Focus Group Research Articles

Supporting safe disclosure of sexual violence in healthcare settings: findings from a realist evaluation applying candidacy theory through a trauma-focused lens

ObjectivesMost people who have experienced sexual violence (SV) will disclose the event(s) to someone. Key recipients of disclosure are those working in healthcare, and using sexual and reproductive health services...

Burnout among medical residents in Haiti: a mixed-methods study

ObjectivesTo investigate the prevalence and risk factors associated with burnout among residents and to explain their experiences with burnout.DesignMixed-methods convergent parallel study with an explanatory follow-up.SettingsOne tertiary hospital in Mirebalais...

Lessons learnt from the 2021 Pacific Northwest heat dome: a qualitative study of western Washington’s healthcare community response

ObjectiveThe 2021 Pacific Northwest heat dome was Washington state’s deadliest recorded weather event and presented unprecedented response challenges to the state’s health sector. Understanding the impacts of this extreme heat...

Management of Persons With Haemophilia Requiring Antithrombotic Therapy: A Canadian Modified Delphi Consensus Study.

Advancements in haemophilia care have extended the life expectancy of persons with haemophilia (PWH), giving rise to new clinical challenges including the need for antithrombotic therapy (ATT) in mitigating arterial or venous thrombotic risk. However, evidence to support clinical decision-making in this context remains limited, despite its growing importance. To develop Canadian consensus recommendations for managing PWH requiring ATT. A modified Delphi technique was used. Initial statements were generated using information from a scoping literature review and focus groups with Canadian haemophilia experts. Key areas included risk assessment, tailored treatment planning, ATT selection and management of breakthrough bleeding. Expert panellists were recruited through the Association of Haemophilia Clinic Directors of Canada using convenience sampling. Participants independently reviewed and rated each statement using a 7-point agreement-based Likert scale, with consensus defined a priori as over 70% agreement among panellists. Statements that did not reach consensus in the first round were modified based on participants' comments. Eight physicians (median experience in PWH care: 11.0years) from five haemophilia treatment centres across four Canadian provinces participated. All panellists had experience managing thromboembolic complications and using ATTs in PWH. Consensus was attained for 32 statements on general aspects of care, risk assessment, treatment planning and management of bleeding complications. All statements attained consensus after two rounds with a 100% completion rate. This Canadian study yielded 32 consensus-based recommendations for managing PWH requiring ATT, addressing an unmet need to guide clinical decision-making in this complex and evolving area.

Technological interventions in overcoming language barriers and facilitating travel experiences of international students

ABSTRACT With increasing globalization, more students are choosing to study abroad. Meanwhile, emerging new technologies are being widely applied. This study explores the relationship among international students’ language barrier, travel experience, and technical support during their studies abroad. In Study 1, five focus groups were created to test the technology-based model. In Study 2, 12 in-depth interviews were analyzed to triangulate and generalize the model. The findings in Study 1 indicate strong relationships among language barrier, travel experience, and technical support. A foreign language is only a small barrier to travel intentions, but technical support is an essential element for international students’ travel activities abroad. Although a foreign language can limit a traveler’s experience, technical support can resolve this to a certain extent. The travelers’ experiences reveal the subjective view of technology-based support, including possibility, assistance, dependence, and constraint. The results of Study 2 confirmed the findings and the relationships among language barrier, travel experience, and technical support. The results provide the basis for future research on language constraints, technical support, and tourist behavior.

Inspiring tomorrow’s geriatricians: a qualitative exploration of the facilitators and barriers to medical students choosing geriatric medicine

ABSTRACT Education in the care of older people, beginning at undergraduate-level, will help to meet the needs of our aging population. Thus, we need to understand why and in what ways medical students have difficulty engaging with older people and geriatric medicine. Twenty-two medical students studying at the University of Bristol (UK) participated in focus groups, exploring their attitudes toward older people and toward geriatric medicine. Five themes were derived using reflexive thematic analysis. Relationships with older relatives contribute toward students’ perceptions of older patients and can enhance their empathy. However, some compartmentalize personal experiences from professional practice to mitigate moral distress. Students are aware of ageism, and in turn encounter challenging views among the older population, which both present significant challenges. It was clear that career decision-making is multi-faceted; inspiring role models, welcoming learning environments, and undergraduate experience were all important. Critically, undergraduate exposure to the full breadth of geriatric medicine and the spectrum of aging was key to changing students’ negative pre-conceptions about caring for older people and geriatric medicine. Undergraduate medical education offers a crucial point during medical training where we can intervene to improve the attitudes of and inspire career interest in tomorrow’s doctors.

