Explore Healthcare Providers Research Articles

Knowledge, attitudes, and barriers of dietitians toward screening patients for food insecurity

Abstract Background Global food insecurity (FI) prevalence in 2020 was 30.4%. In Israel, in 2021, it was 16.2%. FI is associated with a high prevalence of chronic diseases, more hospital admissions and visits, and a shorter lifespan. Screening for FI in the health setting is less common, despite recommendations. Methods Between July 2022 - February 2023, a mixed-methods study distributed an online survey and a request for qualitative interviews among a convenience sample of registered dietitians (RDs). The survey obtained sociodemographic characteristics and information on work experience, knowledge, attitudes, and barriers toward screening for FI. Sixty-one questions were modified from existing questionnaires. An expert committee reviewed the questions. Later, the questionnaire was pilot-tested by ten RDs and amended according to their comments on the clarity. Results Overall, 140 RDs were surveyed, and 7 RDs were interviewed. 96.7% of the participants were female, with a mean of 13.36±9.9 years of experience. 97% of RDs didn't screen for FI. 65.5% didn't know the percentage of households living with FI in Israel, and 72.1% of RDs didn't know where to refer food-insecure patients for additional assistance. Positive attitudes toward screening and treating FI were documented. About 80% of RDs indicated that FI is relevant to their patients and are willing to screen for FI. Religious and traditional RDs had 10.08 times and 4.46 times, respectively, greater odds of having positive attitudes toward screening and treating food-insecure patients. The main barriers identified were a lack of time, knowledge of screening tools, and missing information on appropriate treatment and referral. Conclusions Further education and training in screening FI should be implemented among RDs. System barriers should be addressed to allow RDs routine screening for FI. Additional research is needed to explore healthcare providers’ attitudes and barriers toward screening and treating FI. Key messages • Most registered dietitians had a low level of knowledge and did not screen routinely for food insecurity. • The majority were positive towards screening, highlighting system and training barriers.

Healthcare providers’ perspectives on stigma when working with people with functional seizures

PurposeThis study aimed to explore healthcare providers’ (HCPs) perspectives and experiences of stigma when working with people with Functional Seizures (FS). Particular focus was given to understanding HCPs’ experience and knowledge of FS, discovering the attitudes held by HCPs towards working with FS as a mental health condition, and exploring HCPs’ views of how their stigma manifests towards people with FS when in an occupational setting. MethodsSemi-structured individual interviews were conducted with thirteen HCPs who specialised in the diagnosis and/or treatment and management of FS. A reflexive thematic analysis was utilised to analyse the semi-structured interviews for means of identifying themes within the data. ResultsThemes identified included those of contextual factors which indirectly influence stigma, inclusive of a lack of time and resources. HCPs additionally described having a general limited understanding of FS as a condition and becoming frustrated with their patients, which in turn fuelled a stigmatising culture. HCPs also pointed to the idea of diagnostic terms being inappropriate and adding to stigma. HCPs’ personal stigma as well as institutionalised stigma were identified. The HCPs also reported on the negative attitudes and actions directed towards FS patients. Strategies to reduce stigma were also explored. ConclusionThere are various ways in which HCPs’ stigma towards individuals with FS can occur, both directly and indirectly. HCPs play a key role in supporting their FS patients and alleviating the effects of stigma; thus, it is important to understand their perspectives and experiences through further research.

An Approach to the Design and Development of an Accredited Continuing Professional Development e-Learning Module on Virtual Care.

