Follow-up Qualitative Interviews Research Articles

Exploring Chinese secondary students’ behaviors towards online homework based on the UX model: Does homework completion relate to academic performance?

The benefits of online homework are widely acknowledged for student learning. Numerous studies have provided evidence supporting the notion that the completion of an adequate amount of traditional homework is associated with enhanced academic success. However, there are inconsistent conclusions on the effect of homework completion on academic performance among the students who were exposed to online homework, particularly in China. In order to explore the behaviors of Chinese secondary students towards online homework, a correlational analysis is employed to determine the relationship between homework completion and academic performance among 103 students from China. Findings suggest a positive yet moderate association between online homework completion and academic performance. A follow-up qualitative interview with 10 purposefully selected students, based on the UX model by Topolewski, Krawczyk, Pallot & Huotari (2020), reveals that the cognitive and emotional factors are most influential on their behaviors towards online homework. Further studies are recommended to delve into the factors influencing students’ intention to engage with online homework. Additionally, limitations of this study are outlined.

Variation Exists in Service Delivery: Similarities and Differences in the Provision of a Whole Genome Sequencing Service for Paediatric Rare Disease Patients in the English National Health Service.

The English National Health Service (NHS) is the first to offer whole genome sequencing (WGS) as part of standard care. As a high-income country with a universal healthcare system, England contributes a valuable perspective to global developments in WGS. We used an implementation science approach with mixed methods to characterise delivery of WGS for paediatric rare diseases. Observations and field notes of consent appointments in clinical genetics and mainstream settings and follow-up qualitative semi-structured interviews with the clinical team. Process maps were developed for each department to identify similarities and variations between sites, and thematic analysis of interview data to understand barriers and facilitators. Data collection occurred in 12 departments (7 genetic, 3 neurology, 1 cardiology and 1 general paediatric) across 7 NHS Trusts. 26 observations of 21 healthcare professionals were conducted, alongside 19 follow-up interviews. Two master maps were developed - one for clinical genetics and one for the mainstream. We identified 11 steps involved in delivering WGS, including 9 variations and 9 similarities. We identified most variation in the processes related to the 'who', 'when', 'how' and 'where' as these were aspects that could be adapted to fit into the specific set-up of the department. Barriers included reluctance to uptake in the mainstream and difficulties tracking samples. Recommendations include developing SOPs and hiring healthcare professionals responsible for facilitating consent alongside administrative aspects. These would reduce the burden on clinical geneticists and improve turnaround times as well as contribute to streamlining and standardisation of the service.

Comparing the psychological impact of the Shanghai lockdown on local and non-local college students: an explanatory sequential mixed method approach.

In 2022, the Shanghai municipal government enforced strict COVID-19 lockdown measures. Lockdown experiences for college students varied. Local students normally returned home and had familial support while non-local students relied more on institutional support when quarantining in dormitories. The difference could profoundly impact their access to necessary material resources and emotional support, affecting their mental health. This study compared the psychological effects of the Shanghai Lockdown on local and non-local college students using an explanatory-sequential mixed methods design. Quantitative analyses of data from 327 college students examined local and non-local students' mental health outcomes during the lockdown. Follow-up qualitative interviews (N = 12) contextualized their sources of stress and group differences. Higher prevalences of probable anxiety (34.6%), depression (45.1%), and poor subjective mental well-being (65.4%) are found among non-local students compared to local students (23.7% anxiety, 29.4% depressive symptoms, and 47.9% poor well-being). Suicidal ideation was higher among local students (8.6% prevalence difference). Being a non-local college student was associated with increased odds of probable anxiety, depression, and poor well-being. Interviews identified group differences such that non-local students received more school support (i.e., food and financial) and perceived emotional support but faced poorer quarantine living environments compared to local peers. Non-local college students were more vulnerable to the impact of lockdown. Our findings also provide insights into the impact of familial versus institutional support on student mental health during times of crisis.

