Follow-up Focus Group Discussions Research Articles

“The burden is upon your shoulders to feed and take care of your children, not religion or culture”: qualitative evaluation of participatory community dialogues to promote family planning’s holistic benefits and reshape community norms on family success in rural Uganda

BackgroundFamily planning has significant health and social benefits, but in settings like Uganda, is underutilized due to prevalent community and religious norms promoting large family size and gender inequity. Family Health = Family Wealth (FH = FW) is a multi-level, community-based intervention that used community dialogues grounded in Campbell and Cornish’s social psychological theory of transformative communication to reshape individual endorsement of community norms that negatively affect gender equitable reproductive decision-making among couples in rural Uganda.MethodsThis study aimed to qualitatively evaluate the effect of FH = FW’s community dialogue approach on participants’ personal endorsement of community norms counter to family planning acceptance and gender equity. A pilot quasi-experimental controlled trial was implemented in 2021. This paper uses qualitative, post-intervention data collected from intervention arm participants (N = 70) at two time points: 3 weeks post-intervention (in-depth interviews, n = 64) and after 10-months follow-up (focus group discussions [n = 39] or semi-structured interviews [n = 27]). Data were analyzed through thematic analysis.ResultsThe community dialogue approach helped couples to reassess community beliefs that reinforce gender inequity and disapproval of family planning. FH = FW’s inclusion of economic and relationship content served as key entry points for couples to discuss family planning. Results are presented in five central themes: (1) Community family size expectations were reconsidered through discussions on economic factors; (2) Showcasing how relationship health and gender equity are central to economic health influenced men’s acceptance of gender equity; (3) Linking relationship health and family planning helped increase positive attitudes towards family planning and the perceived importance of shared household decision-making to family wellness; (4) Program elements to strengthen relationship skills helped to translate gender equitable attitudes into changes in relationship dynamics and to facilitate equitable family planning communication; (5) FH = FW participation increased couples’ collective family planning (and overall health) decision-making and uptake of contraceptive methods.ConclusionCommunity dialogues may be an effective intervention approach to change individual endorsement of widespread community norms that reduce family planning acceptance. Future work should continue to explore innovative ways to use this approach to increase gender equitable reproductive decision-making among couples in settings where gender, religious, and community norms limit reproductive autonomy. Future evaluations of this work should aim to examine change in norms at the community-level.Trial registrationClinicaltrials.gov (NCT04262882).

Does service quality matter in FinTech payment services? An integrated SERVQUAL and TAM approach

As the number of FinTech start-ups continues to rise globally, the utilization of these services by users becomes increasingly crucial, especially considering potential risks. Various factors affect users' utilization of financial technology, with the quality of services offered by FinTech providers standing out as a significant consideration. The aim of this study is to investigate the relationship between the quality of services offered by FinTech payment platforms and the utilization of FinTech services. We develop a novel conceptual model integrating elements from SERVQUAL and TAM (the Technology Acceptance Model) to investigate these dynamics. To gain a comprehensive understanding, we employed a mixed methods research approach. This approach included a quantitative survey analyzed using a partial least squares structural equation model (PLS-SEM) to examine the proposed framework and the relationships between its constructs. Following the survey, a follow-up focus group discussion with industry experts and academics was conducted to delve deeper into the findings and explore the "why" behind the statistical relationships. The findings reveal a significant impact of the quality of services offered by FinTech payment service providers on the utilization of such services. It demonstrates that in the FinTech sector, perceived usefulness does not always dominate perceived ease of use. Moreover, it confirms the profound influence of perceived usefulness in shaping attitudes and subsequent behaviour related to technology use. These insights contribute to an enhanced understanding of the factors driving the utilization of FinTech services.

Advancing One Health through veterinary education: a mixed methods needs assessment for implementing a WOAH-harmonized national veterinary medicine curriculum in Ethiopia.

