Inductive Content Analysis Research Articles

Choosing non-pharmacological treatments for neuropathic pain in spinal cord injury: a qualitative study

Purpose The aims of this study were to explore (1) the considerations of people with spinal cord injury (SCI) in choosing to use non-pharmacological treatments (N-PTs) for neuropathic pain (NP), (2) which factors influence their decision and who is involved in this choice. Materials and methods Eleven individuals with SCI and NP were interviewed. Interviews were transcribed verbatim, transcripts were analysed through thematic coding, following an inductive content analysis approach. Results A journey towards finding and choosing N-PTs emerged. Key phases in this journey were: motives, strategy and practical considerations. Pain and its impact on their life led participants to consider N-PTs. Motives were participants’ negative attitudes towards regular medication, willingness to try everything and disappointment and frustration with the guidance from their health care provider (HCP). The search strategies often involved third parties and the internet. This led them to choose a specific N-PT. The journey was influenced by one’s attitude, previous personal experience, experience of HCPs, financial considerations, availability and convenience of the treatment. Conclusions The journey individuals with SCI and NP go through to find N-PTs to manage pain is difficult and often lonely. Findings highlight the importance of HCPs accompanying people with SCI in finding N-PTs.

Rehabilitation following periacetabular osteotomy for acetabular dysplasia: A qualitative interview study exploring challenges, hopes and expectations among patients in Denmark and Australia

IntroductionGuidelines have been proposed for post-operative rehabilitation following periacetabular osteotomy (PAO). However, the perspectives of individuals undergoing PAO have not been considered. AimThe present study aimed to explore the perceived challenges of everyday life and hopes for and expectations of post-PAO rehabilitation from the perspective of individuals with acetabular dysplasia living in Denmark and Australia. MethodsIn this qualitative study, we used a hermeneutic phenomenological approach with semi-structured interviews to explore the perspectives of 25 participants (four males), aged 16–43 years, who underwent a PAO. Purposeful sampling was used to provide variations in age and sex. Inclusion criteria were age above 15 years, radiographic evidence of acetabular dysplasia, PAO within the last seven weeks and undergoing post-operative rehabilitation. Inductive content analysis was adopted to code and analyse interviews. ResultsThe analysis of the interview transcripts revealed four major themes: different expectations, self-confidence, tailored rehabilitation and aligning expectations. Several subthemes emerged within each theme, and similar patterns with minor variations were identified across countries. However, the financial burden of self-funded surgery and rehabilitation challenged some Australian participants, whereas none of the Danish participants mentioned this challenge. ConclusionOur findings elucidate the diverse range of hopes and expectations in individuals undergoing PAO, and how these relate to their perceived challenges. In particular, the findings highlight the importance of aligning expectations between individuals and clinicians when designing the rehabilitation.

Factors that support children and young people to express their views and to have them heard in healthcare: An inductive qualitative content analysis.

Despite development of healthcare charters supporting Article 12 of The United Nations Convention on the Rights of the Child, children and young people remain largely silenced in discussions about their healthcare. This article is based on the premise that children and young people should be able to exercise their right to express their views and be heard in all matters that affect their lives. This study examined children's and young people's experiences of expressing their views and having them heard in an Australian healthcare context. Using child-centred inquiry and 'draw, write, and tell' methods, data were collected from 20 children and young people. Five factors that supported children and young people to express their views and have their views heard were identified: time, relationships with health professionals, communication, teamwork, and family support. By paying attention to these factors, clinicians and others in health settings can better facilitate child-centred practices and support children and young people to express their views and have those views heard.

Description of the culture of childbirth and parenting classes in Cyprus: An ethnographic approach.

Childbirth and parenting classes are very important because they potentially help couples to make the right decisions during pregnancy, childbirth, and the postpartum period, which has a direct effect on the health of the mother and neonate. However, in Cyprus, the culture of childbirth and parenting classes has not been previously explored. An ethnographic study design was adopted, specifically non-participant observation was undertaken of 19 classes. Semi-structured telephone interviews were employed to collect data in addition to field notes and a reflective diary. Inductive content analysis was undertaken to analyze the data. Four main thematic categories emerged from data analysis: 1) Views and opinions about the course, 2) Important perinatal topics, 3) Usefulness and reasons for attending the classes, and 4) The journey of learning. The importance of antenatal classes has not been given sufficient attention in Cyprus. There is a clear need for a standardized curriculum within the current configuration of national maternity healthcare in Cyprus. Policymakers must implement a standardized curriculum, integrating diverse pedagogical methods to provide in-depth information for expectant parents and parents. While emphasizing the crucial role of midwives in perinatal education, this study also advocates for collaboration with other healthcare professionals emphasizing the imperative need for a comprehensive, standardized approach to perinatal education within the national healthcare system of Cyprus.