Improving breast cancer care post-pandemic from the patient perspective

Abstract Background Since the onset of the pandemic, breast cancer (BC) services have been disrupted in most countries. The purpose of this qualitative study is to explore the unmet needs, patient-priorities, and recommendations for improving BC healthcare post-pandemic for women with BC and to understand how they may vary based on socio-economic status (SES). Methods 37 women were invited to take part in follow-up semi-structured qualitative interviews in early 2023. The interviews explored their perspectives of BC care since the easing of COVID-19 government restrictions, including unmet needs, patient-priorities, and recommendations specific to BC care. Thematic analysis was conducted to synthesize each topic narratively with corresponding sub-themes. Additionally, variation by SES was analysed within each sub-theme. Results Of the 28 women who participated in interviews, 39% were categorized as high-SES, while 61% were categorized as low-SES. Women expressed unmet needs in their BC care including routine care and mental and physical well-being care, as well as a lack of financial support to access BC care. Patient-priorities included: developing cohesion between different aspects of BC care; communication with and between healthcare professionals; and patient empowerment within BC care. Recommendations moving forward post-pandemic included: improving the transition from active to post-treatment; enhancing support resources; and implementing telemedicine where appropriate. Overall, women of low-SES experienced more severe unmet needs, which resulted in varied patient-priorities and recommendations. Conclusions As health systems are recovering from the COVID-19 pandemic, the emphasis should be on restoring access to BC care and improving the quality of BC care, with a particular consideration given to those women from low-SES, to reduce health inequalities post-pandemic. Key messages • The pandemic has impacted BC services considerably and this study has identified a range of unmet needs, patient-centered priorities, and recommendations. • Particular consideration needs to be given to those women from lower socioeconomic groups, in order to reduce health inequalities, which have been further exacerbated by the pandemic.

Reducing PTSD in mass medical events: An immediate preventive intervention

A preventive approach to Post-Traumatic Stress Disorder (PTSD) through an Immediate Psycho-Trauma Intervention (IPTI) may significantly reduce PTSD likelihood and provide a cost-effective way to alleviate suffering. This mixed-method study 1) compared medics who received an IPTI to those who did not after a mass medical event, 2) compared the number medics diagnosed with PTSD from the IPTI group to the minimum number in similar cases reported in the literature. The results indicated that 1.09 % of the medics who underwent the IPTI (N = 275) followed by peer discussion groups and a memorial ceremony were formally diagnosed with PTSD in contrast to the 5 %-20 % reported in similar circumstances. Of these, all but three resumed work within their emergency medical teams. In the one-year qualitative follow-up interviews (N = 14), the IPTI recipients exhibited significantly fewer PTSD symptoms and negative effects than the non-IPTI group. They reported fewer negative themes and a reduced need for professional psycho-trauma assistance, with no significant differences in event recollections between groups. These findings point to the efficacy of the VIOS IPTI in mitigating PTSD risk and suggest its potential for widespread application in clinical settings as a preemptive measure in response to traumatic events.

Road to Recovery: protocol for a mixed-methods prospective cohort study evaluating the impact of a new model of substance use care in a Canadian setting

IntroductionThe Road to Recovery (R2R) Initiative is an innovative model of substance use care that seeks to increase treatment capacity by creating approximately 100 new addiction treatment beds to provide...

How Do Location-Based AR Games Enhance Value Co-Creation Experiences at Cultural Heritage Sites? A Process Perspective Analysis

The sustainable development of tourism in cultural heritage sites benefits from the active participation of tourists in the co-creation process. Location-based AR games show great potential in tourists’ participation in creation and positive experiences. This study explores the relationship between the stage factors of the co-creation experience and the overall co-creation. Combining the service-dominant logic and process perspective of value co-creation theory, this research proposes a conceptual framework for co-creating experiences in cultural heritage tourism using augmented reality technology through two studies. In the first phase of the study, quantitative research was conducted on 256 visitors to measure the impact of factors in the three processes of pre-co-creation experience, on-site experience, and post-co-creation experience on the overall co-creation experience. In the study’s second phase, follow-up qualitative interviews were conducted based on multiple linear regression analysis results to expand the interpretation of the relationship and importance of factors affecting the co-creation experience process. The results show that psychological engagement, awareness, knowledge, and social relations during pre-visitation help enhance the overall co-creation experience. In contrast, the overall co-creation experience is enriched by real-time storytelling, interaction, and emotional resonance in both on-site and post-experience processes. The proposal of this framework model advances the discussion of augmented reality technology and co-creation experience to the empirical level. It provides a basis for further tourism co-creation experience design practice.