International organizations now actively promote and implement One Health collaborative approaches to prevent, detect, and control diseases in humans and animals, recognizing the critical importance of the veterinary and agricultural sectors. Moreover, Veterinary Services are chronically under-resourced, especially in low- and middle-income countries. Given the importance of National Veterinary Services to food security, nutrition, poverty alleviation, and global health security, strengthening veterinary capacity is a priority for the international community. The World Organisation for Animal Health (WOAH) outlines a set of minimum competencies veterinarians need to support National Veterinary Services effectively. To improve the quality of veterinary education, Ethiopia has developed a new 2020 national curriculum that is harmonized with the WOAH competencies. A mixed methods needs assessment was conducted to identify barriers and challenges that Ethiopian veterinary medicine programs have faced in implementing the new WOAH-harmonized national curriculum. Representatives from active veterinary programs granting a Doctor of Veterinary Medicine (DVM) degree were invited to share their experiences via an online survey and follow-up focus group discussion. Fourteen veterinary programs, representing 93% of eligible programs nationwide, participated in the needs assessment. Quantitative analysis indicated that the most difficult topics associated with the new curriculum included Organization of Veterinary Services (Competency 3.1), Inspection and Certification Procedures (3.2), and practical applications of the regulatory framework for disease prevention and control (multiple competencies). Challenges associated with specific instructional methodologies, particularly the facilitation of off-site (private and public sector) student training, were also perceived as barriers to implementation. Focus group discussions elucidated reasons for these challenges and included limitations in faculty expertise, resource constraints (e.g., supplies, infrastructure), and access to off-site facilities for hands-on teaching. The results of this needs assessment will be used to identify and prioritize solutions to implementation challenges, helping Ethiopian veterinary medicine programs move the new WOAH-harmonized curriculum from theory to practice. As veterinarians are integral partners in advancing One Health, strengthening the capacity of Veterinary Services can ultimately safeguard animal and human health, grow economies, and improve lives.

A Mobile App to Assist the Mentors of African American Young Men Who Have Sex With Men: Usability Study.

Mentoring can promote positive youth development. Owing to social and structural factors, young people in underresourced communities often lack adequate access to mentors, and naturally occurring mentors are more common than formal, programmatic mentors. There is little information on the impact of naturally occurring mentors on youth in general and even less on the role that mentors may play in promoting healthy outcomes in sexual and gender minority youth. African American young men who have sex with men (YMSM) are more likely to reside in communities with limited access to formalized mentorship programs and may benefit from naturally occurring mentoring relationships that address health outcomes, specifically related to HIV. This study is a usability test of a mobile app designed for the mentors of African American YMSM to increase mentors' knowledge of and confidence in talking about HIV prevention and related topics with mentees. Following consent, eligible and naturally occurring mentoring pairs involving African American YMSM in Baltimore; Philadelphia; and Washington, District of Columbia, tested the app, UrbanMentorHub, for usability. Participants downloaded the app and used it for 1 month, completed pre- and postintervention surveys, and participated in a follow-up focus group discussion. Participants' sociodemographic characteristics and HIV- and mentorship-related measures were characterized using descriptive statistics. Wilcoxon signed rank tests were used to test for pre- and postintervention differences in knowledge, confidence, and outcome expectancy measures. Focus group discussions were audio recorded and transcribed. Transcripts were thematically coded and analyzed to identify ways that UrbanMentorHub could be improved in the mentoring context. Nine mentorship pairs participated in this usability study (N=18). Mentors obtained high scores on knowledge, confidence, outcome expectancies, skills, and intentions related to HIV and mentoring. No pre- or postintervention changes were observed in these measures. Mentors reported usually initiating conversations around HIV testing and pre-exposure prophylaxis; mentees and mentors equally initiated conversations on sexual practices and same-sex relationships. Mentors reported sexual practices as the most frequently discussed topic in the past month and pre-exposure prophylaxis being the least discussed. Mentees reported high comfort with HIV-related conversations. No pre- or postintervention change was observed regarding HIV knowledge. Most mentees reported having discussed most HIV-related topics with their mentor in the past month. Mentor feedback on the app was mostly neutral, although they reported positive perceptions of the idea of the app, indicating the potential for addressing a need in their communities. Mentors suggested ways to improve the app content and design elements. Although there was no observed statistical change in measured outcomes, and qualitative feedback was overall neutral, the results of this usability study can inform future work to design and promote interventions and resources that support mentoring relationships for African American YMSM.