Football on the frontlines: the unjust burden of the climate crisis on Pacific Island nations

ABSTRACT Oceania is a region which contributes little to anthropogenic causes of climate change yet bears many of its most immediate burdens. This can be demonstrated through football in the region as several member associations of the Oceania Football Confederation (OFC) are threatened by rising sea levels, floods, heat and other climate harms while lacking the organisational capacity to adapt to climate change. Using a climate justice lens to understand this disparity, this study provides a climate impact assessment to the OFC and its member associations. Focus groups and interviews with key stakeholders were used to assess organisational climate capacity with a goal of addressing the climate changed future of football in this region. Findings suggest all member associations are at risk of high heat and coastal flooding while others may face heavy rains and wildfires. Member associations are highly aware of their climate risks but lack many of the organisational resources necessary to adapt. This inherently demonstrates the injustice faced by this region as it is an immediate victim of climate change.

Benefits of a mindfulness and compassion program for cancer patients: experience in a Spanish public hospital setting.

Mindfulness-based interventions have been shown to improve the quality of life of cancer patients and are widely recommended. This was a non-randomized, single-center study designed to assess the feasibility and benefits of a mindfulness and compassion program for individuals living with cancer (MCP-C). The primary objective was to evaluate the feasibility of the program, while the secondary objective was to assess its effectiveness in adult cancer patients and their relatives. Before and after completing the program, participants completed the 12-item General Health Questionnaire (GHQ- 12) and the Hospital Anxiety and Depression Scale (HADS). A qualitative study was also conducted using focus groups and a structured qualitative survey. A total of eight courses were delivered, six in person in 2019 and two online in 2020. A total of 153 participants were enrolled, of whom 142 were considered evaluable. Among them, 90 (64.3%) completed the program, including 75 patients (83.3%) and 15 relatives. The intervention was associated with significant reductions (p < 0.01) in mean scores on the GHQ- 12 and the HADS-A and HADS-D subscales. In the qualitative assessment, participants reported multiple benefits, including increased awareness of health-related decision-making, improved relationship with the disease, a sense of companionship, emotional support, and overall enhancements in daily life. Implementing an 8-week mindfulness and self-compassion program within the routine practice of a public hospital was feasible and led to significant improvements in the psychological well-being of cancer patients and their relatives.

Meeting them where they’re at: service provider perspectives on the needs of extended foster care participants

ABSTRACT To provide the best services possible to young people eligible for extended foster care (EFC), it is critical to understand their needs and to structure services accordingly. This study examined the perspectives of service providers working with young people eligible for EFC regarding their clients’ needs and how to be responsive to marginalized subgroups. This study included four focus groups and 14 individual interviews with service providers working with youth eligible for or receiving EFC. Results illustrate a range of unmet service needs and changes needed so that EFC services can better support the transition to emerging adulthood for young people. .

Preschool teachers’ perceptions of a curriculum-integrated video-based yoga program

ABSTRACT The utilization of children’s yoga as a resource for improving children’s overall well-being has become a prevalent conversation among yoga, health, and early childhood settings. However, there is a deficiency in the literature regarding the impact of curriculum-integrated video-based yoga programs on preschool-aged children. Subsequently, this study examined a video-based yoga program aligned with state-adopted preschool curriculum. Implementation occurred in Pre-K4 classrooms across three Mississippi school districts in the United States. A qualitative approach was employed to collect data on teachers’ experiences with the yoga videos via a lesson feedback form, lesson observations, and teacher focus groups at the end of the academic year. Three themes emerged after data analysis: (a) interest builds engagement; (b) variety builds enjoyment and community; and (c) building new skills through yoga. These findings are novel in the literature on video-based yoga programs for preschool children and reveal the potential benefits of curriculum-integrated yoga videos.