The feasibility and acceptability of delivering a group trauma-focused intervention to children in care.

Young people in care (i.e., in the child welfare system) are a group who have often experienced very high rates of potentially traumatic events, including maltreatment. It is well-documented that they have high rates of trauma-related mental health difficulties, such as posttraumatic stress. To address the needs of the large number of young people who may benefit from support, scalable interventions are crucial. But also important is that they are effective and deliverable - particularly given the complexity of this group and services. We assessed a five-session group CBT-based intervention for PTSD. The primary goal was to understand core procedural and protocol uncertainties to address prior to a definitive trial. Participants were 34 10-17 year olds in care, with moderate to severe posttraumatic stress symptoms, and their caregiver. We ran seven groups (four online), delivered in social care and NHS-based mental health teams. Data were collected via pre-, post-, 3-month follow-up questionnaires and qualitative interviews. Of the 34 participants allocated to the intervention, 27 (80%) attended at least three of the five sessions (most attended all). Caregiver attendance was lower (50%). There was generally good completion of assessment measures. Qualitatively, most participants were positive about the intervention, and many reported improvements in areas such as coping, sleep, and willingness to talk about experiences. However, there were important concerns about the lack of ongoing support, given this was a low-intensity intervention for a group who often had complex needs. The intervention and research protocols were acceptable to most young people and carers. With modifications, a future definitive trial would likely be possible. However, key considerations include: how (and whether) to screen for PTSD; the trial design; and the option to embed high-intensity support (e.g., via assessing a stepped-care model).

An exploratory analysis of Early Adopters in education innovations

Purpose The purpose of this study is to gain a better understanding of the conditions and motivations that influence teachers to adopt innovations. Design/methodology/approach Using Diffusion of Innovation theory (Rogers, 2003) and Self-Determination theory (Ryan and Deci, 2017), data from two surveys (n = 568; n = 108) and qualitative follow-up interviews of Early Adopter teachers (n = 16) were triangulated to discern relationships among their identification as Early Adopters, satisfaction of their basic psychological needs (BPN) and their implementation of an educational innovation. Findings Early Adopters had a positive and statistically significant relationship with the implementation of the innovation. Satisfaction of teachers’ BPN had the largest impact on innovation. Research limitations/implications The findings are preliminary and based on a small sample size of teachers. Reliability of the measure of BPN was not as high as the standard, but it did have the largest impact on implementation. Additional studies should explore the connections among Early Adopter teacher motivation, leadership and the satisfaction of their BPN. Practical implications School leaders should leverage the influence of Early Adopters to support innovation, and they should provide additional time, training and resources to supports teachers’ BPN. Originality/value This study examines how to identify and support Early Adopter teachers as enablers of change within schools. We know of no other studies that have used both Diffusion of Innovation theory and Self-Determination theory to understand the motivations of Early Adopter teachers.

“I Had No Idea about This:” A Mixed-Methods Exploration of Sexual Health and HIV Prevention Needs among Black Youth in a Southern City

HIV disparities continue to persist among Black youth in the South. We conducted quantitative surveys (N = 83) and follow-up qualitative interviews (n = 13) to assess sexual health needs including but not limited to Pre-Exposure Prophylaxis (PrEP) awareness. Participants all identified as Black; most survey respondents identified as being assigned female sex at birth and heterosexual. Both qualitatively and quantitatively, knowledge about HIV and PrEP and engagement in sexual health preventive behaviors was low. Participants described a need for more comprehensive sexual health education at younger ages and more routinized HIV testing. The latter was recommended even for people with a low perceived risk of HIV. Future studies should explore how to tailor communication to youth of color specifically and understand nuances of experiences they may have based on their sexual orientation and gender identity to promote engagement in sexual health preventive care, including but not limited to HIV prevention and PrEP uptake. The findings suggest that comprehensive sexual care that provides education on HIV, STI, and pregnancy prevention is critical for youth experiencing inequities in a Southern city context.