Desire and Marketizing English Version of Education as a Commodity in the Linguistic Market in Bangladesh

In recent years, the globalization of English as a Medium of Instruction (EMI) policy has grown exponentially, driven by socio-economic, political, cultural, and educational desires and forces. Despite having a well-established elite English-medium education in Bangladesh, EMI-based, a new type of education system has emerged recently at primary and secondary levels called English-version (EV) education. This paper investigates parents' desires to choose EV schools for their children and how those desires contribute to marketizing EV schools as a new and popular commodity in the education market of Bangladesh. Data were collected using open-ended questionnaires from 120 parents of primary school children studying at five EV schools. Moreover, further qualitative data was collected by conducting three follow-up focus group discussions (FGDs) with 14 parents and three key informant interviews (KIIs) with three EV school principals. Findings show that parents believe in the material value and promises of English as a linguistic capital that has implanted multiple desires in them for their children. They aspire for their children in EV to benefit from their improved English skills in the future at a reasonable cost while continuing to uphold Bangladeshi culture and values. In other words, the exponential market of EVs lies in its affordable cost and future benefits, in tandem with an informed distance from the culture associated with the English language.

Engaging boys in menstrual hygiene management (MHM) interventions in Bangladeshi schools: a pilot study to assess acceptability and feasibility

AbstractEducating boys about puberty and menstruation has been hypothesized to aid in reducing menstrual stigma and negative attitudes about menstruation. We developed and piloted a school-based intervention for girls and boys to increase knowledge about puberty and foster a more supportive environment for menstruating schoolgirls. In this sub-study, we conducted 24 formative in-depth interviews and four group vignette exercises for schoolboys to develop the intervention package. We then carried out pre- and postintervention surveys and conducted four follow-up focus group discussions to determine the feasibility, acceptability, and effects of the intervention package among schoolboys and to develop recommendations for scale up. During the formative phase, boys reported minimal knowledge concerning puberty but felt puberty education was vital for all. Following the intervention, boys' awareness of menstruation increased compared to baseline [PD: 15%; 95% confidence interval (CI): 2, 29]. The reported comfort level of discussing puberty-related issues in a school club or with friends also increased [PD: 13%; 95% CI: 2, 24]. In focus groups, boys reported finding the sessions helpful and informative. Engagement of schoolboys, combined with well-delivered intervention materials and social and behavior change communication interventions is feasible and can contribute to a more supportive and girl-friendly environment in schools.

The Perceptions of Pendidikan Guru Penggerak Towards Blended Learning

This study aimed to report Pendidikan Guru Penggerak’s views on applying blended learning in these activities. In the study, the explanatory sequential mixed method was used as the study design. The quantitative data from the survey was conducted, followed by the follow-up interview, documentation study, and focus group discussion (FGD) as the qualitative data. To collect the data in this study, a specifically perceives of using blended learning in PGP was distributed to the total sample of 28 Guru Penggerak Angkatan 1 from Kabupaten Lombok Timur, Kabupaten Bima, and Kota Malang. Then, the interview was conducted with three selected participants from each city/regency, while the FGD involved the entire sample. The aim was to gain a deeper understanding of the research results. The results showed that participants perceived blended learning in PGP very well in terms of learning management system (LMS), synchronous and asynchronous online learning, and face-to-face mentoring and lokakarya. The realization of a learning community among fellow participants was an added value for PGP. As a result, participants could also improve their teaching skills which ICT-based.

Availability and experiences of differentiated antiretroviral therapy delivery at HIV care facilities in rural Zimbabwe: a mixed-method study.

