Individual Phone Interviews Research Articles

Challenges for Newly Credentialed Athletic Trainers During Their Transition to Practice.

Understanding the challenges faced by newly credentialed athletic trainers (ATs) as they transition into clinical practice could assist employers and professional programs in developing initiatives to enhance this transition. To explore the challenges faced by newly credentialed ATs during their transition from student to autonomous practitioner. Qualitative study. Individual phone interviews. A total of 34 ATs certified between January and September 2013 participated in this study (18 women, 16 men; age = 24 ± 2 years; work settings = college, secondary school, clinic, and other). Data saturation guided the number of participants. An interview guide was used. All interviews were recorded and transcribed verbatim. Data were analyzed via phenomenologic reduction, with data coded for common themes and subthemes. Trustworthiness was established via intercoder reliability, member checks, and peer review. Initially, participants had difficulty making decisions independently. However, making decisions and receiving positive feedback helped them develop confidence. Communication with coaches and parents was challenging, especially for those in the secondary school setting. Participants also experienced role ambiguity, as they were unsure of basic organizational and administrative structures and expectations. Mentor inaccessibility was the final challenge described by respondents. In particular, those in the secondary school setting and with part-time employment felt they did not have a supervisor or mentor whom they could contact for support and guidance. Professional programs should educate students on potential challenges to help them understand what they might encounter during the transition to clinical practice. Employers should provide clear expectations and job descriptions to alleviate some of the stress and role ambiguity. If a mentor is not provided by the employer, the newly credentialed AT should seek one to assist during the transition.

In the Eyes of Those Who Were Randomized: Perceptions of Disadvantaged Older Adults in a Tai Chi Trial.

Older adults living in subsidized housing have typically been excluded from exercise intervention studies. We conducted a qualitative study to explore the perceived physical, psychological, social, and economic factors that influenced participation in and adherence to a year-long Tai Chi intervention within an ongoing cluster-randomized controlled trial (RCT) for older adults living within subsidized housing facilities. Focus groups were held with participants of the RCT who were allocated to the trial's Tai Chi intervention. Individual phone interviews were conducted with those allocated to Tai Chi who had low adherence or who had withdrawn their participation from the study. Emergent themes were extracted using grounded-theory methods. In this qualitative study, we enrolled 41 participants who were allocated to the RCT's Tai Chi intervention: 38 completed and 3 withdrew from the study. Average Tai Chi class attendance was 64.3%. Pragmatic factors that led to higher adherence and retention included: locating classes within each facility; providing programs at no cost; and deployment of a skilled research support team. In addition, the use of an accessible, simplified Tai Chi program improved confidence, social support, self-efficacy, and self-reported improvements in physical and psychological well-being. Perceived physical, psychological, social benefits, and self-efficacy likely enhance adherence and retention to research-based Tai Chi interventions for older adults. Delivering an on-site, no cost, and supportive program appears critical to overcoming financial and environmental barriers to participation for those living within subsidized housing.