Lessons learned from COVID-19: improving breast cancer care post-pandemic from the patient perspective

BackgroundSince the onset of the pandemic, breast cancer (BC) services have been disrupted in most countries. The purpose of this qualitative study is to explore the unmet needs, patient-priorities, and recommendations for improving BC healthcare post-pandemic for women with BC and to understand how they may vary based on social determinants of health (SDH), in particular socio-economic status (SES).MethodsThirty-seven women, who were purposively sampled based on SDH and previously interviewed about the impact of COVID-19 on BC, were invited to take part in follow-up semi-structured qualitative interviews in early 2023. The interviews explored their perspectives of BC care since the easing of COVID-19 government restrictions, including unmet needs, patient-priorities, and recommendations specific to BC care. Thematic analysis was conducted to synthesize each topic narratively with corresponding sub-themes. Additionally, variation by SDH was analyzed within each sub-theme.ResultsTwenty-eight women (mean age = 61.7 years, standard deviation (SD) = 12.3) participated in interviews (response rate = 76%). Thirty-nine percent (n = 11) of women were categorized as high-SES, while 61% (n = 17) of women were categorized as low-SES. Women expressed unmet needs in their BC care including routine care and mental and physical well-being care, as well as a lack of financial support to access BC care. Patient priorities included the following: developing cohesion between different aspects of BC care; communication with and between healthcare professionals; and patient empowerment within BC care. Recommendations moving forward post-pandemic included improving the transition from active to post-treatment, enhancing support resources, and implementing telemedicine where appropriate. Overall, women of low-SES experienced more severe unmet needs, which in turn resulted in varied patient priorities and recommendations.ConclusionAs health systems are recovering from the COVID-19 pandemic, the emphasis should be on restoring access to BC care and improving the quality of BC care, with a particular consideration given to those women from low-SES, to reduce health inequalities post-pandemic.

The role of spirituality in pain experiences among adults with cancer: an explanatory sequential mixed methods study.

Foundational research demonstrates that spirituality may affect the way people with cancer experience pain. One potential route is through alterations in thoughts and beliefs, such as pain-related catastrophizing. The purpose of this study is to understand whether spirituality impacts pain experiences through pain-related catastrophizing. This explanatory sequential mixed methods study was informed by an adapted Theory of Unpleasant Symptoms. Data were collected via online surveys (N = 79) and follow-up qualitative interviews (N = 25). Phase 1 employed Empirical Bayesian analysis. Phase 2 used deductive content analysis. Phase 3 involved creating a mixed methods joint display to integrate findings and draw meta inferences. Results indicate that total spiritual well-being was directly negatively associated with pain-related catastrophizing, and indirectly negatively associated with the outcomes of pain interference, pain severity, and pain-related distress. Qualitative categories highlight the supportive role of spirituality when facing pain, while also shedding light on the limitations of spirituality in the context of some pain (i.e., severe, neuropathic, and/or chronic). Mixed methods findings reveal the importance of spirituality for some people as they face cancer and cancer-related pain, as well as the need for integrating spirituality as part of a larger pain management plan. This research advances supportive cancer care by exploring the complex role of spirituality in pain experiences. Findings will inform further exploration into the role of spirituality in supporting holistic symptom management in the context of cancer, as well as developing and testing interventions to enhance spirituality and address symptom-related suffering.

Mobile Intervention to Address Cannabis Use Disorder Among Black Adults: Protocol for a Randomized Controlled Trial.