Dismantle and rebuild: the importance of preparedness and self-efficacy before, during and after allogeneic haematopoietic cell transplantation.

The aim of this study was to explore patients' experiences of being prepared for allogenic haematopoietic cell transplantation and to explore their perceived self-efficacy and preparedness for self-care after allogenic haematopoietic cell transplantation. Nine participants, who recently underwent allo-HCT, were interviewed regarding their views on preparedness, self-efficacy and self-care. The interviews were analysed using inductive qualitative content analysis. An overarching theme, Life is taken apart, then you have to know how to put the pieces together, and four sub-themes: Convert information into something understandable; Taking responsibility, maintaining and preparing for an uncertain time in life; Balancing vigilance with independence; and Reorientating in an altered body places new demands on self-care illustrate the dismantlement of life during treatment and how actions and approaches can build a new life. Both participants and healthcare professionals prioritised preparing for allo-HCT in the period before admission. However, during admission, preparation decreased and the time was not used for preparatory learning. This meant that participants were well prepared for the acute phase but unprepared for life after completion of treatment. Among the participants, self-efficacy was good. They sought information about taking care of their health before and in the aftermath of allo-HCT. This study provides insight into, and knowledge about, how patients prepare before, during and after treatment. This knowledge should primarily be directed towards healthcare professionals to be used for future patients who may need advice and support, as well as continued preparation for a life after transplantation.

Introducing waterbirth in a university hospital setting in Sweden: A qualitative study of midwives' experiences.

Waterbirth is a popular and increasing care option in several countries but is still debated. In Sweden, there are challenges in the process of reintroducing waterbirth after decades of interruption invoked by a dissuasion. The aim of this study was to explore factors affecting midwives' provision of waterbirth at a university birthing clinic in Sweden. A qualitative research design was used with three focus group interviews with 18 midwives at three birthing units. The data were analyzed using the principles of inductive content analysis. The midwives in the study expressed positive attitudes and potentiality about waterbirth, contributing to their desire to support physiological birth. However, obstacles were also disclosed, maiming waterbirth evolvement. Hence, two categories emerged, promoting factors and obstructing factors. The subcategories were: Provides a good experience whilst promoting physiological birth; Increased knowledge and information about waterbirth; Support from management; Updated guidelines; Ergonomic challenges; Lacking practical conditions; Lack of knowledge; Paradigm conflicts; and Limiting guidelines. The study concluded that midwives recognized both promoting and obstructing factors affecting the provision of waterbirth. The predominant factor highlighted was the care-culture, with a clear distinction between a risk-focused, medicalized approach that inhibits waterbirth and a salutogenic perspective advocating for it. This dichotomy underscores the importance of providing opportunities that support women's choices to facilitate an empowering birth experience.

Exploring Nursing Students' First Experiences Providing Wound and Ostomy Care to Patients: A Qualitative Study.

Undergraduate nursing students experience significant differences between practice with models, manikins, or simulation applications and real patients in a clinical setting. Students' experiences applying their theoretical knowledge to real patient-care practices are little understood. To determine the experiences of nursing students in providing skin, chronic wound, and ostomy care to real patients for the first time in a clinical setting within the content of the Ostomy and Wound Care Nursing Track Program (OWCNTP) and to define factors affecting this program. The research was conducted qualitatively using the individual critical incident technique, and 17 senior undergraduate nursing students enrolled in the Nursing OWCNTP were selected using a simple random sampling method. In the classroom setting, individual face-to-face interviews were conducted using the critical incident technique. Data were analyzed with inductive content analysis. The research found that students experience genuine caregiving in putting their experiences from the Track Program into practice with real patients in a clinical setting. Three main themes were identified: experiencing real patient care in a clinical setting, being a competent student, and being a novice student. The study found that nursing students enrolled in the OWCNTP could apply their theoretical knowledge to care for real patients in clinical settings. Therefore, it is recommended that these programs be integrated into nursing curricula.

