Focus Group Research Articles

Mental health workers’ perspectives on the implementation of a peer support intervention in five countries: qualitative findings from the UPSIDES study

ObjectiveThe introduction of peer support in mental health teams creates opportunities and challenges for both peer and non-peer staff. However, the majority of research on mental health workers’ (MHWs) experiences...

Support needs for return to work among self-employed workers: A focus group study.

The aim of this study is to gain insight into the facilitators, barriers, and support needs of Dutch self-employed workers when returning to work (RTW) after sick leave. Three focus groups were conducted, involving 15 Dutch self-employed workers who were on sick leave due to health problems. The transcripts were analysed through thematic content analysis. Five main themes regarding barriers, facilitators and needs of self-employed workers to RTW were identified: autonomy, social support, client management, financial security and information on sick leave. Having autonomy was considered a facilitator for RTW. However, the participants expressed a need for more financial support, additional guidance from occupational health professionals, and tailored information regarding RTW. The results of this study emphasize a need for optimizing national policy and support for self-employed workers regarding sick leave and RTW.

North Carolina Caregiver Listening Study: Caregiver Experiences and Perspectives on Services and Supports in an Aging U.S. State

ABSTRACT Family caregivers experience health, financial, and social burdens related to caregiving responsibilities. North Carolina has an estimated 1.3 million caregivers, equating to a value of $13.1 billion per year. Caregiving demands warrant additional understanding of the caregiver lived experiences. Our objective was to document these North Carolina caregiver experiences during the era of COVID-19 through focus groups. Participants were recruited through diverse community organizations. All 44 caregivers who completed interest solicitation surveys were invited to participate; 29 caregivers participated across 11 groups. Thematic analysis was used to code and synthesize transcripts from each participant using Dedoose software and guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ). Caregiver routines (caregiving as an all-encompassing role; dimensions of support); most challenging parts (exhaustion and defeat; lacking support; evolving relationships); most rewarding parts (care recipient resilience; quality time; sense of purpose); social service and healthcare system interactions (positive interactions; negative interactions; inaccessible services); COVID-19 impacts on caregiving (opportunities; challenges); and caregiver suggestions for system improvements (increasing financial support; improved coordination; ideological shifts). Caregivers shared unmet needs, challenges, and opportunities for improvement. Examining these needs and experience-informed recommendations can help advance additional caregiving research, policy-making, and program development.

Psychometric evaluation of Suicide Management Competency Scale for nursing students: A cross-sectional study.

Suicide management skills are essential for nursing students, as they are often the initial healthcare contact for individuals at risk of suicide. Recognising signs of suicidal ideation and behaviour is critical for initiating timely interventions. This study aimed to develop and access the psychometric evaluation of the Suicide Management Competency Scale (SMCS) for nursing students. A first draft of the SMCS was initially developed following literature and focus group, and a scale containing 28 items was constructed. We recruited 216 participants from two nursing schools. Construct validity was evaluated with exploratory factor analysis (EFA). Internal consistency reliability was determined with Cronbach's alpha, and test-retest reliability was examined with intra-class correlation. After four rounds of EFA and item analysis, we reduced the number of items to 16. We deleted 12 items, including 4 items for communalities less than 0.40, 3 items for cross-loading, 3 items for factor loading less than 0.40, and 2 items for low corrected item-total correlation. The final 16-item SMCS resulted in three subscales, which explained 55.813% of the total variance: emotional challenges in suicide risk assessment, delivering suicide interventions, and suicide risk nursing competence and confidence. Cronbach's alpha was 0.854 for the total score and 0.748 to 0.847 for the subscales. The newly developed SMCS was found to have good reliability and validity, suggesting that this scale could be used to evaluate nursing students' perceived competency in managing suicide, which might help cultivate competence in nurses' ability to effectively manage and prevent suicide, thus contributing to saving lives.

