSTRACT Background: Gestational diabetes mellitus in pregnancy is associated with polyhydramnios, macrosomia, and shoulder dystocia, and it also increases maternal and perinatal mortality. Methods: This sequential explanatory mixed-method study was conducted for six months. All the pregnant women attending the outpatient department of the Obstetrics and Gynaecology Department at 24-28 weeks of gestation were subjected to universal screening with 75 gms of glucose and 2 hours of plasma glucose &gt;140 mgs% is taken for diagnosis (according to DIPSI guidelines). After diagnosis, they were subjected to an HbA1c test. Women with HbA1c is &gt;6.5% were excluded from the study. If pregnant women are screened negative by the DIPSI test, the test was repeated in the third trimester (32-34 weeks of gestation). Chi-square tests were used to find out the test of association for quantitative data and manual content analysis was performed for qualitative data. Results: DIPSI test was found to decrease the adverse maternal and neonatal outcome by early screening and management. The stakeholders’ perspectives identified by key informant interview were improper knowledge and awareness about the testing and others were anxiety and fear associated with the testing procedure. Conclusions: As DIPSI test is an effective single step in screening and diagnostic test, hence all pregnant mothers should undergo this glucose challenge test in their antenatal visits.

Are the mothers admitted for childbirth in a tertiary care hospital satisfied with the health care services? A mixed methods study from Mangaluru, Karnataka state, India

ContextPatient Satisfaction is the strongest determinant of hospital functioning and is an indirect or proxy indicator of the quality of doctor. AimsThe study aims to assess maternal satisfaction with healthcare services during childbirth during hospital stay, explore factors influencing satisfaction, and assess the perceptions of both mothers and their bystanders regarding the healthcare services provided. Methods and materialIt is a sequential explanatory mixed method study conducted in the Obstetrics and Gynaecology department in a tertiary college hospital among 291 pregnant women admitted for childbirth. Quantitative data obtained using expert validated questionnaire was entered in an Excel sheet and analyzed using IBM SPSS Version 23. Descriptive statistics were reported as median (IQR) for continuous variables and as frequencies and proportions for categorical variables. Normality was tested using Shapiro Wilk test and to test significant difference in satisfaction scores across the variables Mann Whitney U test was used. For the qualitative phase, in-depth interview was conducted to explore factors determining patient satisfaction in healthcare services. ResultsQuantitative results showed that mothers were satisfied with the admission process, support given during breastfeeding, immunization and vaccination, health education and very satisfied with the privacy, doctors and nursing services, overall cleanliness. Qualitative results revealed the admission process was time consuming, overall cleanliness was poor, guidance on breast feeding and immunization and service provided by doctors and nurses are good. ConclusionThe study concluded that while mothers were generally satisfied with healthcare services, particularly with support during breastfeeding, immunization, and doctor and nursing services, there were concerns about the admission process and overall cleanliness.

Systems delay in women with breast cancer – A sequential explanatory mixed-methods study from central rural India

ABSTRACT Background: Globally, breast cancer is the most common malignant tumor in both developed and developing nations, with an incidence of 2 million cases every year and around 6 lakh deaths. Even after the availability of healthcare facilities, delays in the management of breast cancer are seen in both developed and developing countries. Objectives: To assess the patient and system-level delays and to determine the factors that cause the identified delays in women with breast cancer from central rural India. Methodology: The present Mixed-method study was conducted in a tertiary care hospital in central rural India among 128 female breast cancer patients. Socio-demographic and clinical information of the patients was summarized using frequency and proportions. Delays were reported using a median number of days and interquartile range. To assess the factors associated with the delays, we used Negative log-binomial regression analysis. Qualitative data analysis was done by manual thematic analysis. Results: The mean age of the study participants was 50.54, SD was 10.46, Median was 50, and the Interquartile range (IQR) was 43-58 years. A median patient delay of 45 days, and IQR was 15-120. A median system delay of 19 days and IQR was 7-35 days. We identified seven themes addressing the factors influencing delays at various levels by thematic analysis. Negative log-binomial regression models were built for the association of the socio- demographic and clinical variables with patient and system delays. Conclusion: Our study concludes that there is a substantial delay at patient level reporting to healthcare care providers, which needs an increase in awareness levels in the community through dedicated Behavior Change Communication strategies along with addressing identified socio-cultural and economic determinants influencing delay at various levels.

Burden and challenges in managing TB infection among people with occupational exposure to silica in India.

Occupational exposure to silica increases the risk of TB infection (TBI) and disease. This study aimed to determine the prevalence of TBI and explore challenges in TBI management in such individuals in two districts of India during 2023. This was an explanatory mixed-methods study with a quantitative cohort design and qualitative descriptive in-depth interviews. Among 1,555 individuals with occupational exposure to silica, 593 (38%, 95% CI 36-41) underwent interferon-gamma release assay (IGRA) for TBI, of whom 255 (43%, 95% CI 39-47) were found IGRA-positive. Males with occupational silica exposure for ≥20 years had a significantly higher risk of TBI. Of these 160 individuals eligible for TB preventive therapy (TPT), 153 (96%, 95% CI 92-98) were initiated on TPT and 124 (81%, 95% CI 74-88) completed TPT. The low uptake of IGRA was attributed to the stigma associated with TB and reluctance to undergo any medical evaluation. Compared to the general population, individuals with occupational exposure to silica have an almost two times higher prevalence of TBI. Further research is required to identify the threshold of silica exposure to be considered for screening for TBI. Efforts to increase awareness and decrease stigma can improve the uptake of testing for TBI and TB disease.