Towards characterizing subjective cognitive decline in older adults.

BackgroundSubjective cognitive decline (SCD), where older adults perceive a persistent decline of cognitive abilities without showing an objective cognitive impairment, may represent a preclinical stage of Alzheimer's disease (AD) in some individuals.ObjectiveThe complex characteristics of SCD cannot only be revealed by existing self-report questionnaires. Rather, it is necessary to involve individuals affected in the research process with methods like focus group discussions (FGDs).MethodsStudy conduction took place in three steps: telephone interview, neuropsychological assessment and questionnaires, four FGDs with 16 older adults (11 female, 5 male) affected by SCD. FGDs were analyzed with qualitative content analysis using an inductive - deductive code system.ResultsAlthough the neuropsychological assessments did not indicate a cognitive impairment, participants reported a decline for all cognitive domains within the FGDs, especially for the memory- and speech domain, with declining word-finding abilities as the most salient symptom. Participants reported strong concerns related to SCD and difficulties in social participation.ConclusionsSCD seems to go beyond age-related cognitive changes, but as individuals do not show an objective cognitive impairment (yet), their symptoms are often not taken seriously enough. The FGDs revealed information that questionnaires or neuropsychological tests do not capture. The gained insight into SCD symptoms, related coping strategies and concerns is important to be able to develop measures for identifying individuals at risk for a transition to AD and to develop intervention measures that aim at delaying a further decline and increasing the quality of life of individuals affected.

Young people’s conceptions of political agency in relation to climate change

ABSTRACT This article explores how young people conceptualise political agency in the context of climate change. Drawing on a Reflexive Thematic Analysis of 22 focus groups with 154 young people living in Portugal, aged 13 to 35, we identified four conceptions of political agency: transformational collective agency, proto-political collective action, individualised action and disempowered action. Our findings indicate that young people who identify as climate activists view oppositional and disruptive actions as the pathway for achieving transformational social change. In contrast, non-activists tend to favour proto-political collective action or individual approaches as means of gaining political influence. For some young people, disempowered action reflects a limited sense of political agency, which constrains their perceived role in addressing climate change. Overall, we suggest that young people’s political agency regarding climate change is shaped by both motivating and inhibiting factors, a desire for political influence and perceived power to bring about transformative change.

Self-efficacy of VET students, variations across student groups, efficacy domains and the impact of a citizenship education program

ABSTRACT Self-efficacy is a major factor in promoting academic success, success in life, and political participation, and education programmes can have long-term impacts on students’ efficacy beliefs. Our descriptive and mixed-method study complements existing knowledge by examining secondary vocational students’ self-efficacy in study and work and their political efficacy, the relation between (self-)efficacy measures and student background, the impact of a citizenship education programme on efficacy in these domains, and impact differences across student characteristics. Economics students in one large vocational education institute participated in a pre- and postsurvey and complimentary focus groups. Examining the relation between (self-)efficacy and student background revealed that the educational level of students’ mother, home language, and students’ gender mattered. In addition to the programme’s significant impact on students’ individual political efficacy and collective civic efficacy, our analysis also indicates that the programme targeting political efficacy may also affect students’ self-efficacy in other domains. Confirmation of the relative impact of this programme on the political efficacy of specific groups of vocational students makes our study of particular interest to scholars and practitioners involved in furthering educational and political equality in democratic countries within and beyond the EU that seek to support political participation of vocational students.

Parent Perspectives on Water Safety for Children with Autism.

Among children with autism, drowning is the leading cause of death through 14 years old. Attributes such as wandering, sensory issues, impulsivity, and a limited sense of danger could increase risk. In addition, autistic children often have trouble participating in structured group activities like swimming lessons. The purpose of this study is to better understand water safety experiences of parents of children with autism. Parents of autistic children were asked to participate in a focus group about their family's water safety experiences. Six focus groups and one interview were held. Six major themes were identified from transcripts that were common among participants: autism characteristics influence water safety risk; water safety fears influence family life; it is difficult to find and access water safety and swimming lesson information for children with autism; autism characteristics affect participation in swimming lessons and other aquatic activities; autistic children have unique swimming lesson needs; and instructor preparedness is key to swimming lesson success for autistic children. Water safety needs to be elevated in importance for families of autistic children. Information on drowning risk and prevention should be made more accessible. Barriers to adaptive swimming lessons such as cost, scheduling, and availability need to be addressed. More training opportunities need to be provided to swimming instructors to improve teaching children with complex needs, such as those with autism.

