Focus Group Discussions Research Articles

Young onset gastrointestinal cancer: A needs analysis.

383 Background: The global incidence of Young Onset ( YO) cancers diagnosed in adults under 50 years, is increasing for unknown reasons. YO Gastrointestinal (GI) cancers, which account for approximately 27% of newly diagnosed cancer cases and 37% of cancer deaths present distinct challenges in areas including sexual health, finance, career and family. We assessed the holistic needs of these patients through a mixed methods approach. Methods: A single institution needs analysis study was undertaken in YO GI patients diagnosed 2014-2024 through an anonymous survey and Focus Group Discussions (FGD). The surveys asked about their experiences of sexual health and function, psychosocial concerns, financial concerns, career developments and when in their cancer journey would they prefer to speak to a health care professional about these. FGD's used nominal group technique to deepen the analysis. Results: 88 participants responded via survey and 10 participated in a FGD. The average age at diagnosis was 43 years. 80% of participants reported they would have benefitted from a conversation about fertility, sexual health/function (82%) and financial supports (98%) at diagnosis. 93% of patients were out of work during cancer treatment with average length of time > 1 year. Conclusions: This needs analysis highlights the importance of specialised clinical pathways for young onset GI cancer patients focusing on these unique and complex needs. Financial supports, conversations regarding sexual health/function, fertility preservation and psychosocial support are critical areas requiring structured intervention. 2014-2024 young onset SJH. UGI ( N=233) Colorectal (N=275) Clinical Stage at diagnosis Oeso Stage 4 = 39% Gastric stage 4 = 26% Stage 3= 46% Stage 4 = 20% Treatment intent % Radical =54% Palliative =38% Radical/Palliative = 8% Radical =75% Palliative 25% Mortality rate 66% 25% GI Survey results ( N=236) Support offered Y/N Preferred timing of support Sexual health/ function No=85% Yes =15% 82% At diagnosis Financial support No=95%Yes= 5% 98% At diagnosis Fertility preservation No = 65% Yes=35% 80% At diagnosis

The Effect of Lean Hospital Practices on Nurses' Direct Care Activities: Time and Motion Study.

This study investigates the effects of lean management practices on nurses' direct patient care activities and the interruptions they encounter in healthcare settings. The literature indicates that lean management enhances efficiency and improves patient care. Increased nursing time per patient correlates with better outcomes; however, rising patient loads and frequent interruptions hinder nurses' ability to deliver effective care, jeopardising patient safety. Addressing these inefficiencies is essential, given nurses' critical role in ensuring quality care. Using a single-centre, observational, pre-post time and motion design alongside participatory action research from August 2019 to July 2022, the study included three phases: a survey assessing nurses' views on problem-solving and lean management; observations identifying nurses' activities and interruptions; and focus group discussions. The results presented here are from the observation phase, with 34 nurses from surgical, internal medicine, and mixed services participating. Quantitative variables were expressed as means, standard deviations, and significance was assessed at a 95% confidence interval (p < 0.05). Observations in 2019 (324 h) and 2022 (314 h) revealed that nurses dedicated a significant portion of their time to direct patient care, which increased post-lean implementation (surgical: 50.67%, internal: 50.09%, mixed: 44.38%). Waste rates decreased by 35.81%, and documentation time decreased by 23.55%. Overall interruptions also decreased significantly (p < 0.05). Lean management effectively reduces waste and improves direct patient care time, enhancing patient safety and care quality. Continuous improvement initiatives in nursing practices are essential for success.

"The mannequins have been pink for a very long time." Navigating whiteness and realness in simulation.