Impact of Disease Cyclicity on Quality-of-Life Impairment – A Mixed Method Explanatory Study

BackgroundDisease cyclicity, a composite measure of unpredictable and daily fluctuations of symptoms, strongly predicts quality-of-life (QoL) impairment. ObjectiveTo explore the mechanisms by which cyclicity impacts QoL. Methods1:1 semi-structured interviews were conducted and qualitatively analyzed using grounded theory. Common themes were identified and used to derive a theoretical framework. Results23 adults, (median age 28.5, range 20-72) with a range of chronic inflammatory diseases including eczema, psoriasis and inflammatory arthritis were prospectively recruited. Cyclicity, characterized by unpredictability, uncontrollability, and lability, contributed to a varying productivity and inconsistent ability in performing daily activities. Challenges intensified if external expectations of the patient were inconsistent with their fluctuating ability. Coping abilities, shaped by internal and external factors, moderated the relationship between cyclicity and QoL impairment. LimitationsQualitative interviews assume patients have accurate insights into their own behaviours. The generalizability of findings may be limited in other populations. ConclusionDisease cyclicity defines many inflammatory diseases. This study provides a theoretical framework for understanding and managing the challenges patients with a cyclical condition face.

Examining the Impact of PBIS Experience on MTSS Implementation in Secondary Schools: A Mixed Methods Study

This sequential explanatory mixed methods study with a complementarity rationale examined the differential experiences of MTSS implementation in three Positive Behavior Interventions and Supports (PBIS)-implementing and three non-implementing secondary schools in the Midwestern United States. Using a survey and follow-up interviews with a sample of 25 secondary school leadership team (SLT) members, this study sought to understand (1) their beliefs and attitudes toward MTSS prior to implementation and (2) unique barriers and facilitators to MTSS implementation in secondary education following initial MTSS implementation. Overall, the results of this study indicated that generally, SLT members had positive beliefs and attitudes toward MTSS prior to implementation which were maintained a year later at follow-up. Additionally, several differential barriers and facilitators to implementation emerged between PBIS and non-PBIS schools, though shared barriers and facilitators were also evident. Lastly, experience with PBIS differentially impacted the experiences of SLT members from PBIS and non-PBIS schools. Implications for secondary school practitioners, schools, and local educational agencies are discussed.

What can we learn from pandemic educational methods?: military general practice trainees’ attitudes to feedback from recorded consultations

ABSTRACT Background Recorded consultations are a useful tool for developing consultation skills for general practice speciality trainees (GPSTs). Historical barriers to utility include a lack of recording equipment and trainee discomfort. Widespread use of online communication platforms during the pandemic led to the introduction of the Recorded Consultation Assessment (RCA), prompting an exploration of its impact on GPSTs’ attitudes and acceptability of using recorded consultations for feedback. Aim This sequential explanatory mixed methods study explored attitudes of military GPSTs towards using recorded consultations for feedback to develop consultation skills, and identify factors influencing GPST attitudes. Methods Participants of this study completed a questionnaire, followed by a representative sample focus group. Descriptive statistics were used to analyse quantitative data, reflexive thematic analysis was employed for qualitative data. Triangulation was conducted using a meta-matrix. Results Results indicated agreement among respondents on the usefulness of recorded consultations for developing consultation skills, particularly communication skills. Perceived trainer attitudes significantly influence the GPST utility of this tool. The RCA positively impacted attitudes, providing familiarity, free access to easy-to-use online recording platforms, simplified consenting procedures, secure data storage, and improved feedback quality from trainers. Conclusion Pre-pandemic studies cited equipment access and consent procedures as barriers to utilising recording as a method of feedback. The pandemic and RCA introduced online resources and imperative to utilise this method, resulting in largely positive GPST learning experiences. As we move away from the RCA it is important to retain institutional memory of the benefits gained from feedback using recorded methods.

Brief communication: The extent and determinants of viral suppression among patients on protease inhibitor-based Anti-retro-viral therapy undergoing intensive adherence counselling in a public HIV care center in Uganda

BackgroundProtease inhibitor (PI)-based Antiretroviral Therapy (ART) regimens are key drugs in HIV management, especially when used as second line drugs. However, some PI-based ART have high adherence demands or tolerable adverse effects which may affect adherence and subsequently viral suppression. We assessed the extent of viral suppression, its determinants, and the experiences of clients on PI-based ART undergoing intensive adherence counselling (IAC) in a public HIV clinic.MethodsMixed methods sequential explanatory study involving a quantitative retrospective chart review for clients on PI-based ART who had received IAC from Dec 2016 to May 2023 and qualitative interviews for clients on PI-based ART who had received IAC in the past six months at an urban public HIV clinic in Uganda.ResultsIn this study, a total of 189 client charts were included. The median number of IAC sessions received was three (interquartile range, IQR, of 3 to 4) with median time of receiving IAC of three ( IQR, of 2 to 4). One half (51%, 95/186) of the clients had achieved viral suppression and the odds of suppression increased by 30% for every additional month on IAC. Respondents perceived the effectiveness of PI-based ART and IAC in achieving and supporting viral suppression, respectively.ConclusionDespite the perceived effectiveness of PI-based ART and IAC, suboptimal levels of viral suppression were observed among clients on PI-based ART who had received IAC. Therefore, it is important to provide IAC for optimal duration as it increases the chances of viral suppression. Further investigation of the barriers of viral suppression for clients on PI-based ART undergoing IAC is needed.