Grief and Collaborative Storytelling: The Colours of Loss

ABSTRACT This article describes a novel methodology for involving the public in a creative co-produced project about grief, which invited bereaved people to work together to create a fictional story about loss and then reflect on the experience in focus groups. Devised by Crowded Room Theatre Company and researchers at the University of Bristol, the project aimed to explore the risks and benefits of collaborative storytelling about emotionally charged subjects. Thematic analysis of the focus group transcripts generated seven themes: storytelling as protective and enabling; support and understanding; new perspectives; connecting to grief and loved ones who have died; complicated emotions; workshop anxiety; and anticipating the audio story. These findings corroborate research that suggests storytelling can provide a safe space to explore and make meaning from difficult emotions and experiences; it may also appeal to bereaved individuals who are less likely to attend conventional support groups. The audio story created from the workshop recordings is available online (https://www.spreaker.com/episode/the-colours-of-loss--53334166).

"This patient is not appropriate": Perspectives of physiotherapy students and clinical educators on exposing students to patients with complex needs during clinical practice placements.

Clinical practice placements play an important role in preparing students for challenging areas of clinical practice. Little is known about student learning needs for working with patients with complex needs during clinical practice placements, and clinical educator decision-making that underpins this exposure. To explore the perspectives of physiotherapy students and clinical educators on exposing students to working with and learning from patients with complex needs during clinical practice placements across Queensland and New South Wales, Australia. Six semi-structured focus groups with pre-registration physiotherapy students undertaking clinical practice placements (n = 19) and semi-structured one-on-one interviews with clinical educators (n = 20). Data were analyzed using reflexive thematic analysis. Four overarching themes were generated following analysis: 1) Complexity is challenging; 2) Tension between student exposure and patient care; 3) Variance in expectations; and 4) Readiness for complexity. Physiotherapy students and clinical educators recognize the challenges and importance of exposure to patients with complex needs. Student learning experiences are influenced by clinical educator decision-making, which is often unclear, leading to varying opportunities. This study highlights the need for enhanced support from clinical educators to prepare students for working with patients with complex needs.

Practice of breast self-examination and associated factors among women of reproductive age in the North Shoa Zone, Oromia, Ethiopia, 2022: a convergent mixed-methods study

ObjectiveTo assess practice of breast self-examination (BSE) and associated factors among women of reproductive age in the North Shoa Zone, Oromia, Ethiopia.DesignCommunity-based cross-sectional study with a convergent mixed-methods approach.SettingThe study...

유아기 자녀를 둔 부모공감능력의 의미와 구성요인에 관한 델파이 연구

Objectives This study aims to clarify the meaning of parental empathy ability using the Delphi technique and to derive constituent and sub-factors. Methods To this end, the concept of parental empathy ability was defined through preceding research and liter-ature review, and the structuring factors of the ability were derived. An expert Delphi survey was conducted using the derived data to confirm the exploratory study of deriving the components of parental empathy ability. The data analysis method of the first Delphi survey questionnaire was conducted in order to define the concept of parental empathy and derive the structuring factors. A structured questionnaire, free-choice and open-ended questions were conducted with 13 experts in order to confirm the content validity. Using SPSS 25.0, the average value, standard deviation, skewness, agreement, convergence, and CVR ranges of each variable were calculated, and questions that did not meet each criterion were modified and deleted. Since the number of panels participating in the Delphi survey in this study is 13, if the CVR value is .554 or higher, it can be judged that the content validity is valid. The contents, were revised and supplemented with the experts, used to construct the second Delphi survey. It was used to construct the second questionnaire by reflecting the opinions of experts and revising and supplementing the contents. The second survey tool were gathered from the responses of the first survey. In or-der to clarify the opinions of each panel, structured questions with a 5-point rating scale were presented. Results First, the area of the scale consisted of three areas: ‘emotional empathy ability’, ‘cognitive empathy abil-ity’, and ‘behavioral empathy ability’, ‘emotional empathy ability’ consisted of perspective acceptance, cognitive empathy, and perspective acceptance, ‘cognitive empathy ability’ consisted of emotional response, emotional al-location, and emotional perception, and ‘behavioral empathy ability’ consisted of pseudo-movement, expression consistency, listening, and relationship formation. Conclusions The study is significant in that it derives categories and sub-factors of parental empathy ability that have recently come into focus. Furthermore, the study is significant in that it can be used as basic data for deriving the question composition through focus group interviews in the future.