The end of treatment process in medically assisted reproduction: a qualitative study of healthcare professionals’ views

In the medically assisted reproduction (MAR) pathway, one of the most complex phases is the end of the treatment. Unlike other medical contexts, there is no biological endpoint in the MAR setting. This absence makes the decision to end MAR treatment extremely challenging for both patients and healthcare professionals. Accordingly, our research aimed to examine the process related to the end of MAR treatment, as devised by healthcare professionals. Our sample included physicians, biologists, and psychologists aged ≥18 years with specialised training in assisted reproduction. Data were collected through four focus groups [in February-May 2023], focusing on the topic of the end of treatment (EoT) and its definition. Data were collected and analysed according to the principles of Grounded Theory. The findings shed light on the attributes and components related to the end of the treatment process. The central category “the end of treatment” consists of a definition of what is considered the end of treatment and the associated decision-making process. In the phase leading up to the EoT, the process is influenced by contextual and proximal factors, which interact and influence each other. To cope with and manage the EoT, healthcare providers adopt spontaneous strategies that lead to positives or negative outcomes. End-of-treatment management is a key facet of clinical practice. This contribution increased knowledge about EoT and highlighted healthcare professionals’ perspectives, which should be considered for the implementation of best practice points and respect for patients’ rights to the highest attainable standard of mental and physical health.

Enhancing Advance Care Planning in Primary Care: A Three-Year Implementation Study in Nebraska.

Despite the benefits of discussing patients' preferences on care decisions, the uptake of advance care planning (ACP) in the U.S. is low. This study aimed to (1) identify barriers to ACP implementation, (2) implement two strategies (onsite ACP coordinator and Lightning Report facilitation-a rapid process improvement involving prompt feedback synthesis and timely action), and (3) track ACP outcomes (reach, implementation, and effectiveness). This study took place at two primary care sites participating in the Nebraska Geriatric Workforce Enhancement Program from 2020 to 2023. We conducted a multi-stage evaluation mixed-methods study guided by the Practical, Robust Implementation and Sustainability Model (PRISM). Qualitative data from clinic staff interviews and focus groups were collected to identify implementation barriers, develop an optimal workflow, and educate providers and patients (implementation). Quantitative data from electronic medical records (EMR) were collected at baseline and every six months thereafter to assess ACP outcomes, including reach (patient-provider discussion of ACP) and effectiveness (ACP document completion). We mapped barriers to implementation strategies, mechanisms, and ACP outcomes based on PRISM domains. From 2019 to 2021, ACP outcomes remained consistent: Clinic A (reach: data not available; effectiveness: 20.5%-20.2%) and Clinic B (reach: 2.3%-2.6%; effectiveness: 1.8%-1.9%). After implementing the ACP coordinator and Lightning Report in 2022, moderate-to-high improvements were observed: Clinic A saw a 10-percentage point increase in reach (43.6%-53.6%) and a 2.5 increase in effectiveness (20.2%-22.8%). Clinic B experienced a significant 25.3-percentage point increase in reach (2.6%-27.9%) and a 16.5 increase in effectiveness (1.9%-18.4%). We also updated the clinic workflow to integrate the ACP initiative into standard practice (implementation). The introduction of an ACP coordinator, along with the Lightning Report approach, may enhance ACP reach, effectiveness, and implementation in primary care settings for older patients.