African American or Black (hereafter referred to as Black) adults who use cannabis use it more frequently and are more likely to meet criteria for cannabis use disorder (CUD) than both White and Hispanic or Latin individuals. Black adults may be more apt to use cannabis to cope with distress, which constitutes a false safety behavior (FSB; a behavior designed to reduce psychological distress in the short term). Although FSB engagement can perpetuate the cycle of high rates of CUD among Black individuals, limited work has applied an FSB elimination treatment approach to Black adults with CUD, and no previous work has evaluated FSB reduction or elimination in the context of a culturally tailored and highly accessible treatment developed for Black individuals. This study aims to develop and pilot-test a culturally tailored adaptive intervention that integrates FSB reduction or elimination skills for cannabis reduction or cessation among Black adults with probable CUD (Culturally Tailored-Mobile Integrated Cannabis and Anxiety Reduction Treatment [CT-MICART]). Black adults with probable CUD (N=50) will complete a web-based screener, enrollment call, baseline assessment, 3 daily ecological momentary assessments (EMAs) for 6 weeks, and a follow-up self-report assessment and qualitative interview at 6 weeks after randomization. Participants will be randomized into 1 out of the 2 conditions after baseline assessment: (1) CT-MICART+EMAs for 6 weeks or (2) EMAs only for 6 weeks. The enrollment started in June 2023 and ended in November 2023. Data analysis will be completed in March 2024. No culturally tailored, evidence-based treatment currently caters to the specific needs of Black individuals with CUD. This study will lay the foundation for a new approach to CUD treatment among Black adults that is easily accessible and has the potential to overcome barriers to treatment and reduce practitioner burden in order to support Black individuals who use cannabis with probable CUD. ClinicalTrials.gov NCT05566730; https://clinicaltrials.gov/study/NCT05566730. DERR1-10.2196/52776.

Arranged cohabitation among Chinese Muslims

While modern family-related ideas and behaviors have become more widely accepted in contemporary China, Chinese Muslim minorities continue to hold on to traditional religious practices. Surprisingly, data from our survey conducted in Gansu province in China's northwestern borderlands reveal that Muslims of the Hui and Dongxiang ethnicities reported much higher rates of cohabitation experience than the secular majority Han. Based on follow-up qualitative interviews, we found the answer to lie in the interplay between the highly interventionist Chinese state and the robust cultural resilience of local Islamic communities. While the state maintains a high minimum legal age of marriage, the early marriage norm remains strong in Chinese Muslim communities, where religion constitutes an alternative and often more powerful source of legitimacy-at least in the private sphere of life. Using the 2000 census data, we further show that women in almost all 10 Muslim ethnic groups have higher percentages of underage births and premarital births than Han women, both nationally and in the northwest where most Chinese Muslims live. As the once-outlawed behavior of cohabitation became more socially acceptable during the reform and opening-up era, young Muslim Chinese often found themselves in "arranged cohabitations" as de facto marriages formed at younger-than-legal ages. In doing so, Chinese Muslim communities have reinvented the meaning of cohabitation. Rather than liberal intimate relationship based on individual autonomy, cohabitation has served as a coping strategy by which Islamic patriarchs circumvent the Chinese state's aggressive regulations aimed at "modernizing" the Muslim family.

Methodology of Natsal-COVID Wave 2: A large, quasi-representative, longitudinal survey measuring the impact of COVID-19 on sexual and reproductive health in Britain