IntroductionZimbabwe adopted differentiated HIV care policies in 2015 to promote client‐centred care and relieve strain on health facilities. We examined the availability, experiences and perceptions of differentiated antiretroviral therapy (ART) delivery in rural Zimbabwe following the policy adoption.MethodsWe undertook a cross‐sectional mixed methods study in all the 26 facilities providing HIV care in a rural district in Zimbabwe. We collected quantitative data about ART delivery and visit durations from 31 healthcare providers and a purposive stratified sample of 378 clients obtaining ART either through routine care or differentiated ART delivery models. We performed 26 semi‐structured interviews among healthcare providers and seven focus group discussions (FGDs) among clients to elicit their perceptions and experiences of ART delivery. Data were collected in 2019, with one follow‐up FGD in 2021. We analysed the transcripts thematically, with inductive coding, to identify emerging themes.ResultsTwenty facilities (77%) offered at least one differentiated ART delivery models, including community ART refill groups (CARGs; 13 facilities, 50%), fast‐track refill (8, 31%), family refill (6, 23%) or club refill (1, 4%). Thirteen facilities (50%) offered only one model. The median visit duration was 28 minutes (interquartile range [IQR]: 16–62). Participants in fast‐track had the shortest visit durations (18 minutes, IQR: 11–24). Confidentiality and disclosure of HIV status, travelling long distances, travel costs and waiting times were the main issues influencing clients’ views on differentiated ART delivery. Fast‐track refill was perceived as the preferred model of clients for its limited involuntary disclosure and efficiency. In contrast, group‐ and community‐based refill models reduced travel costs but were felt to be associated with involuntary disclosure of HIV status, which could discourage clients. Healthcare providers also experienced an additional workload when offering facility‐based group models, such as CARGs.ConclusionsDifferentiated ART delivery models were widely available in this rural setting, but most facilities did not offer a choice of models to address clients’ diverse preferences. A minority offered fast‐track refills, although this model was often mentioned as desirable. Confidentiality, travel expenses and client waiting times are key elements to consider when planning and rolling out differentiated HIV care.

Recreational Physical Activity in Urban India: Perceptions and a Pilot Intervention

AbstractThe inactive lifestyle of urban Indians has increased their risk of non-communicable diseases (NCDs). A qualitative study was designed to explore barriers and facilitators related to exercise participation among urban Indians. Underpinned by the developmental life course theory, nine focus group discussions (FGDs) were conducted with 29 women and 26 men residing in Mumbai, India. Focus groups were gender and age stratified. Both thematic analysis and content analysis techniques were used to analyse the data. While the lack of time was mentioned as a barrier by all groups, an unstructured schedule was mentioned specifically by women and awareness of physical health benefits emerged as the most popular facilitator for recreational physical activity. Based on the results of the FGDs, a pilot exercise intervention for sedentary women (N = 6) was conducted which consisted of a morning walk six days a week for 10 weeks. Post-intervention, an FGD was conducted to explore participants’ perspectives on their experience in the intervention. The participants reported that the intervention enhanced exercise self-efficacy and well-being. Exercise as relaxation, spousal support, and need for peers to exercise with emerged as primary themes during the follow-up FGD. These findings can inform the development of age and gender-specific as well as culturally appropriate interventions to facilitate active living.

Examining the Utility of the HIV Disability Questionnaire (HDQ) in Clinical Practice: Perspectives of People Living with HIV and Healthcare Providers.

Our aim was to examine the utility of the HIV Disability Questionnaire (HDQ), a patient-reported outcome measure for use in clinical practice from the perspectives of people living with HIV (PLWH) and healthcare providers. We conducted a qualitative descriptive study. Fifteen PLWH and five healthcare providers participated in an interview, of which ten PLWH participated in a follow-up focus group discussion. The HDQ has value in clinical practice, including its role in assessing disability, facilitating communication, tailoring treatments, and guiding referrals. Strengths of the HDQ included its comprehensiveness, relevance of domains, and importance of specific items. Concerns related to length of the HDQ, the potential for some items to trigger emotional response, and negative connotations with the term ‘disability.’ Recommendations for HDQ implementation included the importance of score interpretability, shortening the questionnaire, and tailoring administration to the individual. Results suggest the HDQ possesses clinical utility with PLWH and healthcare providers.