Building an implementation strategy for community-based rehabilitation for mental health in Colombia.

Scientific evidence indicates that the community-based rehabilitation (CBR) model is recommended for recovery from mental disorders. However, this approach encounters barriers and often lacks implementation strategies. The aim of this study is to create a strategy for the implementation of CBR for mental health in Colombia through the identification of barriers and facilitators, together with the expected outcomes, from the perspective of mental health decision-makers in Colombia. This study adopts a qualitative descriptive approach, using focus group data collection methods and thematic analysis to code and analyze the data. A total of 208 individuals participated in the study, including mental health decision-makers and health care professionals. Intersectoral collaboration, contextualization, financial resources, and community commitment and autonomy were identified as barriers and facilitators. The element that was considered a priority for successful implementation was the contextualization of strategies. CBR needs to be strengthened through implementation science if these strategies are to be successfully developed and implemented in various contexts. http://links.lww.com/IJEBH/A210.

Impact of an Intergenerational Book Club on Cross-Generational Attitudes: A Mixed-Methods Study

ABSTRACT This mixed-methods study explores the impact of an intergenerational book club, Pages Across Ages, on cross-generational attitudes between older adults and college-aged students. Amidst growing concerns over ageism and demographic shifts, the study investigates how structured dialogue around selected literary works can facilitate understanding and empathy across generations. Pages Across Ages comprised weekly in-person and virtual meetings to discuss Kristin Hannah’s The Four Winds, a novel selected for its potential to foster point-driven conversation about relevant issues across the age continuum. Employing a combination of qualitative and quantitative measures, including the Aging Semantic Differential scale, the study reveals significant shifts in attitudes post-participation. Qualitative data from focus groups corroborate these findings, highlighting themes of mutual learning, changing perspectives, and social justice discussions as a result of intergroup contact. This research underscores the potential of book clubs, which have a rich history in America for their ability to act as vehicles for social change, as platforms for fostering intergenerational engagement and addressing age-related prejudices.

The added value of virtual reality to parent–child interaction therapy: a qualitative study with parents and therapists

BackgroundVirtual reality (VR) is one of the most rapidly growing technological advancements being studied, developed, and implemented in mental health care. It offers a wide array of possibilities that go beyond the traditional ways of providing mental health care services. Many interventions require clients to learn new skills in order for change to occur. Relevant to this study, behavioral parent-training (BPT) interventions are focused on the acquisition of parenting skills in order to change child behavior. VR was added to the Parent–Child Interaction Therapy (PCIT) – a known BPT intervention — as an additional practice tool. In the present study, which is part of a larger study, the qualitative experiences of (PCIT-)VR from both parents’ and therapists’ perspectives are evaluated, as well as their suggestions for implementation.MethodSemi-structured interviews were conducted with eleven parents. Five therapists participated in a focus group and three additional semi-structured interviews were conducted with therapists. To analyze, a combination of deductive and inductive thematic analysis was used.ResultsResponses from interviews were divided into three categories: (1) parents’ evaluation, (2) therapists’ evaluation, and (3) suggestions for implementation from both parents and therapists. Next to a positive overall experience with PCIT, a large number of parents were also positive about the addition of VR to treatment. Both parents and therapists experienced VR as a useful additional practice tool. The additional practice in VR led to a boost in confidence in using positive parenting skills. There were mixed experiences regarding the ease and immersion of the tool. Suggestions for implementation from both parents and therapists were to make the tool more appealing and realistic, to vary more in VR modules and to improve certain practical aspects.ConclusionAdding VR to PCIT is still a pioneering piece of technology within PCIT. The value of this VR tool lies in the provision of the possibility to practice with skills outside of the therapeutic encounter, which has the potential to instill confidence in using those skills. Given the positive experiences regarding PCIT-VR, it is important to further develop the VR tool. We believe that ultimately, PCIT-VR can potentially serve as a customized way for parents to practice what they are taught during the treatment.