Priorities for Rural Lymphoma Survivors: An Exploratory Study

▪Background: Rural cancer patients, including those with lymphoma, have unique needs and barriers to care, including access to preventive and specialized care, economic resources, and proximity to supportive services. Research is needed to thoroughly understand these needs and propose solutions to health outcome disparities in these populations.Objective: We conducted a qualitative study with lymphoma survivors living in rural areas to: 1) determine perceived unmet needs regarding lymphoma care in rural areas and 2) examine views, understanding, and priorities for rural patients' participation in and education about therapeutic and non-therapeutic clinical research studies.Methods: We conducted 11 individual semi-structured phone interviews in the spring of 2018 with lymphoma survivors living in rural counties in the state of Georgia. Patients were identified by a home address in counties classified as rural based on Rural/Urban Commuting Areas (RUCAs), a categorization system used in the research community to classify rural and urban areas based on census track level data. Individual interview participants were recruited from regional patient education conferences and among current research participants at a university research hospital in the state of Georgia. Interviews were recorded and transcribed verbatim. Thematic analysis was used to identify themes emerging from these data. MAXQDA 18.0.8 qualitative data analysis software was utilized to facilitate a constant-comparative coding process to identify the resulting themes.Results: The greatest barrier to care expressed by the participants was distance. Interviewees had to frequently take time off of work and travel any time they needed to see a specialist or visit a cancer center in a larger city, often requiring several hours of travel by car. Many participants felt they were burdening their family and friends by relying on them for transportation. Rural lymphoma patients and caregivers described difficulty navigating between their local clinics and the larger cancer centers. Distance also was a barrier to attending educational events or support groups. Many participants were frustrated with their diagnosis experience at small clinics and regretted that they didn't seek the opinion of a specialist sooner. Some also felt that the team at their local clinic was not as knowledgeable about their treatment plan or its long-term effects. Although smaller, local clinics facilitated building relationships with the team and provider, there were drawbacks to relying on a local clinic, including lack of specialized providers and opportunities to participate in research. Communication between local and specialized clinics complicated the process, and participants had more difficulty contacting or seeking advice from the team at larger cancer centers. However, electing to receive treatment from specialized clinics farther away also had consequences. One solution agreed upon by nearly all of the participants was the use of technology to communicate. Participants were extremely supportive of online patient portals available at larger cancer centers which allowed them to more easily communicate with their clinical care team and helped them feel involved with their care, while educational or informative smartphone applications allowed them to access and streamline information that otherwise was not available in a rural area.Conclusion: These findings suggest that targeted research and interventions are necessary to address the specific needs of rural lymphoma survivors. To address the disparity in health outcomes that exists in this population, health care professionals and investigators can utilize these data to engage rural survivors in their treatment decision-making. In particular, the preference in this study population for using technological innovation to communicate contributes to the body of research regarding the significance technology has and can continue to have in lymphoma care. DisclosuresFlowers:TG Therapeutics: Research Funding; Pharmacyclics: Research Funding; Denovo Biopharma: Consultancy; Gilead: Research Funding; Abbvie: Research Funding; Spectrum: Consultancy; Janssen Pharmaceutical: Research Funding; Burroughs Wellcome Fund: Research Funding; Karyopharm: Consultancy; Genentech/Roche: Consultancy; Bayer: Consultancy; Genentech/Roche: Research Funding; Millennium/Takeda: Research Funding; OptumRx: Consultancy; Celgene: Research Funding; Eastern Cooperative Oncology Group: Research Funding; Abbvie: Consultancy, Research Funding; BeiGene: Research Funding; Acerta: Research Funding; Pharmacyclics/ Janssen: Consultancy; Gilead: Consultancy; National Cancer Institute: Research Funding; V Foundation: Research Funding.

Survivor and Caregiver Perceptions of Lymphoma: A Qualitative Study

▪Background: With more than 80% of Hodgkin lymphoma patients being cured and non-Hodgkin lymphoma 10-year survival rates improving, there has been a dramatic growth in the number of lymphoma survivors. Despite these successes, survivors are often left coping with adverse outcomes resulting from cancer treatment. Research examining the needs of lymphoma survivors and their caregivers is needed as this population continues to grow.Objective: We conducted a qualitative study with lymphoma survivors and caregivers to: 1) determine perceived needs and priorities regarding lymphoma care and 2) examine views, understanding, and priorities for participation in therapeutic and non-therapeutic research studies.Methods: The qualitative study consisted of two phases: semi-structured focus groups and individual semi-structured telephone interviews. In Phase I, two semi-structured focus groups were conducted in 2017 with lymphoma survivors (n=8) and caregivers (n=7) recruited among attendees of regional and national lymphoma patient education conferences. Participants were asked to discuss their experiences, opinions, and priorities for lymphoma care and research. Results from the focus groups informed the telephone individual interview guide. In Phase II, researchers conducted 19 individual semi-structured phone interviews in the spring of 2018 with lymphoma survivors (n=17) and caregivers (n=2). Individual interviews allowed for an in-depth exploration of the themes garnered from the initial focus groups of lymphoma survivors and caregivers. Individual interview participants were recruited from regional patient education conferences and among current research participants at a university research hospital in the state of Georgia. Focus groups and interviews were recorded and transcribed verbatim. Thematic analysis was used to identify themes emerging from these data. MAXQDA 18.0.8 qualitative data analysis software was utilized to facilitate a constant-comparative coding process to identify the resulting themes.Results: Most focus group participants were frustrated by a lack of information received regarding diagnoses, treatment options, survivorship-related care, and research opportunities. Survivors and caregivers commonly felt disconnected from their clinical care team due to lack of communication, although some described trusting relationships. In particular, caregivers described their needs as being completely unaddressed in the care process. Participants expressed great interest in research, but were frustrated by the difficulty of finding research studies and results relevant to them. In Phase II, individual interviewees described their own unmet emotional needs and those of their caregivers. Several participants described their desire for more holistic and survivorship-oriented research, including studies to generate guidance for quality of life of cancer patients and survivors, alternative and non-traditional medicine, diet, and emotional or mental health. Emotionally, participants described how debilitating the fear of the unknown can be and the coping strategies they employed to combat this, including reliance on support systems, practicing gratefulness, and fostering trusting relationships with their clinical care teams. Interestingly, participants also experienced benefits from their cancer experiences, most notably strengthened relationships with their loved ones and increased spirituality or mindfulness.Conclusion: Results gleaned from focus groups and individual interviews provided insight into the unmet emotional and supportive needs of this population. Lymphoma survivors and their caregivers expressed their frustrations with their cancer experiences. These findings identified unmet patient-oriented research needs including research regarding quality of life after cancer treatment, messaging and communication between the scientific community and cancer patients, and emotional well-being. Health care professionals and investigators can utilize these data to provide meaningful information regarding care delivery, supportive services, and lymphoma research that meets the needs of lymphoma survivors and caregivers. DisclosuresFlowers:Bayer: Consultancy; Denovo Biopharma: Consultancy; Gilead: Research Funding; Millennium/Takeda: Research Funding; Abbvie: Consultancy, Research Funding; Gilead: Consultancy; Janssen Pharmaceutical: Research Funding; Abbvie: Research Funding; Pharmacyclics/ Janssen: Consultancy; Pharmacyclics: Research Funding; OptumRx: Consultancy; Karyopharm: Consultancy; Genentech/Roche: Consultancy; TG Therapeutics: Research Funding; Acerta: Research Funding; Spectrum: Consultancy; BeiGene: Research Funding; Genentech/Roche: Research Funding; Celgene: Research Funding; Burroughs Wellcome Fund: Research Funding; Eastern Cooperative Oncology Group: Research Funding; National Cancer Institute: Research Funding; V Foundation: Research Funding.