Simulation training provides health professions learners access to training not readily available to them and in a manner that does not harm patients. Simulation also supports learners to develop dispositions and professional communication and reflect on their biases. This study examines how learners, clinical education faculty, and simulation professionals reflect on diversity and antiracism in simulation and contextualize these reflections with their lived experience. We undertook interviews and focus group discussions with medical students, simulation professionals, and clinical education faculty (n=47) at a public medical school in the U.S. Midwest with three campuses. Students, faculty, and simulation professionals recognized the importance of simulation as a safe and judgment free zone where they could build rapport with patients with a variety of health conditions and medical histories. Moreover, students recognized how simulation professionals created environments where they could ask questions, practice techniques, and feel more prepared for their future clinical encounters. Students, faculty, and simulation professionals recognized how cases written by faculty, simulation professionals and equipment were insufficiently inclusive of the patient populations that students would eventually see, in terms of race, language, disability, body size, and age. Simulation reproduced biases and posed challenges to the perceived realness of encounters with simulated patients. Students who were visible minorities found it harder to relate to simulated patients and found these patients to be biased towards them. The ways faculty wrote cases and the inability to relate to standardized patients reinforced perceptions that the simulation did not feel real enough. While simulation has the potential to address the dimensions of medical training and practice that harm students and patients, it can also inadvertently reproduce these dimensions. We contend that these harmful products of simulation hinder the very efforts to create cultures of belonging and solidarity that antiracist practices in simulation seek to achieve.

Do you like my voice? Stakeholder perspectives about the acceptability of synthetic child voices in three South African languages.

There is a global need for synthetic speech development in multiple languages and dialects, as many children who cannot communicate using their natural voice struggle to find synthetic voices on high-technology devices that match their age, social and linguistic background. To document multiple stakeholders' perspectives surrounding the quality, acceptability and utility of newly created synthetic speech in three under-resourced South African languages, namely South African English, Afrikaans and isiXhosa. A mixed methods research design was selected. After the creation of naturalistic synthetic child speech which matched the vocal identity of three children with expressive communication difficulties, those three children answered questions about the quality, acceptability and utility of the synthetic voices using a pictographic three-point scale. A total of 11 adults who are known to the children participated in subjective quality assessments in the form of mean opinion scores, intelligibility tests and focus group discussions. Despite the synthetic adult voices appearing more natural, stakeholders were accepting of all the synthetic voices. Although personalization of the voices is important, intelligibility is prioritized and standard dialects are often preferred. When communication partners have adequate training and are willing to model and support children in all environments, children with expressive communication difficulties thrive, but when augmentative and alternative communication (AAC) use is inconsistent, there is reduced vocabulary development and poor system transitioning, and AAC abandonment is greater. This research suggests that stakeholders from low- and middle-income countries are interested in the development of synthetic voices in their home languages. Our research highlights that children would prefer to incorporate these voices on their high-tech devices, and adults would prefer them for their children, learners and/or clients' devices, rather than using British or US English voices. What is already known on this subject Caregivers, service providers, peers and other communication partners play a substantial role in a child AAC user's early communicative success, and their acceptance of AAC ultimately influences the effectiveness of the intervention. When communication partners advocate and support the inclusion of specific speech-generating devices, AAC applications, and suitable synthetic voices, children are more willing to consistently utilize the technology. What this paper adds to the existing knowledge As literature focusing on stakeholder perspectives from low- and middle-income countries is less common than research from high-income countries, and often lacks input from multi-perspective stakeholders, our study offers a unique perspective from South African children with expressive communication difficulties, caregivers of those children, their speech-language pathologists and teachers, about the quality, acceptability and utility of synthetic speech in under-resourced languages. What are the potential or clinical implications of this work? Our research highlights that stakeholders would prefer South African languages and dialects on South African speech-generating devices, rather than relying on devices that only incorporate British or US English voices. The development of synthetic speech in under-resourced languages has the potential to support marginalized AAC communities. Children with expressive communication difficulties would finally be able to participate in class and do so with a voice that matches their age, gender and social and linguistic background. This paper highlights the importance of providing a variety of synthetic voice options and emphasizes the significance of introducing novel voices for high-tech AAC to children in a manner that respects and aligns with their linguistic and cultural backgrounds.

Emergency managers' challenges with wildfires and related cascading hazards in California.

This study investigates the complexities faced by emergency managers in wildfire-prone areas to uncover pressing issues and potential solutions. Four themes are discerned through three focus group discussions with emergency managers from nine counties across California. First, there is unequal access to resources for both risk assessment and response, with counties that have fewer resources facing significant challenges in effectively managing wildfire risks. Second, effective risk communication depends on the available resources and the unique characteristics of each community. Participants stress the need for improved communication tools to reach vulnerable groups (e.g., seniors, individuals with disabilities, non-English-speaking residents). Third, the complexity and confusion surrounding multi-level collaboration in wildfire management is a recurring theme. Participants note that unclear roles and responsibilities between state and federal agencies hinder response efforts, underscoring the need for better coordination and transparent communication at all levels. Fourth, innovative responses (e.g., creative evacuation strategies, collaborative efforts) are recognized as imperative for managing wildfires and their cascading impacts in resource-constrained areas. The findings highlight that achieving equitable and effective preparation, response, and resilience for vulnerable communities requires a comprehensive understanding of wildfire severity and community susceptibility, coupled with active collaboration among emergency managers, policymakers, and both governmental and non-governmental organizations.