Navigating the gender dimensions in English language teaching: perceptions of senior high school teachers in the Philippines

ABSTRACT In the Philippines, previous studies have revealed that the implementation of gender mainstreaming in education has remained vague. Also, there is a lacuna in the literature about informed accounts of teachers, particularly English language teachers, in their attempts to mainstream gender-and-development (GAD) education in Philippine schools. Through a qualitative survey among 124 Filipino senior high school teachers of English and follow-up focus group discussions, this paper explores English language teachers’ perceptions of the advantages, ways of, and challenges to incorporating gender dimensions in ELT. Findings indicate that teachers are ready to integrate a gender perspective into their teaching; however, concrete frameworks, curriculum materials, teacher education, and institutional support are crucial given the sensitive, ethical concerns that consideration of gender may generate among educators, students, and the wider community. Implications from this investigation could trigger similar accounts and experiences in teaching-learning contexts where the gender perspective may be integrated.

Khuluma: Using Participatory, Peer-Led and Digital Methods to Deliver Psychosocial Support to Young People Living With HIV in South Africa.

Khuluma is a psychosocial and peer-to-peer mHealth intervention that uses text messaging to facilitate support groups for adolescents living with HIV (ALWH) with the aim of contributing toward positive health outcomes. Although use of mobile technology in the form of mHealth interventions has proliferated recently in the field of health, published literature describing methods and processes of its application are limited. We present a set of methods and processes utilised to develop and pilot the Khuluma mHealth intervention amongst young people (15–20 years) in South Africa. We recruited and enrolled 52 adolescents (15–20-year olds) from four clinics in Pretoria and Cape Town to participate in a 6-month pilot of Khuluma. Participants were ALWH, aware of their status, on antiretroviral therapy for more than 12 months, and not suffering from severe depression. We conducted four pre and post intervention focus group discussions (FGDs) with a proportion of ALWH (n = 36) enrolled in the pilot study using participatory methods. Several processes were utilised to then implement this pilot study. These included engaging ALWH for minor study implementation modifications; forming virtual groups; activating the mHealth platform; facilitating and delivering the Khuluma intervention. The acceptability of the intervention was informed by follow-up focus group discussions and text message data. The initial participatory processes helped to tailor the intervention design to participants' needs. The peer-led facilitation of the groups allowed for the provision of sensitive psychosocial support that allowed young people to express themselves freely, develop a sense of self-worth, and interact more. The nature of the mobile technology also allowed participants to build friendships beyond their geographic area and interact with their peers in real time. Within the evolving context of COVID-19, establishing evidence-based processes and methods for intervention design and curation in virtual spaces is critical.

Nurse Practitioner Students' Perceptions on Delivering Culturally Congruent Care to Vulnerable Mexican Immigrants: A Qualitative Study.

Increasingly, nurse practitioners serve as vanguards in providing primary health care to vulnerable Mexican immigrants. The aims of this study were to explore the lived experiences of nurse practitioner students in caring for Mexican immigrant patients and to capture their meaning of cultural influences deemed essential to the delivery of culturally congruent care. An exploratory descriptive design was employed. Purposive sampling was used to select 17 nurse practitioner students who volunteered to complete a semistructured face-to-face audio-taped interview and follow-up focus group discussion. Constant comparison was utilized to analyze data. From this process, four distinct themes emerged: Culturally congruent care extends beyond race and ethnicity, understands the importance of therapeutic communication, accepts complementary and alternative medical modalities, and recognizes the importance of eating patterns, food choices, and perceptions of ideal weight and health. These findings build on our understanding of key evidence-based cultural beliefs and practices that are important in delivering culturally congruent care to this subgroup.