Stakeholder perceptions of barriers and facilitators to sexual health discussions between foster and kinship caregivers and youth in foster care: A qualitative study

PurposeYouth in foster care are more likely to contract a sexually transmitted infection (STI) and become pregnant than other youth, who have not been in foster care. This study explored stakeholder perceptions of barriers and facilitators to conversations about sexual health between foster/kinship caregivers and youth in foster care, with the goal of developing a brief, scalable sexual health training for caregivers. MethodsWe conducted individual phone interviews with twenty stakeholders from a variety of occupations that work closely with foster and kinship caregivers in New York, NY, Seattle, WA and Los Angeles, CA. Stakeholders were asked semi-structured open-ended questions regarding their thoughts on a caregiver's role in discussing sexual health, barriers and facilitators in having these conversations, and staff members' comfort level in having these discussions with youth in foster care. We coded and analyzed transcripts using Thematic Analysis technique. ResultsThemes emerged around three main categories: 1) barriers to sexual health conversations with youth in their care, including caregivers' religious and personal beliefs impeding youth access to accurate sexual health information and crucial medical services, staff and caregiver lack of sexual heath knowledge, caregiver and/or youth discomfort in engaging in sexual health conversations, and a lack of mandatory training for caregivers and staff on sexual health; 2) facilitators to sexual health conversations with youth, including open and nonjudgmental communication between youth in foster care and caregivers, and engagement in deliberate relationship-building activities with the youth; and 3) recommendations for content and format of a training for caregivers and agency staff to address barriers to conversations, such as making trainings mandatory and in-person. ConclusionsStakeholders identified several barriers and facilitators to sexual health conversations and viewed conversations between caregiver and the youth in foster care as essential to the youth's wellbeing. Clear guidance from child welfare agencies and caregiver-oriented trainings that include straightforward information and skill-building strategies could help to mitigate these barriers and related health disparities.

Fostering Excellence: An Examination of High-Enrollment VHA Medical Foster Home Programs.

This qualitative study aimed to assist the US Veterans Health Administration (VHA) to efficiently target recruitment into VHA Medical Foster Homes (MFHs) by understanding how high-enrollment MFH (HE-MFH) program attributes optimized MFH enrollment. We used an emergent exploratory design to study 3 HE-MFH programs across the United States. Data were collected from August 2013 through June 2014 through individual in-person and phone interviews and in-person focus group discussions with 39 MFH care providers. Three main themes emerged as essential for optimizing HE-MFH program enrollment: (1) alignment of right caregiver, right home, and right Veteran; (2) care practices that support caregiver, Veteran, and home-based primary care (HBPC); and (3) workplace practices and processes that demonstrate support of the MFH coordinator role by facility leadership and the HBPC team.