Background The National Surveys of Sexual Attitudes and Lifestyles COVID study (Natsal-COVID) was designed to understand the impact of COVID-19 on Britain’s sexual and reproductive health (SRH). Natsal-COVID Wave 1 survey and qualitative follow-up interviews were conducted in 2020. The Wave 2 survey was designed to capture one-year prevalence estimates for key SRH outcomes and measure changes over the first year of the pandemic. We describe the Wave 2 survey methodology and assess the sample representativeness. Methods Natsal-COVID Wave 2 was conducted March-April 2021; approximately one year after the start of Britain’s first national lockdown. Data were collected using an online web-panel survey administered by Ipsos. The sample comprised a longitudinal sample of Wave 1 participants who had agreed to re-contact plus a sample of participants residing in Britain, aged 18-59, including a boost sample comprising people aged 18-29. Questions covered reproductive health, relationships, sexual behaviour and SRH service use. Quotas and weighting were used to achieve a quasi-representative sample of the British population. Comparisons were made with recent national probability surveys, Natsal-3 (2010-12) and Natsal-COVID Wave 1 to understand bias. Results A total of 6,658 individuals completed the survey. In terms of gender, age, ethnicity, and rurality, the weighted Natsal-COVID Wave 2 sample was like the general population. Participants were less likely to be married or to report being in good health than the general population. The longitudinal sample (n=2,098) were broadly like participants who only took part in Wave 1 but were older. Among the sexually active, longitudinal participants were less likely to report multiple sexual partners or a new sexual partner in the past year compared to those who only took part in Wave 1. Conclusions Natsal-COVID collected longitudinal, quasi-representative population data to enable evaluation of the population-level impact of COVID-19 on SRH and to inform policy.

Examining the use of psychiatric collaborative care and behavioral health integration codes at federally qualified health centers: A mixed-methods study.

Despite evidence to support the integration of behavioral health and physical health care, the adoption of Integrated Behavioral Health (IBH) has been stymied by a lack of reliable and sustainable financing mechanisms. This study aimed to provide information on the use of Psychiatric Collaborative Care Model (CoCM) and behavioral health integration (BHI) codes and the implementation of IBH in federally qualified health centers (FQHCs). This cross-sectional, mixed-methods study involved an electronic survey of administrators and follow-up qualitative interviews from a subset of survey respondents. Quantitative data were analyzed using descriptive analysis and thematic coding was used to analyze qualitative data to identify salient themes. Administrators (N = 52) from 11 states completed the survey. Use of CoCM (13%) or BHI codes (17.4%) was low. Most administrators were not aware that CoCM (72%) or BHI codes (70%) existed. Qualitative interviews (n = 9) described barriers that further complicate IBH and code use like workforce shortages and insufficient reimbursement for the cost to deliver CoCM services. Although FQHCs are working to meet the needs of the communities they serve, a lack of billing clarity and awareness and workforce issues hinder the adoption of the CoCM. FQHCs face many demands to provide care to safety net populations, yet are not fully equipped with the resources, workflows, staffing, and payment structures to support CoCM/BHI billing. Increased financial and logistical support to build practice infrastructure is needed to reduce the administrative complexity and inadequate reimbursement mechanisms that currently hinder the implementation of the CoCM and integrated care delivery. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Investigating Health Literacy in Thalassemia: Founding a Patient-Led Research Approach