Ageing Healthy: Perceptions of Older Persons, Community Members, and Other Stakeholders in Uganda.

Promoting healthy ageing would benefit from an understanding of what this means to stakeholders. We explored healthy ageing perceptions in rural and peri-urban Ugandan communities. Community dialogues, focus group discussions with older persons, community members, community-based organization leaders, key informant interviews with Ministries of Gender (2), Health (1), non-governmental organizations (3) and elderly representatives (5) were held. Thematic content analysis framework was used. Physical perceptions of ageing healthy included physical fitness, absence of health challenges, good physical appearance and looking younger. Emotional perceptions were a stress-free life with children's care, a balanced diet, basic needs and activity involvement. Socio-economic included financial stability, medical accessibility, future planning and network engagement. Spirituality, ageing with dignity and knowledge of body changes were others. The study provides insight into physical, emotional, and socio-economic perceptions of healthy ageing. Additional research in other settings would inform the UN Decade of Healthy Ageing.

Implementation of Digital Technology to Improve Balance at Elderly Posyandu

ABSTRACT This community service initiative was designed to enhance balance among the elderly by leveraging digital technology at Posyandu Lansia RW 06, Rangkapan Jaya Baru, Depok City. The underlying issue was that Indonesia's increasing life expectancy was not accompanied by healthier lifestyle habits, leading to a higher risk of falls. Poor balance among the elderly elevated the likelihood of falls, which could adversely affect their independence and quality of life. The research methodology involved conducting Focus Group Discussions (FGDs) to identify primary concerns, educating participants on the importance of balance, and providing balance exercise training through digital instructional videos. Evaluations were performed using pre-test and post-test assessments. The results indicated a significant improvement in the participants' knowledge. In conclusion, despite challenges like limited access to technology, the program successfully achieved its objectives and showed potential for further development and implementation in other locations. This initiative provided tangible benefits to the elderly, boosting their confidence in daily activities, reducing the risk of falls, and thereby enhancing their overall quality of life. Keywords: Elderly, Balance, Exercise, Technology

Cultivation of Grit in Nursing Students: A Qualitative Descriptive Study "Cultivation of Grit".

Predicted nursing deficits and low nursing student retention rates highlighted the need to investigate cultivation of grit, a malleable trait involving perseverance and passion to achieve long-term goals amidst challenges and difficulties. The objective of this study was to identify how cultivation of grit and additional academic and non-academic strategies aided gritty second-year associate degree-seeking nursing students in addressing nursing program challenges and completing their nursing program. Twenty-two second-year associate degree-seeking nursing students in rural central Arizona completed demographic and Grit-O Scale questions using Survey Monkey™ and participated in semi-structured interviews or focus group discussions held from September through December 2022. Research questions provided study foundation: RQ1: How do second-year nursing students with high levels of self-perceived grit of greater than 3.5 out of 5 as measured on the Grit-O Scale describe how grit was cultivated during their associate degree-seeking nursing program? RQ2: How do second-year nursing students with high levels of self-perceived grit describe how additional academic and non-academic strategies added to them in dealing with the challenges of their associate degree-seeking nursing program? Qualitative Descriptive Research. Inductive thematic analysis revealed six themes: importance of perseverance and passion, facets of grit; identification of program challenges and strategies used to deal with challenges; and the significance of support from nursing cohort, family, and friends, and nursing instructors. Effective strategies for participating nursing student retention and program completion involved cultivation of grit and its facets of perseverance and passion and additional academic and non-academic strategies of nursing cohort and instructor support aided students in dealing with challenges faced during their associate degree-seeking nursing program at a rural, central Arizonan community college.

“What women want”: Focus group discussions to inform the design of nutrition resources for women impacted by menopause following cancer treatment

“What women want”: Focus group discussions to inform the design of nutrition resources for women impacted by menopause following cancer treatment

User-centred design of ChestCare: mHealth app for pulmonary rehabilitation for patients with COPD; a mixed-methods sequential approach.