Current Practice “Constraints” in the Uptake and Use of Intensive Upper Extremity Training: A Canadian Perspective

ABSTRACTBackground: Intensive upper extremity training (IUET) has demonstrated efficacy in clinical and functioning outcomes in children with hemiplegia. However, implementation in the clinical context requires novel service models and knowledge translation. Aims: To map implementation of IUET in Canada, to identify factors associated with the implementation and best practices for implementation. Methods: Mixed-methods design; descriptive statistics, chi-square tests. Individual phone interviews and focus groups with purposeful sampling. Thematic analysis; telephone surveys with managers of 31 pediatric rehabilitation centers across Canada. Four focus groups across Canada and one in the Netherlands. Results: Implementation of IUET group interventions is limited in Canada (7/31). Barriers included beliefs and values related to evidence-based practice, opportunities for continuing education, researchers-clinicians partnerships, access to scientific literature, and the presence of a champion. Pressure from parents and media presenting IUET as a novel and effective therapy, support and flexibility of families, having the critical mass of clients and a managerial willingness to accommodate new ideas and restructure service provision were some facilitators. Conclusions: Uptake of the evidence requires many steps described in the knowledge translation cycle. Factors identified in the study could be considered in most clinical settings to facilitate the uptake of research evidence for IUET.

Exploring the Perceptions of Newly Credentialed Athletic Trainers as They Transition to Practice.

Research is limited on the transition to practice of newly credentialed athletic trainers (ATs). Understanding this transition could provide insight to assist employers and professional programs in developing initiatives to enhance the transition. To explore newly credentialed ATs' experiences and feelings during their transition from student to autonomous practitioner. Qualitative study. Individual phone interviews. Thirty-four ATs certified between January and September 2013 participated in this study (18 women, 16 men; age = 23.8 ± 2.1 years; work settings were collegiate, secondary school, clinic, and other). Data saturation guided the number of participants. Participants were interviewed via phone using a semistructured interview guide. All interviews were recorded and transcribed verbatim. Data were analyzed through phenomenologic reduction, with data coded for common themes and subthemes. Credibility was established via member checks, peer review, and intercoder reliability. The 3 themes that emerged from the data were (1) transition to practice preparation, (2) orientation, and (3) mentoring. Transition to practice was rarely discussed during professional preparation, but information on the organization and administration or capstone course (eg, insurance, documentation) assisted participants in their transition. Participants felt that preceptors influenced their transition by providing or hindering the number and quality of patient encounters. Participants from larger collegiate settings reported more formal orientation methods (eg, review policies, procedures manual), whereas those in secondary school, clinic/hospital, and smaller collegiate settings reported informal orientation methods (eg, independent review of policies and procedures, tours). Some participants were assigned a formal mentor, and others engaged in peer mentoring. Employers could enhance the transition to practice by providing formal orientation and mentorship. Professional programs could prepare students for the transition by discussing how to find support and mentoring and by involving preceptors who provide students with opportunities to give patient care.

Low-Income Women's Feeding Practices and Perceptions of Dietary Guidance: A Qualitative Study.

Objectives Describe themes characterizing feeding behaviors of low-income women participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and identify the attitudes, beliefs, and sources of information that inform these practices. Methods Formative research was conducted including focus groups and semi-structured individual phone interviews with a total of 68 low-income women participating in WIC. Qualitative data were recorded, transcribed, imported into NVivo 8.0, and analyzed for common themes. Results Mothers reported feeding behaviors inconsistent with guidance from WIC and the American Academy of Pediatrics. Three main themes were identified. First, mothers reported receiving conflicting messaging/advice from medical professionals, WIC nutritionists, and family members, which was confusing. Mothers also reported dissatisfaction with the "one size fits most" approach. Lastly, mothers reported relying on their "instincts" and that "all babies are different" when deciding and rationalizing what feeding guidance to follow. Conclusions Future interventions targeting this high-risk population should consider developing personalized (individualized) messaging, tailored to the needs of each mother-child dyad. Focused efforts are needed to build partnerships between WIC providers and other health care providers to provide more consistent messages about responsive feeding to prevent early obesity.