Identifying Potential for Decision Support Tools through Farm Systems Typology Analysis Coupled with Participatory Research: A Case for Smallholder Farmers in Myanmar

Decision Support Tools (DSTs) in agriculture have been widely developed but have not been well accepted by smallholder farmers. One reason for the limited use is that the tools do not account for the complexity of heterogeneous smallholder farming systems. Identifying farm typologies has facilitated technology transfer to target groups of farmers. Accounting for heterogeneity in farm systems can help in designing and deploying DSTs to address farmer needs. Typology analysis was applied to a 600-household survey dataset to identify different farm system types. Qualitative participatory research was used to assess the potential deployment of DSTs for fertilizer management. Six types of farm systems were identified with distinct characteristics in the study area of central Myanmar. Participatory research through focus group discussions with 34 participants from the six different farm types validated the farm typologies and found that farmers from one type considered that DSTs could be useful in gaining more information and knowledge. An important finding was that DSTs providing prescriptive advice were inconsistent with what many farmers want. Farmers indicated that discussion groups are a preferred learning-based approach rather than a prescriptive tool. Farmers preferred video clips and infographics integrated into existing familiar digital platforms. This study identifies heterogeneity within a large farm sample and develops a deeper understanding of fertilizer decisions as well as knowledge and intentions related to the use of DSTs or apps via follow-up focus group discussions. Incorporating a participatory research framework with typology identification can have a beneficial role in direct interactions with smallholders that may increase their acceptability of DSTs. This study has generated valuable information about farmer types and serves as a starting point for developing a framework for discussion support systems that may better relate to the needs of farmers.

Implementation challenges to patient safety in Guatemala: a mixed methods evaluation

BackgroundLittle is known about factors affecting implementation of patient safety programmes in low and middle-income countries. The goal of our study was to evaluate the implementation of a patient safety...

Patient-centred care: The patients' perspective - A mixed-methods pilot study.

BackgroundPatient centredness is a broad concept, a moral philosophy. Patient-centred care can be viewed as the actions of patient-centredness. One of the most pertinent actions that a healthcare practitioner can utilise to deliver patient-centred care is empathic communication. Whilst many medical programmes include empathetic communication skills as part of their curricula, the recipients of this care are not asked about the relevance of this teaching.AimWe attempted to determine whether the Western constructs of empathy were relevant in our context and also establish whether there were any parts of the medical interview which participants felt were especially important to be communicated to in their home language.SettingTwo urban communities within the City of Cape Town, Western Cape Province, South Africa.MethodsThis was a mixed-methods pilot study using an explanatory sequential design. Participants who would typically make use of public health care facilities and whose first language was Afrikaans or isiXhosa were conveniently sampled. A subgroup of participants was invited to take part in a follow-up focus group discussion to add clarity to the survey responses.Results and ConclusionWestern constructs for empathy appeared to be relevant within our multicultural context. Patients wanted to communicate with their doctors and understand the cause of their problems as well as the management plan. Finally, whilst the numbers in this pilot study were too small to be generalisable, it was evident that patient-centred care was not perceived to be implemented in some public healthcare facilities attended by the participants, which resulted in them feeling unseen and disrespected.

Developing STEM Identity and Talent in Underrepresented Students: Lessons Learned From Four Gifted Black Males in a Magnet School Program

There is well-documented research and data that echo the concern for the future of United States’ ability to globally compete in science, technology, engineering, and mathematics (STEM) innovation and to fulfill the shortage in talent that exists within this field of study. This concern compels us to seek more impactful and long-term solutions to the issues surrounding motivation and retention of underrepresented students in STEM disciplines. It is imperative that we increase our capability to effectively identify, recruit, and retain underrepresented students within the STEM pipeline. Focusing on identity development as the first of these critical capacities, a case study was conducted to determine if any central characteristics exist that shape the STEM self-concept and identity of four gifted, Black male students who were recent graduates from a predominantly Black, Title 1 high school within a southern, rural region of America. Two 90-min, audio-recorded interviews were conducted with a follow-up focus group discussion a year later. Their experiences were told in retrospect, narrated using their perspectives as they related to their “life” and “STEM” stories. The data revealed STEM identity development very much connected to race, cultural values, and contextual STEM environment. Exploring the dynamics of development surrounding motivation, this article highlights their STEM success to better understand how their STEM talent was developed. Their stories, common themes, and implications for educators are discussed followed by a call for further research.

Digital Training for Non-Specialist Health Workers to Deliver a Brief Psychological Treatment for Depression in Primary Care in India: Findings from a Randomized Pilot Study.