Development of shake powdered food with cocoa, mesquite pod flour, oak extract and agave fructans, quality characteristics and glycemic index

Purpose The purpose of this study was to development of a new chocolate-flavored powdered food supplement enriched with mesquite pod flour, oak extract and agave fructans, with proper sensory characteristics as well as its physicochemical and glycemic quality. Design/methodology/approach A powdered shake was formulated using experimental design (23) with mesquite (Prosopis laevigata) pod flour, oak (Quercus convallata) extracts, nonalkalinized cocoa, agave fructans, milk protein and xanthan gum. Sensory analysis (choice profile method, ranking test, focus group, quantitative descriptive analysis), moisture, ash, fiber, protein and lipids, pH, color, wettability, dispersibility and rheological tests were done. Phenolic profiling analysis to samples was done by ultraperformance liquid chromatography coupled to photodiode array detection and electrospray ionization tandem mass spectrometry, antioxidant activity was measured by 2,2’-Azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) diammonium salt radical cation, ferric reducing antioxidant power and oxygen radical absorbance capacity, glycemic index (GI) and glycemic load were evaluated. Findings The main sensory attributes in the powders were chocolate, bitter, astringent, grass/linseed flavors (p < 0.05). The product has protein [66.9%], carbohydrates [22.0%], lipids [1.6%], ash [2.7%] and moisture [6.8%], with wettability (23 s), and dispersibility of 77.9%. Catechin, epicatechin, gallocatechin, procyanidin B2, chlorogenic, coumaric and ferulic acids were identified. GI and caloric load not show differences between men (73.3±2.4, 4.4±0.1) and women (67.0±2.1, 4.1±0.1) (p > 0.05). Originality/value The use of mesquite pods, oak and agave fructans in powder food supplement is an alternative to obtain a product high in protein, with good sensory properties, antioxidant activity and moderate GI.

A pilot exploration of staff and service-user perceptions of a novel digital health technology (Virtual Engagement Rehabilitation Assistant) in complex inpatient rehabilitation

Purpose Digital health technologies have the potential to advance rehabilitation. The Virtual Engagement Rehabilitation Assistant (VERA) is a digital technology, co-designed to increase service-user engagement and promote self-management. This qualitative study explored staff and service-user perceptions of implementing VERA on a UK complex inpatient rehabilitation ward. Methods Purposively sampled service-users were allocated to VERA for up to six weeks. The Non-adoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) framework underpinned service-user post-intervention interviews and staff focus groups, and structured analysis of the data. Seven service-users were interviewed. Nine staff contributed to focus groups. Results A framework analysis identified themes (and subthemes) structured by the NASSS framework domains: 1. Nature of Clinical Condition, 2. Technology (Ease of Use, Holding Information/Resources in a single Digital Location, Appointments), 3. Value Proposition (Structuring Time, Feedback, Unexpected Benefits) 4. Adopters (Confidence in using Technology, Usefulness), 5. Wider Organisation. Ease of use and storage of key information in a single location were beneficial. Reliability, and provision of accurate and timely feedback to staff and service-users, were identified as essential. Conclusions A blended approach is required to meet staff and service-user needs. The potential for VERA in a community setting was identified and requires further investigation. Learning from VERA will support development of other digital technologies and their implementation.

Military Family Perspectives on Enrollment and Engagement in the WIC Program.