The Implications of the Timing of Diagnosis of Dementia on the Dementia Caregiver

This is a consumer-reference feedback and feasibility testing of a protocol to obtain qualitative responses of co-residing caregivers to questions regarding the timing of dementia diagnosis and their experience of the disclosure of a diagnosis of dementia. Data collection involved focus group discussions and individual phone interviews of a convenience sample (N = 5) of an Alzheimer’s Australia state based Consumer Advisory Committee. Thematic analysis utilised the Leximancer software. Consumer feedback suggested a reordering of the interview questions and reversing the data collection sequence to reduce the emotional impact on participants. Suggestions were offered to limit the number of participants in the focus group to shorten the duration of the focus group session to prevent fatigue and to provide a support person to improve participant focus group comfort. Responses to the interview questions indicated caregivers retrospectively considered a timely diagnosis would have provided useful dementia-focused planning, reduced the difficulties of living with uncertainty and would have provided more time to obtain information and support. There were strong expectations for medical practitioners to be sensitive to the possibility of dementia and to be cognisant of the diagnostic concerns of caregivers. The diagnosis of dementia and its timing is important to the dementia caregiver in providing an explanation of the problems experienced and allowing earlier organisation of care, future planning and caregiver education to reduce the difficulties of living with undiagnosed and unrecognised dementia.

Survivors speak: a qualitative analysis of motivational factors influencing breast cancer survivors' participation in a sprint distance triathlon.

To examine motivational factors influencing breast cancer survivors to participate in triathlon training, complete a triathlon and maintain an exercise thereafter. Routine exercise has been shown to improve quality of life and reduce recurrence for breast cancer survivors. Yet physical and psychological factors present barriers for initiating and maintaining an exercise routine. Research is limited in exploring factors of exercise motivation from the survivor's perspective. Qualitative design using focus groups and individual follow-up phone interviews to explore motivation for exercise initiation and maintenance. One to two weeks after completing a triathlon, 11 breast cancer survivors who trained together participated in one of three focus groups to discuss their experience. Five months post triathlon 6 of the 11 participants were successfully contacted and phone interviews were conducted to explore exercise maintenance. Focus groups and interviews were analysed using content and thematic analysis. Five themes emerged (1) Champion for Exercise, (2) Part of a Team, (3) Everyone Had a Story, (4) Not Really Exercise and (5) What Do We Do Now? Overall, survivors recognised their need for lifestyle change (e.g. moving from a sedentary lifestyle to a more active one). More importantly, they identified the team approach to exercise initiation was crucial in their success in sustaining a behavioural change. Emphasis needed on developing team exercise training programmes for survivors. Nurses can play a critical role in discussing with survivors, the benefits of exercise initiation and maintenance. Breast cancer survivors are hesitant to initiate routine exercise. Training with women who share a common lived experience increases the likelihood of success. Nurses are in a position to encourage breast cancer survivors to participate in group exercise programmes as a way to improve quality of life.

The Emotional Burden of Pelvic Organ Prolapse in Women Seeking Treatment

We aimed to qualitatively describe the emotional burden experienced by women seeking treatment for prolapse. We hypothesized that the condition of prolapse would have an impact on women's emotional well-being. Women with stage II or greater symptomatic prolapse participated in focus groups or individual phone interviews. A trained facilitator conducted semi-structured focus groups and interviews. These were audio-taped and transcribed. Two authors coded transcripts and identified themes using an "editing" approach. The codebook was amended until no new major themes emerged from the data. Forty-four women participated (25 in focus groups and 19 in phone interviews). Mean (SD) age of women was 60 (10) years and mean (SD) prolapse leading edge was 3 (2) cm. Analysis revealed the following 3 main themes: (1) emotions associated with the condition of prolapse (minimal emotions, annoyance, irritation, frustration, anger, sadness, anxiety, depression), (2) communicating emotions related to prolapse (to friends, family, healthcare providers), and (3) emotions relating to treatment (both positive and negative effects). Prolapse significantly impacts women's emotional health and subjective well-being. An improved understanding of women's emotional experiences of prolapse may help providers better meet patients' needs.

Integrative Medicine in Preventive Medicine Education: Implementation Analysis.

In September 2012, the Health Resources and Services Administration funded 12 preventive medicine residency programs to participate in a 2-year project aimed at incorporating integrative medicine (IM) into their residency training programs. The grantees were asked to incorporate competencies for IM into their respective preventive medicine residency curricula and to provide for faculty development in IM. The analysis conducted in 2014-2015 used the following evidence to assess residency programs' achievements and challenges in implementation: progress and performance measures reports, curriculum mapping of program activities to IM competencies, records of webinar participation, and post-project individual semi-structured phone interviews with the 12 grantee project leaders. Key findings are: (1) IM activities offered to residents increased by 50% during the 2 years; (2) Accessing IM resources already in existence at local grantee sites was the primary facilitator of moving the integration of IM into preventive medicine residencies forward; (3) Among all activities offered residents, rotations were perceived by grantees as by far the most valuable contributor to acquiring IM competencies; (4) Online training was considered a greater contributor to preventive medicine residents' medical knowledge in IM than faculty lectures or courses; (5) Faculty were offered a rich variety of opportunities for professional development in IM, but some programs lacked a system to ensure faculty participation; and (6) Perceived lack of evidence for IM was a barrier to full program implementation at some sites. Grantees expect implemented programs to continue post-funding, but with decreased intensity owing to perceived faculty and curriculum time constraints.