Virtual care appointments expanded rapidly during COVID-19 out of necessity and to enable access and continuity of care for many patients. While previous work has explored health care providers' experiences with telehealth usage on small-scale projects, the broad-level adoption of virtual care during the pandemic has expounded opportunities for a better understanding of how to enhance the integration of telehealth as a regular mode of health care services delivery. Training and education for health care providers on the effective use of virtual care technologies are factors that can help facilitate improved adoption and use. We describe our approach to designing and developing an accredited continuing professional development (CPD) program using e-learning technologies to foster better knowledge and comfort among health care providers with the use of virtual care technologies. First, we discuss our approach to undertaking a systematic needs assessment study using a survey questionnaire of providers, key informant interviews, and a patient focus group. Next, we describe our steps in consulting with key stakeholder groups in the health system and arranging committees to inform the design of the program and address accreditation requirements. The instructional design features and aspects of the e-learning module are then described in depth, and our plan for evaluating the program is shared as well. As a CPD modality, e-learning offers the opportunity to enhance access to timely continuing professional education for health care providers who may be geographically dispersed across rural and remote communities.

A Qualitative Study of Nursing Home Staff Lived Experience With Advance Care Planning

ObjectiveAdvance care planning (ACP) within nursing homes (NHs) is an integral component of resident-centered care yet remains an ongoing area for improvement. This study explored health care providers’ experiences when facilitating ACP discussions with residents and their families. DesignInterpretive description was used to explore meanings and generate knowledge that is applicable for clinical contexts. Setting and ParticipantsA purposive sample of 27 staff members (2 directors of care, 3 assistant directors of care, 1 nurse practitioner, 11 registered nurses, 3 registered practical nurses, and 7 social workers) from 29 NHs located across 3 Canadian provinces that participated in cluster-randomized intervention study to improve ACP. MethodsSemistructured interviews were conducted between January and July 2020. Interpretive description methods were used for analysis. ResultsThree themes were identified. “Navigating Relational Tensions During ACP with Families” captures the relational tensions that participants experienced while navigating ACP processes with residents and their families. The second theme, “Where’s the Doctor?” highlights the general lack of physician involvement in ACP discussions and the subsequent pressures faced by participants when supporting residents and families. The last theme, “Crises Change the Best Laid Plans,” illustrates the challenges participants face when trying to adhere to existing care plans during residents' medical crises. Conclusion and ImplicationsParticipants’ experiences indicate that current ACP processes in NHs do not meet the needs of residents, families, or care teams. Additional support from physicians and changes to structural processes are needed to support resident-centered end-of-life planning within this care context.

A mobile health application for patients eligible for statin therapy: app development and qualitative feedback on design and usability

BackgroundCardiovascular disease is the leading cause of death in the United States (US). Despite the well-recognized efficacy of statins, statin discontinuation rates remain high. Statin intolerance is a major cause of statin discontinuation. To accurately diagnose statin intolerance, healthcare professionals must distinguish between statin-associated and non-statin-associated muscle symptoms, because many muscle symptoms can be unrelated to statin therapy. Patients’ feedback on muscle-related symptoms would help providers make decisions about statin treatment. Given the potential benefits and feasibility of existing apps for cardiovascular disease (CVD) management and the unmet need for an app specifically addressing statin intolerance management, the objectives of the study were 1) to describe the developmental process of a novel app designed for patients who are eligible for statin therapy to lower the risk of CVD; 2) to explore healthcare providers’ feedback of the app; and 3) to explore patients’ app usage experience.MethodsThe app was developed by an interdisciplinary team. Healthcare provider participants and patient participants were recruited in the study. Providers were interviewed to provide their feedback about the app based on screenshots of the app. Patients were interviewed after a 30 days of app usage.ResultsThe basic features of the app included symptom logging, vitals tracking, patient education, and push notifications. Overall, both parties provided positive feedback about the app. Areas to be improved mentioned by both parties included: the pain question asked in symptom tracking and the patient education section. Both parties agreed that it was essential to add the trend report of the logged symptoms.ConclusionsThe results indicated that providers were willing to use patient-reported data for disease management and perceived that the app had the potential to facilitate doctor-patient communication. Results also indicated that user engagement is the key to the success of app efficacy. To promote app engagement, app features should be tailored to individual patient’s needs and goals. In the future, after it is upgraded, we plan to test the app usability and feasibility among a more diverse sample.

Health care providers' perspectives on challenges and opportunities of intercultural health care in diabetes and obesity management: a qualitative study.