Background: Thalassemia is a hereditary hemolytic anemia (HHA) with a variable phenotype and clinical severity, and constantly changing demographic profile. Despite advances in management, there are many unmet needs in this diverse population, with needs varying among different groups. The Thalassemia Advocacy Advisory Council (Thal AAC) was founded to define and better understand the unmet needs of the thalassemia patient community. This ten-person group consists of patients, caregivers, advocates, and healthcare professionals (HCPs) from six countries (USA N=5, Cyprus N=1, Italy N=1, Greece N=1, Taiwan N=1, Brazil N=1). We describe how the Thal AAC sought to better define the global community's unmet needs following a multi-step process of collecting, reviewing, and prioritizing the unmet needs experienced by patients with thalassemia (Figure). The process was coordinated, moderated, and supported by Agios Pharmaceuticals. Method: Thal AAC members shared their personal perspective on community unmet needs through a qualitative survey, which included open-ended questions aiming to collect each member's perspective on the top three unmet needs for patients and HCPs in their region and globally. Results were consolidated and reviewed by the AAC in a series of workshops. Two key unmet needs were highlighted: Among patients, there is a lack of understanding of the disease and both long- and short-term complications, which can lead to poor adherence to standard of careAmongst HCPs, improved education and advocacy are needed to support patient access to care, including innovative therapy options and research Based on these findings, the group aligned on the need for better education and understanding of the disease from a patient and HCP perspective, with health literacy (HL) being the central theme that tied these points together. With the goal of broadening understanding of patient HL, the Thal AAC defined four key sub-topics to investigate further: Patients' knowledge of the diseaseChallenges faced by patients in improving their HLPossible motivators for improving HLChannels and formats through which patients seek disease information. A non-exhaustive evidence audit of English-language literature published in the last 10 years on HL in thalassemia was conducted within PubMed and Cochrane databases using key search terms targeting thalassemia, similar hereditary hemolytic diseases, and HL. The published literature, was supplemented with patient advocacy group knowledge and data from other community-based research. Results: The audit showed that there is limited published literature or evidence for HL in the context of thalassemia and related hemolytic anemias (N=58). The format and delivery of information emerged as an important research topic in the context of rare diseases generally, but not thalassemia specifically. Although barriers and challenges to improving HL were studied in the literature (N=9), thalassemia-related items make up only ~10% (N=1), and there is relatively no research into the motivators for improving HL related to disease and outcomes. Thus, patients and their HCPs share unmet informational and educational needs, particularly regarding the long-term implications of inadequate treatment and care. Conclusion: The findings of the audit indicate a clear gap in thalassemia HL research. This gap may create scenarios in which not every patient with thalassemia accesses optimal care, which may have consequences for their long-term health. This provided the impetus for the AAC to launch a community-based, multi-national patient advocacy research initiative, comprising of a global survey and follow-up qualitative interviews, to better understand the community's perspective on HL in thalassemia. Insights from this survey will be used to share learnings and calls to action with community stakeholders, with an aim of contributing to the improvement of thalassemia patient outcomes and care. Thus, the AAC's findings have led to new insights which, in turn, have formed the foundation of a community-based research project.

Digital Health Literacy in Patients with Non-Hodgkin Lymphoma: Informing Intervention Approaches to Address Financial Toxicity

Introduction: Financial toxicity is the harmful effect of treatment costs on a patient's quality of life. Financial toxicity is common among cancer patients, and patients with hematologic malignancies often report worse financial toxicity than patients with other cancers. Thus, interventions to address financial toxicity in patients with hematologic cancers are urgently needed. Promising approaches include the use of digital media such as websites and educational videos. However, digital interventions may not be accessible for patients with low digital health literacy (DHL; the capacity to find and understand health-related information using electronic media). Information about DHL in patients with blood cancers is needed to inform future interventions addressing financial toxicity and other quality-of-life related issues. Here, we present a mixed-methods study describing DHL and its correlates among patients with non-Hodgkin lymphoma (NHL) who participated in a larger study about financial toxicity. Methods: Patients who received systemic therapy for NHL within the last year (N=50) participated in a cross-sectional study about the financial impact of cancer. Participants self-reported financial toxicity (Comprehensive Score for Financial Toxicity; COST) and digital health literacy (electronic Health Literacy Scale; eHEALS). They also rated whether they would consider using online tools to manage cancer-related expenses or communicate with their team about financial concerns, if offered in the future (yes, maybe, no). A subset of survey participants (n=13) completed a follow-up qualitative interview. Survey participants were purposively selected for interviews based on self-reported financial toxicity. Independent-samples t-tests, ANOVA, and correlations were used to test relationships between financial toxicity, DHL, sociodemographic factors, and patient preferences for intervention modalities/approaches. Rapid qualitative analysis was used to summarize participants' suggested modalities for financial toxicity interventions. Results: In this convenience sample of participants with NHL, participants were primarily older adults (median age 66, IQR 58-72.5), male (62%), and white/Caucasian (80%), with some college or more education completed (76%). The mean COST score was 28.0 (SD= 11.6, range: 0-44), with 32% reporting significant financial toxicity (COST score < 17.5). The mean eHEALS score was 24.6 (SD= 8.10, range: 8-40), and DHL did not vary significantly by age, gender, race/ethnicity, or household income (all p-values > 0.05). There was not a statistically-significant association between financial toxicity and DHL (r=0.028, p=0.849). However, DHL varied according to participants' preferences for online tools (Figure 1). Those who were interested in using online tools to manage cancer-related expenses reported higher DHL than those who were not interested(F(2,47)=5.43, p=0.007); there was a similar pattern for those interested in an online tool to communicate with their care teams (F(2,47)=5.73, p=0.006). Qualitative interviews (n=13) provided additional context for preferred formats for financial toxicity intervention preferences. For example, when asked about the best format for financial toxicity interventions, participants with higher levels of DHL suggested websites and phone applications, whereas participants with lower DHL levels suggested non-electronic modalities. Comfort level and barriers for utilizing technology-based interventions were also explored. Conclusions: A subset of NHL patients experiences financial toxicity, which does not appear to be directly related to DHL. Because DHL varies among patients with NHL, it may be important to risk stratify populations by DHL to appropriately focus and design tools for addressing financial toxicity. Patients with lower DHL may prefer other intervention modalities (e.g., written materials) and/or may benefit from additional support to access digital media interventions. Inclusion of participants with lower DHL levels in the early stages of intervention development may help to ensure that the most appropriate and usable tools for supporting patients with NHL are developed. Additional research is needed to better understand influences and correlates of DHL in patients with hematologic malignancies as well as the best approaches to financial toxicity interventions.