One in four U.S. service members endorses food insecurity. The Supplemental Nutrition Program for Women, Infants, and Children (WIC) is an invaluable, underutilized resource that can increase access to nutritious food for families with children under 5 years of age. Our research sought to evaluate military family perceptions and engagement with the WIC program. We conducted a mixed-method study, recruiting from a convenience sample of military families who applied for financial assistance for child care. An 18-question survey and follow-up focus groups assessed participant demographics and experiences with WIC. We utilized descriptive statistics ordinal logistic regression analyses for quantitative data analysis. For qualitative data, descriptive content analysis with constant comparison and inductive and deductive coding of interviews identified emerging themes. This study was approved by the Uniformed Services University of the Health Sciences Institutional Review Board. Among the 399 survey respondents, 25% were currently enrolled in WIC and 39% had been previously enrolled. Service members and their partners learned about WIC from a variety of sources, and there was no significant association between the branch of service or rank and WIC enrollment. There were 40 total participants in 10 completed focus groups. Six themes emerged: (1) Military-specific factors create unique circumstances related to WIC engagement; (2) the WIC program facilitates access to formula supplementation and nutritious foods for military families; (3) lack of program awareness and misinformation are top barriers to WIC engagement in military families; (4) stigma impacts WIC program enrollment and engagement; (5) logistics of enrollment can impact WIC engagement among military families; and (6) the military can support WIC enrollment and engagement through standardization, education, and leadership commitment. Our findings suggest that unique circumstances related to military family life create a profound need for programs addressing food support, such as WIC. Interventions to improve WIC enrollment among military families need to be rooted in broad outreach efforts, not targeted at specific ranks, branches, or ages. Specific recommendations include increasing information dissemination, universally screening military families for WIC, decreasing logistical burdens, and involving military leadership.

Understanding Patient Perspectives on the Use of Gamification and Incentives in mHealth Apps to Improve Medication Adherence: Qualitative Study.

Medication nonadherence remains a significant health and economic burden in many high-income countries. Emerging smartphone interventions have started to use features such as gamification and financial incentives with varying degrees of effectiveness on medication adherence and health outcomes. A more consistent approach to applying these features, informed by patient perspectives, may result in more predictable and beneficial results from this type of intervention. This qualitative study aims to identify patient perspectives on the use of gamification and financial incentives in mobile health (mHealth) apps for medication adherence in Australian patients taking medication for chronic conditions. A total of 19 participants were included in iterative semistructured web-based focus groups conducted between May and December 2022. The facilitator used exploratory prompts relating to mHealth apps, gamification, and financial incentives, along with concepts raised from previous focus groups. Transcriptions were independently coded to develop a set of themes. Three themes were identified: purpose-driven design, trust-based standards, and personal choice. All participants acknowledged gamification and financial incentives as potentially effective features in mHealth apps for medication adherence. However, they also indicated that the effectiveness heavily depended on implementation and execution. Major concerns relating to gamification and financial incentives were perceived trivialization and potential for medication abuse, respectively. The study's findings provide a foundation for developers seeking to apply these novel features in an app intervention for a general cohort of patients. However, the study highlights the need for standards for mHealth apps for medication adherence, with particular attention to the use of gamification and financial incentives. Future research with patients and stakeholders across the mHealth app ecosystem should be explored to formalize and validate a set of standards or framework.

“Keeping the Queen’s Peace”: A Sociomaterial Study of Police and Guns in a “Mangle of Risk”

This sociomaterial study analyzes the ways that material agency plays a key role in the organizing dynamics of risky work through a study of the carrying and use of handguns by U.S. and U.K. police officers. Qualitative data (interviews and focus groups) were collected over a three-year period with police (N = 61) in New York, where officers routinely carry guns, and in London, where they typically do not. Police unanimously describe the agentic role non-human artefacts like guns play in: a) framing their cognitive processes, b) influencing their behaviour and decision-making processes, and c) impacting individuals around them. Expanding Pickering's theorization of a mangle of practice, we inductively develop a mangle of risk to explain how human and non-human agency become entangled in risky work contexts, where danger is real and time pressure is high. Understanding these dynamics requires analysis of both frontline police narratives and the prescribed organizational policies, procedures, and routines intended to contain risky situations. Findings reveal that the tools provided to police to do their job both frame and constrain operational capabilities, potentially escalating danger for police, suspects, and the community in a mangle of risk.