Migrants often face worse health outcomes in countries of transit and destination because of challenges such as financial constraints, employment problems, lack of a network of social support, language and cultural differences, and difficulties accessing health services. As understanding how the migrant context affects patient-provider engagement is critical to the provision of contextually appropriate care, this study aimed at understanding primary health care provider perspectives on challenges and opportunities of the intercultural care process for migrant patients with diabetes and obesity. This qualitative study within a multimethod, participatory research project involved primary care providers in clinics and primary care networks in Edmonton, Alberta, between September 2019 and February 2020. We explored health care providers' approaches to diabetes and obesity management, and experiences of and challenges with intercultural care. We conducted a thematic analysis using an interpretive qualitative approach. We conducted 9 interviews and 4 focus groups and identified 3 themes: a shift from traditional weight loss-centred approaches; relationships and navigating cultural distance; and importance of and limitations in identifying and addressing root causes and barriers. Health care providers encounter considerable nonmedical challenges when supporting immigrant patients, such as navigating cultural distance and working with patients' financial constraints. The nonmedical challenges we identified can hinder the process of chronic disease management. Thus, in addition to educational programs and trainings to enhance the cultural competency of health care providers, incorporating avenues for cultural brokering in health care can provide invaluable support in patient-provider engagements to mitigate these challenges.

Identification of Determinants and Implementation Strategies to Increase Long-Acting Injectable PrEP for HIV Prevention Among Latino Men Who Have Sex with Men (MSM).

Latino men who have sex with men (LMSM) are disproportionally affected by HIV infections in the USA. The uptake rate of pre-exposure prophylaxis (PrEP) for HIV prevention has remained low among LMSM. Long-acting injectable PrEP (LAI-PrEP) may have the potential to improve structural, behavioral, and cognitive barriers to adherence. Given the potential benefits of LAI-PrEP and the limited data with this population, the aim of our study was to explore experiences and attitudes of LAI-PrEP among LMSM and identify implementation barriers compared to the standard oral presentation, align proposed implementation strategies, and propose outcomes to monitor and assess impact. In this qualitative study, guided by the Consolidated Framework for Implementation Research, we explored health care providers perspectives on facilitators and barriers to LAI-PrEP implementation strategies for LMSM. Interviews were recorded, transcribed, and analyzed using thematic content analysis. Fear of immigration policies, ability to conceal PrEP medication, health insurance coverage, health information fatigue, lack of culturally adapted information, and provider's lack of knowledge were among the main barriers to LAI-PrEP. Most providers discussed the need for adapted and/or tailored training materials for and suggested designing marketing materials and specific clinical recommendations for LAI-PrEP. In order to ensure an effective adaptation process that encompasses local and national goals of HIV prevention, future interventions should be designed in a way that incorporates culturally relevant information for LMSM. This study provides an implementation research logic model to guide future studies.

A Participatory Comic Book Workshop to Improve Youth-Friendly Post-Rape Care in a Humanitarian Context in Uganda: A Case Study.

Graphic medicine formats, such as comic books in which health information is presented alongside images, may be a useful learning tool to improve post-rape care and youth-friendly service provision among health care providers in humanitarian contexts. We describe the development and pilot-testing of a workshop using a comic book to improve youth-friendly post-rape care with providers in Bidi Bidi refugee settlement, Uganda. We conducted 6 focus groups with refugee young men (n=3) and women (n=3) aged 16-24 years and 28 in-depth individual interviews (refugee youth: n=12; health care providers: n=8; elders: n=8). Findings informed the development of a workshop that included a participatory comic book on sexual and gender-based violence (SGBV) and youth, SGBV stigma, youth-friendly health care, and post-exposure prophylaxis. Comic book illustrations specifically addressed health care confidentiality and examples of being a supportive health care provider. Then, we conducted a 1-day workshop with health care providers (n=20) that included structured activities addressing SGBV impacts and related stigma and included comic book discussions. Open-ended survey data were collected 8 weeks after the workshop to explore health care providers' experiences with the workshop, perceived impact of the intervention on their work, and support required to implement youth-friendly services for SGBV survivors. Qualitative data were analyzed using thematic approaches. Open-ended response data indicated that: comic book methods were informative and interactive; health care providers felt more empowered to offer youth-friendly services and spaces; and health care providers want additional SGBV training and institutional support for youth-friendly spaces and community engagement. A comic book intervention has the potential to meaningfully engage health care providers in humanitarian contexts to provide youth-friendly health care, acquire skills for engaging in SGBV prevention, create youth-friendly clinic spaces, and identify health care and community SGBV prevention needs.