Exploring the perceptions and experiences of female’s with ß-thalassemia major in a Tertiary Care Private Hospital in Pakistan

Introductionß-Thalassemia, a genetic condition which influences both the physical and emotional facets of individuals specially females while also exerting substantial financial strain on families and healthcare systems. Recognizing the pivotal influence of social support, particularly on mental well-being, this study endeavors to delve into the shared psychosocial challenges experienced by females grappling with ß-thalassemia major. MethodsEmploying a qualitative-descriptive methodology and purposive sampling, this study conducted in-depth interviews with forty-two young girls, 18.64 ± 4.27, diagnosed with ß-thalassemia major and representing diverse academic backgrounds, using a semi-structured in-depth interview guide. NVIVO-12 software facilitated extended data analysis, encompassing coding, categorization, theme development, and mind-mapping techniques to unravel nuanced insights from the collected data. FindingsThis groundbreaking study delves into the psychosocial factors that impact the well-being of female ß-thalassemia patients. The research highlights the key factors that positively contribute to their quality of life by conducting thorough inductive content analysis. These include receiving an education, having robust family support, experiencing overall life satisfaction, and making meaningful societal contributions. The findings of this study can be used to improve the lives of female ß-thalassemia patients and enhance their overall well-being. Contrariwise, notable impediments encompassed depression, social isolation, limited access to insurance services, challenges in educational and employment spheres, as well as difficulties in nurturing social relationships. These findings underscore the multifaceted influences shaping the quality of life for girls navigating ß-thalassemia, shedding light on empowering and challenging elements within their experiences. ConclusionIn conclusion, psychosocial factors supporting or hindering the well-being of young girls with ß-thalassemia major in Pakistan include an inductive environment at homes, organizations, education, institutions with adequate knowledge of thalassemia disease among patients, and society. More research is needed to understand their needs and advocate for societal support and acceptance. Family and friends support are crucial for improving their quality of life, necessitating focused efforts to provide understanding and aid within the community.

"He did girls' things!" Hong Kong and Canadian children's reasoning about moral judgments of peers' gendered behaviors.

Children show less positivity toward gender-nonconforming (GN) than gender-conforming (GC) peers. Yet, little is known about children's reasoning about peers of varying gender expressions, including age-, gender-, and culture-related influences. We investigated how children aged 4- to 5- and 8- to 9-years-old in Hong Kong and Canada (N = 678) reason about their moral judgments of GC and GN peers. After viewing vignettes describing GC and GN boys and girls, we asked children whether each target peer's behavior was right or wrong and why they thought so. We coded children's reasoning using a new coding scheme developed via inductive content analysis. Overall, children's most commonly used reasoning styles were global standard, personal choice, gender stereotypes, "don't know," and others' welfare. Children used more gender stereotype-related reasoning when they were older and from Hong Kong, appraising the GN boy, or when they perceived the target's behavior as wrong. In contrast, children reasoned based on personal choice more when they were from Canada or when they perceived the target's behavior as right. These findings inform how age-, gender-, and culture-related factors are associated with children's reasoning about the acceptability or appropriateness of varying kinds of childhood gendered behavior. They provide insights regarding children's appraisals of different gender expressions by illuminating not only how they view GC and GN peers but also, from their own perspectives, why they do so. These insights have implications for strategies aimed at decreasing gender-related biases and increasing children's acceptance of gender diversity. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Nurses' attitudes, beliefs and knowledge of sleep health in residential aged care: An integrative literature review.

To identify, synthesize and evaluate primary research on registered nurses' (RN) knowledge, attitudes and beliefs about sleep health and sleep health management of older adults living in residential aged care. Integrative review. Medline, Embase and CINAHL databases from inception to September 2023. Databases were searched using a combination of key words, subject heading terms. All abstracts and full-text articles were screened by two researchers. Qualitative synthesis of the included articles was conducted. Inductive content analysis was used to identify themes and analyse data. A total of 923 abstracts were screened resulting in a final yield of 13 articles. Three themes were identified: (i) RN experience with sleep-disturbed residents, (ii) the emotional burden of sleep disturbances on RN and, (iii) organizational barriers to promoting resident's healthy sleep. Inappropriate administration of benzodiazepines and psychotropic drugs to manage residents' sleep disturbances was a major issue and lack of resources in residential aged care to facilitate sleep. There were concerns on nursing activity that disturbed residents' sleep and striking a balance between facilitating sleep and meeting managerial expectations was challenging. This review identified that nurses' decision-making has an integral role in the management of sleep health in residents in aged care. Whilst evidence-based guidelines for managing sleep in residential aged care are available, there is a lack of translation to practice. Understanding RN perspectives is critical to improving sleep health models of care in residential aged care. This review found that RN are attuned to the implications of sleep disturbance in residential aged care but are constrained by current sleep health models of care. Not applicable.