Comparisons of Body Image Perceptions of a Sample of Black and White Women with Rheumatoid Arthritis and Fibromyalgia in the US.

Objective : To explore the disease-related, body image (BI) perceptions of women diagnosed with, rheumatoid arthritis (RA) and fibromyalgia (FM).Methods : A purposive sample of twenty-seven females participated in individual semi-structured phone interviews to elicit BI perceptions relative to pain, activity limitations and coping measures. Sessions were digitally recorded, transcribed verbatim, and content analyzed.Results : Body image perceptions relative to 5 major themes emerged in the analysis. They focused on Pain, Disease Impact on Physical and Mental Function, Weight, Diseased-Induced Fears and, Coping measures. Pain was a common experience of all participants. Other troubling factors verbalized by participants included dislike and shame of visibly affected body parts, and disease-induced social, psychological and physical limitations. RA participants thought that manifested joint changes, such as swelling and redness, undergirded their prompt diagnosis and receipt of health care. Contrarily, women with fibromyalgia perceived that the lack of visible, disease-related, physical signs led to a discounting of their disease, which led to delayed health care and subsequent frustrations and anger. All but one participant used prayer and meditation as a coping measure.Conclusion : The body image perceptions evidenced by the majority of participants were generally negative and included specific focus on their disease-affected body parts (e.g. joints), mental function, self-identity, health care experiences, activity limitations and overall quality of life. Given the global effect of RA and FM, assessment and integration of findings about the BI perceptions of individuals with FM and RA may help define suitable interdisciplinary strategies for managing these conditions and improving participants’ quality of life.

Supervising athletic trainers' perceptions of professional socialization of graduate assistant athletic trainers in the collegiate setting.

Many newly credentialed athletic trainers gain initial employment as graduate assistants (GAs) in the collegiate setting, yet their socialization into their role is unknown. Exploring the socialization process of GAs in the collegiate setting could provide insight into how that process occurs. To explore the professional socialization of GAs in the collegiate setting to determine how GAs are socialized and developed as athletic trainers. Qualitative study. Individual phone interviews. Athletic trainers (N = 21) who had supervised GAs in the collegiate setting for a minimum of 8 years (16 men [76%], 5 women [24%]; years of supervision experience = 14.6 ± 6.6). Data were collected via phone interviews, which were recorded and transcribed verbatim. Data were analyzed by a 4-person consensus team with a consensual qualitative-research design. The team independently coded the data and compared ideas until a consensus was reached, and a codebook was created. Trustworthiness was established through member checks and multianalyst triangulation. Four themes emerged: (1) role orientation, (2) professional development and support, (3) role expectations, and (4) success. Role orientation occurred both formally (eg, review of policies and procedures) and informally (eg, immediate role immersion). Professional development and support consisted of the supervisor mentoring and intervening when appropriate. Role expectations included decision-making ability, independent practice, and professionalism; however, supervisors often expected GAs to function as experienced, full-time staff. Success of the GAs depended on their adaptability and on the proper selection of GAs by supervisors. Supervisors socialize GAs into the collegiate setting by providing orientation, professional development, mentoring, and intervention when necessary. Supervisors are encouraged to use these socialization tactics to enhance the professional development of GAs in the collegiate setting.

Patients' views of teamwork in the emergency department offer insights about team performance.