A qualitative study to explore healthcare providers' perspectives on barriers and enablers to early detection of breast and cervical cancers among women attending primary healthcare clinics in Johannesburg, South Africa.

Low-and-middle income countries (LMICs) contribute approximately 70% of global cancer deaths, and the cancer incidence in these countries is rapidly increasing. Sub-Saharan African (SSA) countries, including South Africa (SA), bear some of the world's highest cancer case fatality rates, largely attributed to late diagnosis. We explored contextual enablers and barriers for early detection of breast and cervical cancers according to facility managers and clinical staff at primary healthcare clinics in the Soweto neighbourhood of Johannesburg, South Africa. We conducted qualitative in-depth interviews (IDIs) between August and November 2021 amongst 13 healthcare provider nurses and doctors as well as 9 facility managers at eight public healthcare clinics in Johannesburg. IDIs were audio-recorded, transcribed verbatim, and entered into NVIVO for framework data analysis. Analysis was stratified by healthcare provider role and identified apriori around the themes of barriers and facilitators for early detection and management of breast and cervical cancers. Findings were conceptualised within the socioecological model and then explored within the capability, opportunity and motivation model of behaviour (COM-B) for pathways that potentially influence the low screening provision and uptake. The findings revealed provider perceptions of insufficient South African Department of Health (SA DOH) training support and staff rotations resulting in providers lacking knowledge and skills on cancer, screening policies and techniques. This coupled with provider perceptions of poor patient cancer and screening knowledge revealed low capacity for cancer screening. Providers also perceived opportunity for cancer screening to be undermined by the limited screening services mandated by the SA DOH, insufficient providers, inadequate facilities, supplies and barriers to accessing laboratory results. Providers perceived women to prefer to self-medicate and consult with traditional healers and access primary care for curative services only. These findings compound the low opportunity to provide and demand cancer screening services. And because the National SA Health Department is perceived by providers not to prioritize cancer nor involve primary care stakeholders in policy and performance indicator development, overworked, unwelcoming providers have little motivation to learn screening skills and provide screening services. Providers reported that patients preferred to go elsewhere and that women perceived cervical cancer screening as painful. These perceptions must be confirmed for veracity among policy and patient stakeholders. Nevertheless, cost-effective interventions can be implemented to address these perceived barriers including multistakeholder education, mobile and tent screening facilities and using existing community fieldworkers and NGO partners in providing screening services. Our results revealed provider perspectives of complex barriers to the early detection and management of breast and cervical cancers in primary health clinic settings in Greater Soweto. These barriers together appear potentially to produce compounding effects, and therefore there is a need to research the cumulative impact but also engage with stakeholder groups to verify findings and create awareness. Additionally, opportunities do exist to intervene across the cancer care continuum in South Africa to address these barriers by improving the quality and volume of provider cancer screening services, and in turn, increasing the community demand and uptake for these services.