Follow-up of patients with urinary tract infections discharged from the emergency department: a mixed methods study.

To evaluate the quality of culture follow-up after emergency department (ED) discharge in patients with urinary tract infections (UTIs). This convergent mixed methods study included an observational cohort study and a qualitative interview study in UTI patients discharged from the ED of a Dutch university hospital. The primary outcomes of the observational study were the proportion of patients requiring adjustment of antibiotic therapy after culture review, and the proportion of patients in whom these adjustments were made. Logistic regression identified factors associated with these outcomes. Interviews assessed patient experiences and transcripts were analysed using inductive thematic content analysis. Integration of the results informed recommendations for high-quality follow-up. Out of 455 patients, 285 (63%) required culture-based treatment adjustments. In most patients, no adjustments were made (239/285, 84%). De-escalation was most frequently omitted (98%), followed by discontinuation of antibiotics (92%). A mean of 7.1 (SD 3.8) antibiotic days per patient could have been avoided in 103 patients. Patients with diabetes were less likely to require adjustments (aOR 0.50, 95%-CI 0.29-0.85). Patients with moderate or severe renal impairment (aOR 4.1, 95%-CI 1.45-11.33; aOR 4.2, 95%-CI 1.50-11.94) or recurrent UTIs (aOR 5.0, 95%-CI 2.27-11.18) were more likely to have received necessary adjustments. Twelve interviews also revealed varying degrees of follow-up. Three themes were identified: 'information and communication', 'coordination and accessibility of care' and 'individual needs and preferences'. Recommendations for high-quality follow-up advocate a person centred approach. This study highlights the importance of urine culture follow-up after ED discharge, mainly to reduce unnecessary antibiotic treatment, promote de-escalation and improve patient experience.

The impact of using the Ida “My Hearing Explained” tool on audiologists’ language and patient understanding of hearing test results: a comparison with standard audiogram explanations

Objective Explore the impact of Ida’s “My Hearing Explained” (MHE) tool on audiologists’ language and patients’ understanding/interpretation of hearing test results. Design Audiologists were video-recorded in two sequential conditions: 1) giving standard audiogram explanations to 13 patients and, 2) following discretionary self-training, giving explanations using the MHE tool (nine patients). Outcomes of interest were audiologists’ language complexity, use of jargon, and audiologist-patient interactivity. Semi-structured patient interviews, conducted 1-7 days after appointments, were analysed using inductive qualitative content analysis. Patient recall was verified. Study Sample Four audiologists from one United Kingdom audiology service, and 22 patients (mean age 63.5 yrs) participated. Results In comparison to standard audiogram explanations, audiologists’ language was simpler and audiologist-patient interactivity greater with the MHE tool. Interview data analysis revealed differences between explanation types within the themes of “Understanding” and “Interpretation.” 54% (standard audiogram) and 22% (MHE tool) of patients expressed a desire for takeaway information. 31% (standard audiogram) and 67% (MHE tool) of patients reported their explanation helped them relay their results to others. Four patients (one receiving the MHE tool) incorrectly recalled information, suggesting inadequate understanding in these cases. Conclusions The MHE tool has potential for improving the accessibility and comprehensibility of hearing test results.

Providers’ and survivors’ perspectives on the availability and accessibility of surgery in gastrointestinal cancer care

BackgroundSurgery is essential for gastrointestinal (GI) cancer treatment. Many patients lack access to surgical care that optimizes outcomes. Scarce availability and/or low accessibility of appropriate resources may be the reason for this, especially in economically disadvantaged areas. This study aimed to investigate providers’ and survivors’ perspectives on barriers and facilitators to the availability and accessibility of surgical care. MethodsSemistructured interviews informed by surgical disparities and access-to-care conceptual frameworks with purposively selected GI cancer providers and survivors in Alabama and Mississippi were conducted. Survivors were within 3 years of diagnosis of stage I to III esophageal, pancreatic, or colorectal cancer. Transcripts were analyzed using inductive thematic and content analysis techniques. Intercoder agreement was reached at 90 %. ResultsThe 27 providers included surgeons (n = 11), medical oncologists (n = 2), radiation oncologists (n = 2), a primary care physician (n = 1), nurses (n = 8), and patient navigators (n = 3). This study included 36 survivors with ages ranging from 44 to 87 years. Of the 36 survivors, 21 (58.3 %) were male, and 11 (30.6 %) identified as Black. Responses were grouped into 3 broad categories: (i) transportation/geographic location, (ii) specialized care/testing, and (iii) patient-/provider-related factors. The barriers included lack and cost of transportation, reluctance to travel because of uneasiness with urban centers, low availability of specialized care, overburdened referral centers, provider-related referral biases, and low health literacy. Facilitators included availability of charitable aid, centralizing multidisciplinary care, and efficient appointment scheduling. ConclusionIn the Deep South, barriers and facilitators to the availability and accessibility of GI surgical cancer care were identified at the health system, provider, and patient levels, especially for rural residents. Our data suggest targets for improving the use of surgery in GI cancer care.