The increasing prevalence and burden of chronic obstructive pulmonary disorder (COPD), the challenges in implementing pulmonary rehabilitation (PR) programs and the limited availability of alternatives and supportive programs to serve patients with COPD necessitate the development of pulmonary telerehabilitation (PTR) systems to provide patients with COPD with PR programs. This study aimed to design and develop the ChestCare mobile Health app using user-centred design (UCD) approach. Thus, it provided PTR for patients with COPD, enhancing their self-management of symptoms and improving their compliance with PR programs. In this mixed-methods sequential research, we deployed the UCD iterative design through the prototype app design and development sequence. The first phase was built based on the results of a previous needs assessment study and an analysis of related apps. This produced the initial mock-up, the foundation for the focus group discussions with physiotherapists and patients. Six physiotherapists with cardiorespiratory specialisation evaluated each app module and item of the latest mock-up using the content validity index (CVI) document. The I-CVI (S-CVI/Ave) and (S-CVI/UA) were computed. Qualitative and quantitative data were integrated, and decisions were made by comparing their results. The UCD iterative design through sequential MMR has generated four mock-up app versions. The latest version identified 13 modules through 150 items validated by six experts using a CVI document. The I-CVI calculation of 145 items was 1, while 0.83 for the remaining items, was within accepted values. The S-CVI scored 99.4, indicating an overall validity of the ChestCare app as a PTR system for patients with COPD. The development and validation of the ChestCare app resulted from conducting UCD iterative design and sequential MMR, which identified 13 functionalities, including symptom assessment, tracking lung volume, functional capacity test, action plan, intervention program, COPD education, COPD community, monitoring and reminders.

Views on cervical cancer screening among female caregivers at the Uganda cancer Institute

Patients admitted to Uganda Cancer Institute (UCI) have their non-medical needs provided by caregivers called “attendants” who are predominantly female family members. This provides a unique opportunity to provide free screening among attendants during their free time at the hospital. The objective of this qualitative focus group study was to understand knowledge of and facilitators and barriers to cervical cancer screening among attendants at the UCI. The goal is to use these data to inform a future opportunistic intervention. Female attendants 25 years of age or older were included in this focus group study. The focus group discussions explored knowledge of cervical cancer and screening modalities, health information sources, barriers and facilitators for cervical cancer screening, and potential use of mobile phone technology to share cervical cancer screening information among one’s social community. Data were analyzed using an inductive approach and thematic analysis. Results showed moderate understanding of risk factors for cervical cancer, supplemented by misinformation. Knowledge of symptoms of advanced cervical cancer was high. Most participants were aware that cervical cancer screening exists but knew little about screening modalities. Responses were mixed regarding preferred information sources, and included healthcare workers and facilities, radio and family members. Participants were enthusiastic about mobile phone messaging to provide information about screening but emphasized a need to catch their attention and incentivize screening with promise of good such as sugar, demonstrating prioritization of immediate needs over future cancer risk. These results will inform an intervention which aims to connect female caregivers with free screening available at the adjacent cancer prevention clinic.

Qualitative Study of Healthcare Seeking Behavior and Development of Behavioural Nudges for a Nutrition Program in Gombe State, Nigeria

Objective: This qualitative study aimed to identify and explain healthcare seeking behaviours among caregivers of young children and apply these findings to develop a mobile phone-based messaging intervention to encourage sustained attendance at a community-based management of acute malnutrition (CMAM) program in Gombe state, Nigeria. Design: Researchers conducted focus group discussions (n=6) and key informant interviews (n=3) with 33 subjects. Transcripts were independently coded and thematic analysis was conducted to gain an understanding of the facilitators, barriers, and motivators shaping caregivers’ decisions to attend health services for malnourished children, as well as access to and use of mobile phones. Participants: Focus groups and interviews were conducted with caregivers of children aged 6-59 months living within travelling distance of three CMAM sites in Gombe state, Nigeria. Results: Barriers to seeking health services included high costs; perceptions of poor quality of care, including poor treatment by health workers; and female caregivers’ limited autonomy. Despite barriers, participants recommended seeking hospital care for a malnourished child. Participants described widespread mobile phone use and recommended messages emphasising that CMAM services are free, conveying respect for caregivers, and reminding caregivers to continue making an effort to attend the CMAM program even as their child began to appear healthier. Conclusions: This study provides a framework for developing contextually salient behavioural nudges for child health and nutrition programs which, in combination with other community outreach strategies, could help motivate and sustain care seeking behaviour.