HELA-CMM: capability maturity model for adoption of learning analytics in higher education

In order to progress in a data-driven society, higher education institutions should strive to integrate learning analytics into their strategic and operational activities. The purpose of this paper is to propose the Higher Education Learning Analytics Capability Maturity Model (HELA-CMM), a capability maturity model for adoption of learning analytics in higher education institutions. The development of the HELA-CMM was based on design science research paradigm and a procedural model for maturity models design. After conducting an extended literature review, a combination of nominal group techniques and focus group were used. The subject-matter experts participating in a nominal focus group elaborated on the structure and evaluated relative importance of its categories and capabilities utilizing the pairwise comparison technique. The proposed maturity model comprises 28 capabilities grouped into eight categories: (1) Teaching / Learning / Assessment, (2) Data Management and Analytics, (3) Ethics, Privacy, Legal Issues, (4) People Competences, (5) Management / Leadership, (6) Culture, (7) Infrastructure, and (8) Quality Assurance. The maturity model will be further developed through an iterative process and evaluated at several higher education institutions in Europe. With the HELA-CMM, higher education institutions will have a tool that on the one hand enables benchmarking and assessment, and on the other hand provides guidance for improving the maturity of learning analytics adoption.

I Found It on Instagram: Exploring the Impact of Social Media on Public Health Communication.

This study aimed to explore the perspectives of social media users and health influencers on the use of these platforms as tools for health communication and literacy. To address the objective, a qualitative descriptive study was conducted using focus groups with general social media users and health content influencers. During the discussions, participants revealed that everyone accesses health information on social media, either actively or unintentionally, thus exposing themselves to this reality. Additionally, a paradigm shift was highlighted due to the 2020 pandemic in relation to the consumption of health information on these platforms. This shift increased interest in the topic as well as general distrust toward official institutions and the phenomenon of misinformation. In response, the importance of the presence of health professionals on social media was emphasized, as well as the need to educate the public to consume this type of information safely. Social media plays a significant role as a public health communication tool, and its use for this purpose is increasingly widespread. However, it is crucial to educate the public to engage in informed and responsible consumption to avoid the consequences of misinformation prevalent on these platforms.

Implementation and Acceptability of a Rural Active Living Initiative

ABSTRACT Health promotion initiatives developed at the community level provide physical and social benefits for older adults. This study examined the implementation and acceptability of an active living program developed for older adults living independently in seniors’ housing apartments in two rural communities (population 650 and 1,500). Using a qualitative descriptive study design, one focus group and seven interviews were completed between December 2023 and February 2024. Focus group participants included managers/directors responsible for developing or supporting the initiative. Interview participants included home care continuing care assistants who delivered the initiative and older adults who participated in the sessions (average age 87 years). Using a six-phase reflexive thematic analysis approach, five themes were developed related to implementation and acceptability: Mind the Gap, the Program that Brings us Together, Everyone Gets a Seat at the Table, When Staff Step Up to the Plate, and the Future is Unclear. Findings suggest the initiative promoted physical activity, mental well-being, and socialization among participants. By exploring the experiences of managers/directors, staff, and participants involved in a rural active living initiative, this study emphasized the importance of considering multiple perspectives when evaluating community health promotion supports for older adults.

Implementation Barriers to Incorporating a Community-Based Doula Program to Improve Birth Outcomes for Black Patients in an Academic Medical Center.

There are significant racial disparities in maternal health and birth outcomes in the USA that disproportionately affect Black individuals. Incorporating community-based doula programs into hospital settings may be an effective intervention to reduce these disparities. However, little research has examined potential barriers and identified strategies to optimize the implementation of a community-based doula program in an academic hospital setting. This study used in-depth interviews with clinicians and nurses (n = 19) and focus groups with doulas (n = 11) to identify multi-level barriers to implementing a doula program for Black pregnant patients in a single academic hospital setting in Milwaukee, WI. Data were analyzed using thematic analysis, and we developed four themes that highlight potential implementation barriers: (1) doulas' advocacy efforts were met with resistance from the healthcare team; (2) there was a lack of trust and established relationships between doulas, clinicians, and nurses; (3) there was a hierarchy of knowledge within medical settings that diminished the value of doulas' expertise; and (4) system-level barriers prevented sustained integration of doula programs. Despite the promise of community-based doula programs, significant investment and resources are needed to support implementation and ensure sustainability.