Developing quality schools: A content analysis of principals’ practices, stressors, and support factors

School heads or principals have various roles in developing school quality, which can often be stressful. In this study we investigated principals’ perceptions of quality schools, the practices performed to improve quality, and the stress and support factors involved. We adopted a qualitative inductive content analysis approach to analyse the transcribed data collected from 14 principals of senior high schools in the Volta region of Ghana. The findings show that principals perceive quality schools as having high academic performance, quality teachers, and adequate resources coordinated in a well organised system. Furthermore, the results reveal practices that principals perform to improve school quality, such as promoting staff professional development, supporting students’ intellectual and skills development, supervising teachers, and providing resources. On the other hand, supervision, non-cooperation of some teachers, inadequate resources, and administrative bureaucracy were revealed as causes of stress in improving school quality. Facing these challenges, the principals relied on their academic qualifications and experiences when engaging in practices to improve school quality. We recommend further research on the possibility of principals using technology to monitor the presence of teachers in classrooms from their offices.

Development of Fear of Falling after proximal femoral fracture.

Background: Proximal femoral fracture is common in older people. Beyond a long recovery process and significant permanent functional limitations, older people often experience subsequent Fear of Falling. The phenomenon of Fear of Falling is not fully understood; qualitative research is underrepresented but can provide insights into the experience of those affected. Objectives: We aimed to explore the experiences of Fear of Falling development and to what extent it affects peoples' life after proximal femoral fracture. Methods: We conducted semi-structured, in-depth interviews with nine older people, aged between 61 and 88, who participated in a prospective observational study. Interview data were analysed through inductive content analysis. Results: Six major themes emerged: The development of Fear of Falling; the effect of FoF and hope for recovery; alternating between moments of fear and security; fear of helplessness and of losing independence; strategies for dealing with Fear of Falling and maintaining independence; need of support by health care professionals. Conclusion: To identify and support older people in coping with Fear of Falling (after proximal femoral fracture), strategies for dealing with Fear of Falling across occupational groups and all healthcare settings should be implemented. Nurses have a key role in this process.

My feet hurt: a qualitative study of self-handicapping in distance runners

ABSTRACT Self-handicapping is a form of self-presentation that allows individuals to protect their self-esteem in the event of failure or enhance their self-esteem via successful performance [Coudevylle, G. R., Gernigon, C., & Martin Ginis, K. A. (2011). Self-esteem, self-confidence, anxiety and claimed self-handicapping: A mediational analysis. Psychology of Sport and Exercise, 12(6), 670–675. https://doi.org/10.1016/j.psychsport.2011.05.008]. Two forms of self-handicapping have been identified; claimed and behavioural. Claimed self-handicapping involves verbalised excuses or justifications for potential failures whereas behavioural self-handicapping is characterised by effort withdrawal or engagement in negative behaviours that create obstacles to performance. This study explored self-handicapping in distance runners who participate in races of a half-marathon distance or longer. Participants (N = 158; Mage = 43.4 years, SD = 11.3) completed an open-response survey about their experience of self-handicapping by self and others. Data were analysed using inductive content analysis. Major categories identified for claimed self-handicapping were injury/illness, training, nutrition, sleep/fatigue, personal factors, and external factors. Major categories identified for behavioural self-handicapping were poor preparation, poor nutrition practices, equipment issues, and deliberate illness/injury. Several subcategories were also identified for each form of self-handicapping based on reoccurring codes in the data. Claimed self-handicapping was more readily discussed and reported than behavioural self-handicapping, which suggests that runners are using self-handicapping for self-presentation rather than self-sabotage. Future researchers are encouraged to focus on the reasons for self-handicapping and the consequences of self-handicapping in distance runners.

"That's My Girl; I love her": The Promise of Compassionate, Inclusive Healthcare for Black Transgender Women to Support PrEP Use.