Key factors in the future of oral and dental health in Iran using scenario writing approach

BackgroundOral and dental health can significantly impact individuals’ quality of life. The World Health Organization introduces oral health as one of the essential priorities of public health worldwide. Given the lack of studies on the future of oral and dental health in Iran, this study used a futures studies approach to identify the factors in oral and dental health in Iran through scenario writing.MethodsThis study was conducted in three stages including the scenario writing approach, qualitative methods, and exploratory future research. First, potential variables affecting future oral and dental health systems were extracted through interviews. The focus group discussion determined the uncertainty and importance of the variables. Then, the cross-impact balance matrix was imported into the Scenario Wizard software to identify the different states of the scenario generator variables and compatible scenarios were extracted.ResultsSeventy variables were extracted as key variables affecting the future of oral and dental health. Regarding the importance and uncertainty, seventeen variables scored higher and fell into policy and governance, economy and financing, social, service delivery, and technology, serving as five categories of scenario generators. Fifteen scenarios with weak consistency and three with strong consistency were obtained using the Cross-Impact Balance matrix in Scenario Wizard software.ConclusionThe probability of a pessimistic scenario where all five categories of the scenarios were in the worst possible state was higher due to its consistency. The government’s support policies and commitment to oral and dental health were two key factors in the future. Achieving an optimistic and favorable scenario for the future of the country’s oral and dental health system depends on the government and policymakers in the health sector adopting a positive attitude towards the role of oral and dental health services in improving societal health. In this scenario, the five categories of the scenario generators were in the best condition.

Improving alcohol and substance use screening in school-age children: translation, adaptation and psychometric evaluation of the CRAFFT tool for Lumasaaba, Uganda

BackgroundChildren at risk of substance use disorders (SUD) should be detected using brief structured tools for early intervention. This study sought to translate and adapt the Car, Relax, Alone, Forget, Family/Friends, Trouble (CRAFFT) tool to determine its diagnostic accuracy, and the optimum cut-point to identify substance use disorders (SUD) risk in Ugandan children aged 6 to 13 years.MethodsThis was a sequential mixed-methods study conducted in two phases. In the first qualitative phase, in Kampala and Mbale, the clinician-administered CRAFFT tool version 2.1 was translated into the local Lumasaaba dialect and culturally adapted through focus group discussions (FGDs) and in-depth interviews, in collaboration with the tool’s authors. Expert reviews and translations by bilingual experts provided insights on linguistic comprehensibility and cultural appropriateness, while pilot testing with the target population evaluated the tool’s preliminary effectiveness. In the second phase, the CRAFFT tool, adapted to Lumasaaba, was quantitatively validated against the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) for diagnosing SUD in Mbale district, through a survey. Participants, chosen randomly from schools stratified according to ownership, location, and school size, were assessed for the tool’s reliability and validity, including comparisons to the MINI KID as the Gold Standard for diagnosing SUD. Data were analyzed using STATA-15. Receiver-operating-characteristic analysis was performed to determine the sensitivity, specificity, and criterion validity of the CRAFFT with the MINI-KID.ResultsOf the 470 children enrolled, 2.1% (n = 10) had missing data on key variables, leaving 460 for analysis. The median age and interquartile range (IQR) was 11 (9–12) years and 56.6% were girls. A total of 116 (25.2%) children had consumed alcohol in the last twelve-month period and 7 (1.5%) had used other substances. The mean CRAFFT score for all the children (n = 460) was 0.32 (SD 0.95). The prevalence of any alcohol use disorder (2 or more positive answers on the MINI KID) in the last 12 months was 7.2% (n = 32). The Lumasaaba version of the CRAFFT tool demonstrated good internal consistency (Cronbach’s α = 0.86) and inter-item correlation (Spearman correlation coefficient of 0.84 (p < 0.001). At a cut-off score of 1.00, the CRAFFT had optimal sensitivity (91%) and specificity (92%) (Area Under the Curve (AUC) 0.91; 95% CI 0.86–0.97) to screen for SUD. A total of 62 (13.5%) had CRAFFT scores of > 1.ConclusionThe Lumasaaba version of the CRAFFT tool has sufficient sensitivity and specificity to identify school-age children at risk of SUD.