Encountering suffering in digital care: a qualitative study of providers’ experiences in telemental health care

BackgroundEncountering patients who are suffering is common in health care, and particularly when providing mental health care. Telehealth technologies are increasingly used to provide mental health care, yet little is known about the experiences of providers when encountering patients who are suffering within remote care. The present study explored health care providers’ lived experiences of encountering patient suffering during telemental health care.MethodsA qualitative phenomenological approach was used to uncover participants’ experiences. In-depth interviews were conducted with a purposive sample of physicians, psychologists, and therapists who used telemental health in varied clinical practices in Sweden. Data were analyzed using descriptive phenomenology.ResultsTelehealth care with patients who were suffering was experienced by providers as loose connections, both literally in compromised functioning of the technology and figuratively in a compromised ability connecting emotionally with patients. Providers’ lived experiences were explicated into the following aspects: insecurity in digital practice, inaccessibility of the armamentarium, and conviction in the value of telehealth care. Interpersonal connection between patient and provider is necessary. Worry and guilt arose for providers with fears that technology would not work, patient status was deteriorated, or the care needed could not be delivered. Providers overcame barriers in telehealth encounters, and expressed they perceived that patients appreciated the care received, and through it found relief.ConclusionsThis study brings an understanding of experiences in providing telemental care for patients who are suffering. Providers experience challenges in connecting with patients, and in accessing tools needed to enable reaching the goals of the caring encounter. Efforts to ensure functioning of technology, comfort with its use, and accessibility of tools might be some accommodations to support providers for successful and rewarding telehealth care encounters.

Healthcare provider perceptions on the implementation of the universal test-and-treat policy in South Africa: a qualitative inquiry

BackgroundSouth Africa had an estimated 7.5 million people living with HIV (PLHIV), accounting for approximately 20% of the 38.4 million PLHIV globally in 2021. In 2015, the World Health Organization recommended the universal test and treat (UTT) intervention which was implemented in South Africa in September 2016. Evidence shows that UTT implementation faces challenges in terms of human resources capacity or infrastructure. We aim to explore healthcare providers (HCPs)’ perspectives on the implementation of the UTT strategy in uThukela District Municipality in KwaZulu-Natal province.MethodsA qualitative study was conducted with one hundred and sixty-one (161) healthcare providers (HCPs) within 18 healthcare facilities in three subdistricts, comprising of Managers, Nurses, and Lay workers. HCPs were interviewed using an open ended-survey questions to explore their perceptions providing HIV care under the UTT strategy. All interviews were thematically analysed using both inductive and deductive approaches.ResultsOf the 161 participants (142 female and 19 male), 158 (98%) worked at the facility level, of which 82 (51%) were nurses, and 20 (12.5%) were managers (facility managers and PHC manager/supervisors). Despite a general acceptance of the UTT policy implementation, HCPs expressed challenges such as increased patient defaulter rates, increased work overload, caused by the increased number of service users, and physiological and psychological impacts. The surge in the workload under conditions of inadequate systems’ capacity and human resources, gave rise to a greater burden on HCPs in this study. However, increased life expectancy, good quality of life, and immediate treatment initiation were identified as perceived positive outcomes of UTT on service users. Perceived influence of UTT on the health system included, increased number of patients initiated, decreased burden on the system, meeting the 90-90-90 targets, and financial aspects.ConclusionHealth system strengthening such as providing more systems’ capacity for expected increase in workload, proper training and retraining of HCPs with new policies in the management of patient readiness for lifelong ART journey, and ensuring availability of medicines, may reduce strain on HCPs, thus improving the delivery of the comprehensive UTT services to PLHIV.

Healthcare providers’ perceptions and expectations of video-assisted debriefing of real-life obstetrical emergencies: a qualitative study from Denmark

ObjectivesVideo-assisted debriefing (VAD) of real-life obstetrical emergencies provides an opportunity to improve quality of care, but is rarely used in clinical practice. A barrier for implementation is the expected mental...