Research into efforts to engage patients in the assessment of health-care teams is limited. To explore, through qualitative methods, patient awareness of teamwork-related behaviours observed during an emergency department (ED) visit. Researchers used semi-structured question guides for audio-recorded interviews and analysed their verbatim transcripts. Researchers conducted individual phone interviews with 6 teamwork subject matter experts (SMEs) and held 5 face-to-face group interviews with patients and caregivers (n=25) about 2weeks after discharge from the emergency department (ED). SMEs suggested that a range of factors influence patient perspectives of teams. Many patients perceived the health-care team within the context of their expectations of an ED visit and their treatment plan. Four themes emerged: (i) patient-centred views highlight gaps in coordination and communication; (ii) team processes do concern patients; (iii) patients are critical observers of ways that team members present their team roles; (iv) patients' observations of team members relate to patients' views of team effectiveness. Analysis also indicated that patients viewed health-care team members' interactions with each other as proxy for how team members actually felt about patients. Results from both sets of interviews (SME and patient) indicated that patient observations of teamwork could add to assessment of team processes/frameworks. Patients' understanding about teamwork organization seemed helpful and witnessed interteam communication appeared to influence patient confidence in the team. Patients perspectives are an important part of assessment in health care and suggest potential areas for improvement through team training.

Men’s Experience with Sexual Dysfunction Post-rectal Cancer Treatment: A Qualitative Study

In an effort to address reports from men that their sex life is worse after treatment for rectal cancer, this qualitative study was designed to better understand their experience with sexual dysfunction following rectal cancer treatment, thus providing information on the adaptation of a psycho-educational sexual health intervention for male rectal cancer survivors and simultaneously investigating barriers and promoters that would influence their participation in a psycho-educational sexual health intervention. Thirteen male rectal cancer survivors who were treated at Memorial Sloan-Kettering Cancer Center (MSKCC) for rectal cancer participated (median time post-treatment was 6.4 years). Six survivors participated in individual semi-structured phone interviews, and seven others took part in focus groups. We performed standard procedures of qualitative thematic text analysis, which involved independent review of interview and focus group transcripts by several analysts followed by consensus meetings to identify key themes. Participants reported bowel dysfunction (N = 13, or 100%) and erectile dysfunction (N = 12, or 92%) as chief complaints. The participants thought a psychoeducational sexual health intervention post-surgery would be helpful because it would provide educational information regarding the etiology of their problems and treatments to improve their sexual health (N = 8, or 62%). Most participants' primary concern immediately after treatment was surviving their disease; improving sexual functioning seemed to become more important over time. Barriers to potentially participating in a psycho-educational sexual health intervention included geographical distance from MSKCC (N = 3, or 3/13) and the risk of embarrassment when discussing sexual issues (N = 5, or 5/13). Men reported that a psycho-educational sexual health intervention would be helpful to improve their sexual functioning post-treatment. Discussion of bowel issues and logistical concerns gave information on the psycho-educational sexual health intervention.

Mental illness in metropolitan, urban and rural Georgia populations

BackgroundMental illness represents an important public health problem. Local-level data concerning mental illness in different populations (e.g., socio-demographics and residence – metropolitan/urban/rural) provides the evidence-base for public health authorities to plan, implement and evaluate control programs. This paper describes prevalence and covariates of psychiatric conditions in Georgia populations in three defined geographic areas.MethodsData came from the Georgia population-based random-digit-dialing study investigating unwellness and chronic fatigue syndrome (CFS) in Georgia populations of three defined geographic areas (metropolitan, urban, and rural). Respondents were screened for symptoms of fatigue, sleep, cognition, and pain at household screening interviews, and a randomly selected sample completed detailed individual phone interviews. Based on the detailed phone interviews, we conducted one-day clinical evaluations of 292 detailed interview participants classified as unwell with a probable CFS (i.e. CFS-like; a functional somatic syndrome), 268 classified as other unwell, and 223 well (matched to CFS-like). Clinical evaluation included psychiatric classification by means of the Structured Clinical Interview for DSM (SCID). To derive prevalence estimates we used sample weighting to account for the complexity of the multistage sampling design. We used 2- and 3-way table analyses to examine socio-demographic and urbanicity specific associations and multiple logistic regression to calculate adjusted odds ratios.ResultsAnxiety and mood disorders were the most common psychiatric conditions. Nineteen percent of participants suffered a current anxiety disorder, 18% a mood disorder and 10% had two or more conditions. There was a significant linear trend in occurrence of anxiety or mood disorders from well to CFS-like. The most common anxiety disorders were post-traumatic stress disorder (PTSD) (6.6%) and generalized anxiety disorder (GAD) (5.8%). Logistic regression showed that lower education and female sex contributed significantly to risk for both PTSD and GAD. In addition, rural/urban residence and Hispanic ethnicity were associated with PTSD. We defined moderate to severe depression as Major Depressive Disorder or a Zung score >60 and logistic regression found lower education to be significantly associated but sex, age and urbanicity were not.ConclusionsOverall occurrence of anxiety and mood disorders in Georgia mirrored national findings. However, PTSD and GAD occurred at twice the published national rates (3.6 and 2.7%, respectively). State and local prevalence and associations with education, sex and urbanicity comprise important considerations for developing control programs. The increased prevalence of anxiety and mood disorders in people with a functional somatic syndrome (or CFS-like illness) is important for primary care providers, who should consider additional psychiatric screening or referral of individuals presenting with somatoform symptoms.