Twice marginalised: the status of Marma language and identity in Bangladesh

ABSTRACT In this paper, we tried to understand the status of the Marma language and identity in Bangladesh. Being an Indigenous community in a country where Bengalis form a numerous as well as political majority, the Marmas in Bangladesh experience cultural and linguistic marginalisation. An added dimension of hegemony comes from the Chakmas who, arguably, are the most prominent Indigenous community in Bangladesh with an active political history. Given the multiple layers of marginalisation, we examined how the Marmas in Bangladesh negotiate their language and identity. Using an ethnographic approach through interviews and focus group discussions, we collected data from 14 Marma community members from Rangamati, Bangladesh. A thematic analysis confirmed the double marginalisation of the Marmas in Bangladesh. The findings also showed a shift in language use primarily driven by socio-economic concerns and an intergenerational negotiation of identity among the community members.

Under nutrition among low-income Guatemalans

This study examines the dietary and health difficulties encountered by impoverished communities in Guatemala, with the goal of gaining a thorough understanding of the intricate elements that affect health outcomes in these marginalized people. The study used a mixed-methods approach, integrating quantitative analyses of secondary and primary data with qualitative insights obtained through interviews and focus group discussions. The research findings emphasize a substantial prevalence of moderate health problems among the communities under study, as seen by the concentration of health outcomes around a value of 70. The consumption of nutrients has been identified as a critical factor in determining health outcomes, since a lower intake is linked to inferior health. Positive associations were observed between socioeconomic level, access to healthcare services, and health outcomes. These findings add to the wider discussion on health inequalities and the factors that influence health in low-income environments. The study emphasizes the significance of focused interventions, advocating for dietary programs, poverty reduction initiatives, and enhanced healthcare access. It highlights the importance of empowering the community, encouraging their involvement, and adopting comprehensive strategies to tackle the complex issues faced by these communities.

Information needs in vascular access decision-making: A qualitative study of patient and clinical stakeholder perspectives.

The information and decision support needs required to embed a patient-centred strategy are challenging, as several haemodialysis vascular access strategies are possible with significant differences in short- and long-term outcomes of potential treatment options. We aimed to explore and describe stakeholder perspectives on information needs when making decisions about vascular access (VA) for haemodialysis. We performed thematic analysis of seven (six online, one in person) focus group discussions including transcripts, post-it phrases and text responses with 14 patients and 12 vascular access professionals (four nephrologists, three surgeons and five nurses - Vascular access nurse specialists/Education and dialysis nurses) who participated in at total of six online and one in person focus group. All patients had experience of haemodialysis and 50% had experience with at least one other modality of RRT. Ten patients had experience of more than one VA modality and 4/14 had experience of AVG, 13/14 had experience of AVF and 8/14 had experience of TCVC. We identified four semantic themes and two latent themes. The themes and their subthemes reflected information needs of patients when making vascular access decisions: Knowledge, Risks and Benefits of Relevant options, long-term treatment strategy and Personal Impact of VA. The latent themes, identified across all stakeholders, were of the need for consistent and trustworthy information. All recent vascular access guidelines propose a shared decision-making approach to vascular access. The ability to implement this in practice carries an information need for both patients and clinicians. This study describes a framework model which can be applied during co-design and assessment of vascular access educational resources to facilitate a patient centred perspective.

Factors involved in the recruitment and retention of voluntary blood donors in South Kivu (Democratic Republic of Congo), results from a qualitative study