Health Care Providers’ Perceptions of Human Trafficking on the U.S. Frontier: Contextualizing Future Steps

ABSTRACT This study explored health care providers’ perceptions of human trafficking in the frontier U.S. state of Wyoming. There were 235 professionals who responded to open-ended questions aimed at illuminating barriers and supports for enhancing the capacity of health care providers to identify and respond to human trafficking while situating that response in the unique rural and frontier settings of the Western United States. Six themes emerged: education and training needs; identification tools; community- and system-level supports; unique sociocultural contexts; challenges of the frontier setting; and collaboration with the two Tribal nations that share a reservation. The findings shed light, through the lens of provider perceptions, on community attitudes toward human trafficking and victims/survivors; the impact of the state’s frontier status; and potential pathways forward for health care providers. This study also provides important contextual considerations pertaining to opinions on the role of the state. Such knowledge is critical to policymaking that promotes human rights broadly and UN Sustainable Development Goals 5 and 16: respectively, the achievement of gender equality and the empowerment of women and girls and the promotion to just and inclusive societies. The findings of this study highlight the importance of confronting persistent victim-blaming as well as the marginalization of Indigenous people in the state if future efforts are to be empowering and inclusive for all.

Virtual care and COVID-19: A survey study of adoption, satisfaction and continuing education preferences of healthcare providers in Newfoundland and Labrador, Canada.

Virtual care has expanded during COVID-19 and enabled continued access to healthcare services. For many healthcare providers, the adoption of virtual care has been a new experience in the provision of healthcare services. The purpose of this survey study was to explore healthcare providers' experiences with virtual care during COVID-19. A web-based survey-questionnaire was developed by applying Rogers' theory of diffusion of innovation and distributed to healthcare providers (physicians, nurses and allied health professionals) in Newfoundland and Labrador, Canada to explore virtual care experiences, satisfaction and continuing professional development (CPD) needs. Analyses included descriptive statistics and thematic analysis of survey responses. Fifty-one percent of respondents (n = 432) indicated they were currently offering virtual care and a majority (68.9%) reported it has improved their work experience. Telephone appointments were preferred over videoconferencing by respondents, with key challenges including the inability to conduct a physical exam, patients' cell phone services being unreliable and patients knowing how to use videoconferencing. Majority of respondents (57.5%) reported quality of care by telephone was lower than in-person, whereas quality of care by videoconferencing was equivalent to in-person. Main benefits of virtual care included increased patient access, ability to work from home, and reduction in no-show appointments. Key supports for adopting virtual care included in-house organizational supports (e.g., technical support staff), local colleague support, and technology training. Important topics for virtual care CPD included complying with regulatory standards/rules, understanding privacy or ethical boundaries, and developing competency and digital professionalism while engaging in virtual care. Beyond the COVID-19 pandemic, virtual care will have a continuing role in enhancing continuity of care through access that is more convenient. Survey findings reveal a number of opportunities for supporting healthcare providers in use of virtual care, including CPD, guidelines and resources to support adaptation to virtual care provision (e.g., virtual examinations/assessments), as well as patient educational support.

Healthcare Providers' Views of Information, Support, and Services Offered to Women in the Postnatal Follow-up Care Period in Oman: A Qualitative Study.

Postnatal care is a component of the maternity care continuum, which is often under-valued and under-offered. The aim of this study was to explore healthcare providers' (HCPs) views about postnatal follow-up care (PNFC) offered to women in Oman. This qualitative study was performed from May 2021 to January 2022; 29 individual participated in semi-structured telephone interviews with staff nurses (N=20), nurse/midwives (N=5), and doctors (N=4) from Khoula and Ibra hospitals and Al Amerat, Muttrah and Al Qabil health centers in Oman. Conventional content analysis was guided by Erlingsson and Brysiewicz. Seventeen sub-categories and four categories emerged from the data; they included communication and timing of PNFC, provision of PNFC with various components, challenges and needs for providing PNFC, and the impact of COVID-19 on PNFC. Providing postnatal follow-up care in Oman is challenging for HCPs due to lack of clinics dedicated to postnatal care, no scheduled appointment times for women, very limited guidance within the National Maternity Care guideline, and some HCPs (i.e., nurses) with no formal education on the components of postnatal care. These hinder the ability to provide information, education, support, and services to women.

Attitudes, Beliefs, and Perceptions on Cannabis Among Older Adults Aged 65 and Older: A cross-sectional Survey.