Introduction: Task sharing holds promise for scaling up depression care in countries such as India, yet requires training large numbers of non-specialist health workers. This pilot trial evaluated the feasibility and acceptability of a digital program for training non-specialist health workers to deliver a brief psychological treatment for depression. Methods: Participants were non-specialist health workers recruited from primary care facilities in Sehore, a rural district in Madhya Pradesh, India. A three-arm randomized controlled trial design was used, comparing digital training alone (DGT) to digital training with remote support (DGT+), and conventional face-to-face training. The primary outcome was the feasibility and acceptability of digital training programs. Preliminary effectiveness was explored as changes in competency outcomes, assessed using a self-reported measure covering the specific knowledge and skills required to deliver the brief psychological treatment for depression. Outcomes were collected at pre-training and post-training. Results: Of 42 non-specialist health workers randomized to the training programs, 36 including 10 (72%) in face-to-face, 12 (86%) in DGT, and 14 (100%) in DGT+ arms started the training. Among these participants, 27 (64%) completed the training, with 8 (57%) in face-to-face, 8 (57%) in DGT, and 11 (79%) in DGT+. The addition of remote telephone support appeared to improve completion rates for DGT+ participants. The competency outcome improved across all groups, with no significant between-group differences. However, face-to-face and DGT+ participants showed greater improvement compared to DGT alone. There were numerous technical challenges with the digital training program such as poor connectivity, smartphone app not loading, and difficulty navigating the course content—issues that were further emphasized in follow-up focus group discussions with participants. Feedback and recommendations collected from participants informed further modifications and refinements to the training programs in preparation for a forthcoming large-scale effectiveness trial. Conclusions: This study adds to mounting efforts aimed at leveraging digital technology to increase the availability of evidence-based mental health services in primary care settings in low-resource settings.

The Cultural Validation of Two Scales assessing Albinism - related Social Stigma among High School Students in Tanzania

Purpose: Albinism in Tanzania causes fierce stigmatisation. Although various stigma reduction interventions (SRI) are employed, research on their effectiveness is lacking. This research aimed to develop a tool to measure albinism-related social stigma among high school students in Tanzania. Cultural equivalence was tested for the Explanatory Model Interview Catalogue Community Stigma Scale (EMIC-CSS) and Albinism Social Distance Scale for Adolescents (ASDS-A) assessing conceptual, item, semantic, operational and measurement equivalence. Methods: The methods used were workshops, in-depth interviews, translation and re-translation, discussions, a test (n=337) re-test (n=142) of the survey, and follow-up focus group discussions (n=25). Results: The Scales have proven to be adequate on all equivalences other than measurement equivalence. The reproducibility statistics raise questions that can be explained by characteristics of the sample. Conclusion and Implications: The analysis provides insights for further validation of the Scales, contributes to the discussion about a universal stigma measurement tool and demonstrates the importance of validation studies of existing and proven tools used in a different context.

Implementation Analysis of a Perioperative Patient Safety Program in Guatemala.

The implementation of programs to improve patient safety remains challenging in low- and middle-income countries. The goal of our study was to define the barriers and facilitators to implementation of a perioperative patient safety program in Guatemala. We conducted semi-structured interviews with 16 staff pre-intervention and a follow-up focus group discussion 1year later in the perioperative department at the Roosevelt Hospital in Guatemala. We performed qualitative thematic analysis to identify barriers and facilitators to the implementation process, with analysis guided by the Consolidated Framework for Implementation Research. We found several dominant themes affecting implementation of a patient safety program. Implementation facilitators included strong prioritization of patient needs, program compatibility with existing workflow, and staff attributes. Barriers included a lack of knowledge about patient safety, limited resources, limited leadership engagement, and lack of formal implementation leaders. Several program modifications were made to enhance successful implementation iteratively during the implementation process. Our analysis highlights several dominant themes which affect the implementation of a perioperative safety program in Guatemala. Understanding the barriers and facilitators to implementation during program deployment allows for program modification and improvement of the implementation process itself.