Maintenance of Individual Identity in Older Adulthood: Responses to Successful Aging in America

AbstractWith social, political, and economic conditions in the United States emphasizing individual productivity and self maintenance, there is a new concern for how American elders take care of themselves. In contemporary American culture, optimal models of the aging process–often labeled “Successful Aging” or “Healthy Aging”–emphasize independence, the importance of evading disease and disability, the maintenance of physical and mental facilities, and sustained engagement in social relationships. In this article I argue that my financially‐comfortable, welleducated older American informants from Boston and West Palm beach communities respond to notions of Successful Aging by creating and constructing identities as “successful aging persons” that acknowledge a need to accept and adapt to change in later life. My informants creatively and resourcefully strove to create health, activity, and productivity in their own lives; in this way, they remained deeply invested in the American ideals of independence and autonomy. At the same time, many informants emphasized the need to not simply retain health, activity, and a youthful independence, but also to resourcefully adapt to the very real changes of age. In other words, the experiences offered by my informants tended to reflect ways they have appropriated culturally inflected notions of success into their own aging routines. Successful Aging for them became about passing through later life's stages with poise, intelligence, resourcefulness, and self‐sufficiency. Data collection began in the Spring of 2012 when I conducted preliminary interviews and gathered observation notes in a Jewish retirement community in Wellington, Florida; collection continued in Boston through the Spring of 2013. Individual phone interviews, home visits, group discussions, and participation in and observance of older‐adult education classes all contributed to the collection of this research data.

Pandemic Planning and Response in Academic Pediatric Emergency Departments During the 2009 H1N1 Influenza Pandemic

The terrorist attacks of September 11, 2001, initiated a shift toward a comprehensive, or "all-hazards," framework of emergency preparedness in the United States. Since then, the threat of H5N1 avian influenza, the severe acute respiratory syndrome epidemic, and the 2009 H1N1 influenza pandemic have underscored the importance of considering infectious events within such a framework. Pediatric emergency departments (EDs) were disproportionately burdened by the 2009 H1N1 influenza pandemic and therefore serve as a robust context for evaluation of pandemic preparedness. The objective of this study was to explore pediatric ED leaders' experiences with preparedness, response, and postincident actions related to the H1N1 pandemic to inform future pandemic and all-hazards planning and policy for EDs. The authors selected a qualitative design, well suited for exploring complex, multifaceted organizational processes such as planning for and responding to a pandemic and learning from institutional experiences. Purposeful sampling was used to recruit medical directors or their designated physician respondents from pediatric emergency medicine training institutions representing a range of geographic regions across the United States, hospital types, and annual ED volumes; snowball sampling identified additional information-rich respondents. Recruitment began in May 2011 and continued until thematic saturation was reached in January 2012 (n = 20). Data were collected through in-depth individual phone interviews that were recorded and professionally transcribed. Using a standard interview guide, respondents were asked open-ended questions about pandemic planning, response, and institutional learning related to the H1N1 pandemic. Data analysis was performed by a multidisciplinary team using a grounded theory approach to generate themes inductively from respondents' expressed perspectives. The constant comparative method was used to identify emerging themes. Five common themes characterized respondents' experiences with pandemic planning and response: 1) national pandemic influenza preparedness guidance has not fully penetrated to the level of pediatric emergency physician (EP) leaders, leading to variable states of preparedness; 2) pediatric EDs that maintained strong relationships with local public health and other health care entities found those relationships to be beneficial to pandemic response; 3) pediatric EP leaders reported difficulty reconciling public health guidance with the reality of ED practice; 4) although many anticipated obstacles did not materialize, in some cases pediatric EP leaders experienced unexpected institutional challenges; and 5) pediatric EP leaders described varied experiences with organizational learning following the H1N1 pandemic experience. Despite a decade of investment in hospital preparedness, gaps in pediatric ED pandemic preparedness remain. This work suggests that raising awareness of pandemic planning standards and promoting strategies to overcome barriers to their adoption could enhance ED and hospital preparedness. Helping hospitals better prepare for pandemic events may lead to strengthened all-hazards preparedness.