Factors influencing consumer motivations for protein choice.

This study evaluated the factors that motivate US consumers (18-65 years) to choose protein products derived from specific protein sources. An online survey was conducted. Participants who purchased protein products (n=673) were shown agree/disagree questions, along with maximum difference (MaxDiff), constant sum, and Kano questions on factors surrounding protein choice. Last, follow-up qualitative interviews were conducted with 51 survey participants to further investigate consumer motivations behind protein choice. Survey participants conceptually desired a protein product or protein-fortified food that was a good source of protein, tasted great, and was healthy. Three clusters of consumers with distinct motivations for protein purchases were identified. Cluster 1 (C1) consumers (n=176) desired plant-based, environmentally friendly products and valued sustainability label claims more than flavor/taste. Cluster 2 (C2) consumers (n=271) were nutritionally conscious and desired high-protein healthy products that were also high in vitamins/minerals. Cluster 3 (C3) consumers (n=226) showed the most loyalty to the products they currently purchased and were also most willing to try new products based on the recommendations. Cluster 1 consumers placed importance on protein sources, while C2 valued price most and C3 gave the highest value to flavor. In side-by-side protein comparisons, plant-based proteins were considered superior to dairy proteins in sustainability, health, ethics, and digestibility, while both protein types were at parity for naturalness, satiety, and taste across all consumers, but differences were documented among consumer clusters. Results from this study demonstrate that there are many different motivations for consumers to purchase protein products. These motivations can be applied to consumer education as well as the strategic positioning of protein products. Practical Application: This study investigated consumer perception of different protein types and the drivers of choice for protein types among distinct consumer groups. Further application of findings from this study may help guide the development and formulation of new products with a diverse range of protein sources.

Decision to adopt body-worn cameras in small and rural Pennsylvania police departments

PurposeInternationally publicized cases of police violence against unarmed black men have led to calls for accountability in policing. Increased footage of police–public interactions, specifically through the form of police body-worn cameras (BWCs), is encouraged and considered an innovation that can improve the policing profession. However, BWC adoption is likely more feasible in big city departments than in small and rural departments, who respond to many of the same issues as their larger counterparts. The purpose of this study is to explore perceptions of BWC among leaders of small and rural police departments.Design/methodology/approachUsing a mixed methods approach, the authors surveyed 349 chiefs of small and rural Pennsylvania police departments and conducted qualitative follow-up interviews with 53 chiefs.FindingsThe results indicate that both adopters and non-adopters esteem BWC in a positive light, particularly toward the ability to improve professionalism and police–community relations. Other findings and implications of these results will be discussed.Originality/valueThis study focuses on small and rural police departments, which make up the majority of police departments but are often understudied.