Background and objectiveVoluntary blood donations remain a major concern in the Democratic Republic of Congo, increasing morbidity and mortality due to shortages of safe blood. Local studies show low rates of recruitment and retention of voluntary donations, as well as a high attrition rate of former donors. The psychosocial factors involved in deciding to become and remain a voluntary blood donor in sub-Saharan Africa remain poorly understood. Our study therefore aimed to explore the motivational factors and perceptions involved in voluntary blood donation in South Kivu.Materials and methodsWe conducted 20 individual interviews, and three focus group discussions were conducted with a total of 26 volunteer donors. As a way of triangulation, two additional focus-groups were held with 19 non-donors. The individual interviews were analysed thematically, using a starting list of 3 predefined units of analysis, namely: initiation, maintenance, and cessation of voluntary blood donation. The data was analysed inductively within these predefined units of analysis to generate possible factors of motivation that were then presented and further discussed during the focus-groups discussions with donors and non-donors.ResultsFear presented as a factor influencing the decisions to donate blood either positively or negatively, from recruitment to maintenance to cessation of donation. Other motivational factors were found to be linked to the perceived meaning of voluntary donation, such as the meaning given to the blood voluntary donation and material or non-material expectations. Our results suggest that expectations for material rewards are still high in the context of poverty.ConclusionIn conclusion, many motivational factors may act as incentives or barriers to voluntary blood donation, including high expectations towards the transfusion system. Local particularities need to be considered when promoting voluntary blood donation. The fear of being abused by the system needs to be addressed, by enhancing accessibility to transfusions.

Experiences, perceptions and ethical considerations of the malaria infection study in Thailand

BackgroundThailand has made significant progress in malaria control efforts in the past decade, with a decline in the number of reported cases. However, due to cross-border movements over the past 5 years, reported malaria cases in Thailand have risen. The Malaria Infection Study in Thailand (MIST) involves deliberate infection of healthy volunteers with Plasmodium vivax malaria parasites, and the assessment of the efficacy of potential vaccine and drug candidates in order to understand acquired protection against malaria parasites.MethodsThis paper drew from ethics and social science qualitative study called MIST-ETHICS embedded within the MIST studies. MIST-ETHICS aimed to describe and understand the experiences, perceptions and ethical considerations of the MIST studies. Data were obtained from semi-structured interviews and a focus group discussion. A total of 46 participants participated in MIST-ETHICS .ResultsThree major themes emerged: experiences and perceptions of MIST, reasons for joining MIST, and ethical considerations. We found that although compensation was a motivation for participation, this was secondary to it being beneficial to self (health checks; link to health networks; building merit) and others (medical research contribution; altruism). Participants expressed varied opinions regarding the requirement of a university degree as one of the inclusion criteria for MIST.ConclusionsOur study revealed widespread concerns about long-term health effects and safety. Ethical considerations, including obtaining valid informed consent and ensuring participant inclusivitiy, were deem essential. Despite some debate regarding eligibility criteria, most participants agreed that the informed consent process was robust, accompanied by a strong sense of responsibility to contribute to the greater good. We emphasize the importance of continuously gathering participants’ feedback for quality control, such as improving information materials to clarify the purpose of initial phases, their contributing to later phases, and the rationale behind each selection criterion.Trial registrationThis manuscript is part of the clinical trials registered under ClinicalTrials.gov IDs NCT04083508 (MIST1) registered on 5 Sep 2019 and NCT05071079 (MIST2) registered on 28 July 2021. However, the manuscript pertains to a qualitative study that does not require trial registration.

Phenomenological insights into socio-psychological and network dynamics of women entrepreneurs

PurposeThis study investigates the socio-psychological and network dynamics influencing women’s entrepreneurial journeys in Bangladesh. It focuses on understanding how societal expectations, financial barriers and emotional resilience shape these women’s entrepreneurial experiences and outcomes.Design/methodology/approachA hermeneutic phenomenological approach was employed, involving in-depth interviews and focus group discussions with 15 women entrepreneurs from various industries in Bangladesh. Thematic analysis was used to identify critical patterns and themes in their experiences.FindingsSix major themes emerged from the data: societal biases and constraints, financial hurdles, balancing family and work, psychosocial processes, the impact of social networks and strategic interventions. The findings not only reveal the deeply ingrained gender biases, limited access to financial resources and the emotional toll of juggling professional and domestic responsibilities but also underscore the remarkable resilience of these women in the face of such challenges.Practical implicationsThe study offers actionable insights for policymakers, support organizations and researchers. It underscores the urgent need for gender-sensitive financial policies, restructuring mentorship programs to include emotional support and developing cultural awareness campaigns to challenge societal norms that hinder women entrepreneurs.Originality/valueThis research uniquely contributes to the underexplored psychosocial dimensions of women’s entrepreneurship in Bangladesh. It highlights how emotional resilience and societal dynamics influence entrepreneurial success, offering valuable insights for enhancing support systems for women entrepreneurs.