With the rise of medical and recreational cannabis use among older adults, concerns about the potential risks and benefits of cannabis use are increasing. This pilot study aimed to determine the attitudes, beliefs, and perceptions of older adults toward cannabis as a medicinal product, to establish a foundation for future research on how healthcare providers communicate with this population regarding cannabis. A cross-sectional survey was conducted on adults aged 65 and older living in Philadelphia. The survey included questions related to participants' demographics, knowledge, attitudes, beliefs, and perceptions of cannabis. Participants were recruited via flyer distributions, publications in newsletters, and a local newspaper. Surveys were conducted from December 2019 through May 2020. Quantitative data were presented using counts, mean, median, and percentages, and qualitative data were analyzed by categorizing common responses. The study aimed to recruit 50 participants, of whom 47 met the requirements, and had their data analyzed, resulting in an average age of 71 years. The majority of participants were male (53%) and Black (64%). Seventy-six percent of participants considered cannabis a highly important treatment for older adults, and 42% considered themselves highly knowledgeable about cannabis. Over half of the participants reported being asked about tobacco (55%) or alcohol (57%) use by their PCP compared to 23% being asked about cannabis. Participants indicated that they most commonly turned to the internet and social media for information about cannabis, while only a small number mentioned relying on their primary care physician (PCP) for such information. The results of this pilot study highlight the need for accurate and reliable information about cannabis for older adults and their healthcare providers. As the use of cannabis as a therapy continues to rise, it is crucial for healthcare providers to address misconceptions and encourage older adults to seek out evidence-based research. Further research is needed to explore healthcare providers' perceptions of cannabis therapy and how they can better educate older adults.

Perceived barriers and enablers of a personal health record from the healthcare provider perspective.

Personal health records (PHRs) have been implemented around the world as a means to increase the safety, quality, and efficiency of health care. The Ministry of National Guard Health Affairs in the Kingdom of Saudi Arabia launched their PHR in 2018. This study aimed to explore healthcare provider (HCP) perspectives of barriers to and enablers of PHR adoption in Saudi Arabia. The 291 participating HCPs (40.5% nurses, 23.0% pharmacists, 17.2% physicians, 15.5% technicians, and 3.8% other) selected the following as top-3 barriers to PHR adoption: 1) lack of patient awareness (19.4%), 2) patient low literacy (17.7%), and 3) patient resistance to new technologies (12.5%). Of these, 36 responded to the open-ended question gauging feedback on the PHR. Three main themes were identified from the comments: 1) general perceptions of the PHR (positive attitudes, negative attitudes, additional features); 2) patient engagement as a requirement for the successful implementation of the PHR; and 3) education/training of HCPs, patients, and caregivers. This analysis extends our understanding of HCP perspectives of barriers and enablers to PHR adoption. Further qualitative research with patients is required to confirm our findings.

Engaging patients in patient safety: a qualitative study examining healthcare managers and providers’ perspectives

BackgroundPatients can play an essential role in improving patient safety by becoming actively involved in their health care. The present study aimed to qualitatively explore healthcare providers’ (HCPs) and managers’ perceptions on patient participation in patient safety processes.MethodsThis qualitative study carried out in three teaching hospitals in Tehran, Iran. The data were collected through semi-structured interviews with 31 HCPs and managers working at public teaching hospitals, medical universities and the Ministry of Health. The data were analyzed using thematic analysis.ResultsThree main themes and 21 sub-themes emerged from the interviews. Participants believed that patients and their families can play an effective role in maintaining and improving patient safety through different roles. However, a variety of barriers were identified at patients, providers, and system levels hindering patient participation in delivering safe care.ConclusionThe participants identified facilitators and barriers to patient engagement in safety-orientated activities at multiple patients, providers, and system levels, indicating that complex, multifaceted initiatives must be designed to address the issue. This study encourages further research to enhance the understating of the problems and solutions to patient involvement in safety initiatives in the Iranian healthcare setting.

We are facing some barriers: A qualitative study on the implementation of kangaroo mother care from the perspectives of healthcare providers.