Developing a survey to measure nursing students’ knowledge, attitudes and beliefs, influences, and willingness to be involved in Medical Assistance in Dying (MAiD): a mixed method modified e-Delphi study

BackgroundMedical Assistance in Dying (MAiD) was legalized in Canada in 2016. Canada’s legislation is the first to permit Nurse Practitioners (NP) to serve as independent MAiD assessors and providers. Registered Nurses’ (RN) also have important roles in MAiD that include MAiD care coordination; client and family teaching and support, MAiD procedural quality; healthcare provider and public education; and bereavement care for family. Nurses have a right under the law to conscientious objection to participating in MAiD. Therefore, it is essential to prepare nurses in their entry-level education for the practice implications and moral complexities inherent in this practice. Knowing what nursing students think about MAiD is a critical first step. Therefore, the purpose of this study was to develop a survey to measure nursing students’ knowledge, attitudes and beliefs, influences, and willingness to be involved in MAiD in the Canadian context.MethodsThe design was a mixed-method, modified e-Delphi method that entailed item generation from the literature, item refinement through a 2 round survey of an expert faculty panel, and item validation through a cognitive focus group interview with nursing students. The settings were a University located in an urban area and a College located in a rural area in Western Canada.ResultsDuring phase 1, a 56-item survey was developed from existing literature that included demographic items and items designed to measure experience with death and dying (including MAiD), education and preparation, attitudes and beliefs, influences on those beliefs, and anticipated future involvement. During phase 2, an expert faculty panel reviewed, modified, and prioritized the items yielding 51 items. During phase 3, a sample of nursing students further evaluated and modified the language in the survey to aid readability and comprehension. The final survey consists of 45 items including 4 case studies.DiscussionSystematic evaluation of knowledge-to-date coupled with stakeholder perspectives supports robust survey design. This study yielded a survey to assess nursing students’ attitudes toward MAiD in a Canadian context.ConclusionThe survey is appropriate for use in education and research to measure knowledge and attitudes about MAiD among nurse trainees and can be a helpful step in preparing nursing students for entry-level practice.

Impact of COVID-19 on Profession and Health of Female Sex Workers: Apprehension, Acquiescence, and Resilience.

In Surat city of Gujarat, India, female sex workers (FSW)-based targeted interventions (TI) and community-based organizations (CBO) have been functioning since 1998. To document the impact of the COVID-19 lockdown (March-May 2020) on FSWs and STI/RTI/HIV preventive measures provided through TI/CBOs in Surat city, sequential, explanatory mixed-methods design was used. We conducted a desk review of quarterly programmatic data (2018-2020) of four TIs and CBOs and interviewed of 221 FSWs to study pre- and post-lockdown socioeconomic conditions, engagement in sex work, health services during COVID-19 lockdown and coping strategies, followed by five focus group discussions of FSWs and TI/CBO project staff. Study identified four major themes: reasons for working as a FSW during COVID-19 lockdown, entry to sex work during or as a consequence of lockdown, exploitation of FSWs during lockdown, and challenges of TI and CBOs in service provision in pandemic situation. Number of new registrations and STI/RTI detection increased immediately after lockdown. TI/CBO and other NGOs working for women welfare must build financial independence by training them in microeconomics, savings, and entrepreneurship. TI/CBO staff must also include experts in finance or business, trained in emergency response. The presence of strong TI/CBO network facilitated prompt delivery of essential commodities and financial aid to FSWs. However, laboratory and screening services were hampered, which warrants need of introducing self-test kits. In backdrop of decrease in condom distribution, continuation of sex work during lockdown and disruption of routine HIV/STI/RTI screening facilities, our study also recommends intensified HIV/STI/RTI screening among FSWs.