A Digital Tool (Technology-Assisted Problem Management Plus) for Lay Health Workers to Address Common Mental Health Disorders: Co-production and Usability Study in Pakistan.

Mental health remains among the top 10 leading causes of disease burden globally, and there is a significant treatment gap due to limited resources, stigma, limited accessibility, and low perceived need for treatment. Problem Management Plus, a World Health Organization-endorsed brief psychological intervention for mental health disorders, has been shown to be effective and cost-effective in various countries globally but faces implementation challenges, such as quality control in training, supervision, and delivery. While digital technologies to foster mental health care have the potential to close treatment gaps and address the issues of quality control, their development requires context-specific, interdisciplinary, and participatory approaches to enhance impact and acceptance. We aimed to co-produce Technology-Assisted Problem Management Plus (TA-PM+) for "lady health workers" (LHWs; this is the terminology used by the Lady Health Worker Programme for lay health workers) to efficiently deliver sessions to women with symptoms of common mental health disorders within the community settings of Pakistan and conducted usability testing in community settings. A 3-stage framework was used for co-producing and prototyping the intervention. Stage 1 (evidence review and stakeholder consultation) included 3 focus group discussions with 32 LHWs and 7 in-depth interviews with key stakeholders working in the health system or at the health policy level. Thematic analyses using the Capability, Opportunity, and Motivation for Behavioral Change (COM-B) model were conducted. Stage 2 included over eight online workshops, and a multidisciplinary intervention development group co-produced TA-PM+. Stage 3 (prototyping) involved 2 usability testing rounds. In round 1 conducted in laboratory settings, 6 LHWs participated in role plays and completed the 15-item mHealth Usability App Questionnaire (MUAQ) (score range 0-7). In round 2 conducted in community settings, trained LHWs delivered the intervention to 6 participants screened for depression and anxiety. Data were collected using the MUAQ completed by LHWs and the Patient Satisfaction Questionnaire (PSQ) (score range 0-46) completed by participants. Qualitative analysis indicated that a lack of digital skills among LHWs, high workload, resource scarcity for digitization (specifically internet bandwidth in the community), and need for comprehensive training were barriers for TA-PM+ implementation in the community through LHWs. Training, professional support, user guidance, an easy and automated interface, offline functionalities, incentives, and strong credibility among communities were perceived to enhance the capability, opportunity, and motivation of LHWs to implement TA-PM+. TA-PM+ was co-produced with features like an automated interface, a personal dashboard, guidance videos, and a connected supervisory panel. The mean MUAQ score was 5.62 in round 1 of usability testing and improved to 5.96 after incorporating LHW feedback in round 2. The mean PSQ score for TA-PM+ was 40 in round 2. Co-production of TA-PM+ for LHWs balanced context and evidence. The 3-stage iterative development approach resulted in high usability and acceptability of TA-PM+ for LHWs and participants.

Factors Influencing Pregnant Women's Participation in Randomised Clinical Trials in India: A Qualitative Study.

To explore factors affecting participation of pregnant women in randomised clinical trials in Belagavi, Karnataka, India. A qualitative study using semi-structured in-depth interviews and focus group discussions as data collection methods. Primary, secondary and tertiary health facilities and their community catchment areas in Belagavi district. Thirty-three in-depth interviews with health workers and previous participants of a pregnancy-focused trial, and 12 focus group discussions with currently pregnant women who had not previously participated in a clinical trial, family and community members, and accredited social health activists. Inductive thematic analysis with a team-based approach to interpretation in the study context. Pregnant women were often unable to distinguish between maternal health programmes and trial interventions. Among previous trial participants, expectations of higher quality care were a key motivation for trial participation. Household gendered power relations and trust in the health workforce influenced decisional dynamics regarding participation. Health workers vouched for trial safety, once they assessed the intervention as acceptable. Trial Implementation by the health workforce required understanding and navigating pregnancy-related beliefs and practices in communities. Anticipated health benefits, improved healthcare access, and trust in health workers are facilitators of trial participation. Engaging primary decision-makers is essential due to household gender dynamics. Trials must integrate strategies that clarify the distinct goals of research versus clinical care.