Health systems at all levels are under pressure to provide comprehensive and high quality of care based on the best evidencebased interventions. The kangaroo mother care (KMC) is one way to care for Low Birth Weight babies (LBW) especially in developing country where the rates of preterm and LBW neonates are higher and the resources are limited. The purpose of this paper is to explore healthcare providers' perspectives of kangaroo mother care implementation in perinatology ward in the rural surgical hospital of East Java Province, Indonesia. We conducted an in-depth interviews to identify KMC implementations. Ten healthcare providers engaged with KMC were interviewed. Data was analyzed using a thematic analysis. Healthcare providers reported positives perceptions of KMC and acknowledged their important roles to give education. The barriers in implementing the KMC including the level of knowledge and the age of the mother of LBW babies. KMC as a method of treating LBW babies is effective intervention care of preterm and LBW babies. This research provides information regarding the need of supports from all levels in KMC implementation.

Health care providers’ perceptions of using misoprostol in the treatment of incomplete abortion in Malawi

BackgroundIn Malawi, abortion is only legal to save a pregnant woman’s life. Treatment for complications after unsafe abortions has a massive impact on the already impoverished health care system. Even though manual vacuum aspiration (MVA) and misoprostol are the recommended treatment options for incomplete abortion in the first trimester, surgical management using sharp curettage is still one of the primary treatment methods in Malawi. Misoprostol and MVA are safer and cheaper, whilst sharp curettage has more risk of complications such as perforation and bleeding and requires general anesthesia and a clinician. Currently, efforts are being made to increase the use of misoprostol in the treatment of incomplete abortions in Malawi. To achieve successful implementation of misoprostol, health care providers’ perceptions on this matter are crucial.MethodsA qualitative approach was used to explore health care providers’ perceptions of misoprostol for the treatment of incomplete abortion using semi-structured in-depth interviews. Ten health care providers were interviewed at one urban public hospital. Each interview lasted 45 min on average. Health care providers of different cadres were interviewed in March and April 2021, nine months after taking part in a training intervention on the use of misoprostol. Interviews were recorded, transcribed verbatim and analyzed using ‘Systematic Text Condensation’.ResultsThe health care providers reported many advantages with the increased use of misoprostol, such as reduced workload, less hospitalization, fewer infections, and task-shifting. Availability of the drug and benefits for the patients were also highlighted as important. However, some challenges were revealed, such as deciding who was eligible for the drug and treatment failure. For these reasons, some health care providers still choose surgical treatment as their primary method.ConclusionFindings in this study support the recommendation of increased use of misoprostol as a treatment for incomplete abortion in Malawi, as the health care providers interviewed see many advantages with the drug. To scale up its use, proper training and supervision are essential. A sustainable and predictable supply is needed to change clinical practice.Plain English SummaryUnsafe abortion is a major contributor to maternal mortality worldwide. Unsafe abortion is the termination of an unintended pregnancy by a person without the required skills or equipment, which might lead to serious complications. In Malawi, post-abortion complications are common, and the maternal mortality ratio is among the highest in the world. Retained products of conception, referred to as an incomplete abortion, are common after spontaneous miscarriages and unsafe induced abortions. There are several ways to treat incomplete abortion, and the drug misoprostol has been successful in the treatment of incomplete abortion in other low-income countries. This study explored perceptions among health care providers using misoprostol to treat incomplete abortions and whether the drug can be fully embraced by Malawian health care professionals. Health personnel at a Malawian hospital were interviewed individually regarding the use of the drug for treating incomplete abortions. This study revealed that health care providers interviewed are satisfied with the increased use of misoprostol. They highlighted several benefits, such as reduced workload and that it enabled task-shifting so that various hospital cadres could now treat patients with incomplete abortions. The health care workers also observed benefits for women treated with the drug compared to other treatments. The challenges mentioned were finding out who was eligible for the drug and drug failure. This study supports scaling up the use of misoprostol in the treatment of incomplete abortions in Malawi; the Ministry of Health and policymakers should support future interventions to increase its use.