There are significant disparities in HIV pre-exposure prophylaxis (PrEP) use that disproportionately impact Black transgender women. Medical mistrust and discriminatory experiences in healthcare settings have been identified as critical barriers to equitable PrEP implementation. This qualitative study examines Black transgender women's experiences in healthcare to better understand how patient-provider relationships can help overcome the challenges brought on by medical mistrust. We interviewed 42 Black transgender women about their experiences with healthcare and PrEP access. Data were analyzed using inductive thematic content analysis to develop the following themes: (1) historical and ongoing marginalization and exclusion from healthcare remains a barrier to PrEP use; (2) Many providers continue to be unprepared to prescribe PrEP; (3) Providers can act as important advocates and sources of support; and (4) Compassionate, trusting patient-provider relationships can facilitate PrEP use. Our results highlight the importance of supportive and positive patient-provider relationships and demonstrate how providers can build trusting relationships with Black transgender women to help overcome barriers to healthcare and PrEP use.

Barriers to exclusive breastfeeding practice among HIV-positive mothers in Tanzania. An exploratory qualitative study.

Ensuring optimal nutrition through early breastfeeding is vital for infant mental development and overall health. HIV infections complicate decisions regarding exclusive breastfeeding, jeopardizing effective infant and young child feeding, which affects nutrition and health outcomes. Recognizing the lack of evidence on barriers to infant feeding in the context of HIV in Tanzania, this study was conducted to explore individual, household, and community obstacles in the Ilala district, Dar es Salaam. A case study design employing a qualitative approach was used. The study was executed at the Reproductive and Child Health (RCH) Clinic within Amana Regional Referral Hospital, Mnazi Mmoja Health Centre, and Buguruni Health Centre. Data collection ensued through the purposive sampling of healthcare providers and HIV-positive mothers, utilizing in-depth interview techniques. The textual data accrued were analyzed using inductive and deductive content analysis strategies, thereby enabling the delineation and formulation of principal thematic constructs. The study involved interviews with twenty-seven key informants, encompassing HIV-positive mothers, nurses, clinicians, and community-based healthcare workers. The analysis of these interviews resulted in the identification of three major themes. Firstly, individual barriers to exclusive breastfeeding were delineated, encompassing sub-themes such as occupation-related hectic schedules, early motherhood-related non-compliance to safe infant feeding directives, postpartum depression, and issues related to breast sores and abscesses. Secondly, household-level barriers were identified, highlighting challenges like food insecurity and inaccessibility to key resources, the influence of male partners and family members on decision-making, and barriers arising from non-disclosure of HIV status affecting Exclusive Breastfeeding (EBF) support. Lastly, community-level barriers were explored, revealing a sub-theme related to the low retentivity of HIV-positive women in the Prevention of Mother-to-Child Transmission (PMTCT) programs. Individual barriers encompass practical, psychological, and physical challenges, while household-level obstacles include food insecurity, limited resources, and family dynamics influencing decisions. At the community level, there's a concern about the low retentivity of HIV-positive women in PMTCT programs, indicating broader societal challenges in supporting exclusive breastfeeding. There is a need for tailored interventions at individual, household, and community levels to promote and support optimal infant feeding practices among HIV-positive women.

"You want people to listen to you": Patient experiences of women's healthcare within the Veterans Health Administration.

To identify constructs that are critical in shaping Veterans' experiences with Veterans Health Administration (VA) women's healthcare, including any which have been underexplored or are not included in current VA surveys of patient experience. From June 2022 to January 2023, we conducted 28 semi-structured interviews with a diverse, national sample of Veterans who use VA women's healthcare. Using VA data, we divided Veteran VA-users identified as female into four groups stratified by age (dichotomized at age 45) and race/ethnicity (non-Hispanic White vs. all other). We enrolled Veterans continuously from each recruitment strata until thematic saturation was reached. For this qualitative study, we asked Veterans about past VA healthcare experiences. Interview questions were guided by a priori domains identified from review of the literature, including trust, safety, respect, privacy, communication and discrimination. Analysis occurred concurrently with interviews, using inductive and deductive content analysis. We identified five themes influencing Veterans' experiences of VA women's healthcare: feeling valued and supported, bodily autonomy, discrimination, past military experiences and trauma, and accessible care. Each emergent theme was associated with multiple of the a priori domains we asked about in the interview guide. Our findings underscore the need for a measure of patient experience tailored to VA women's healthcare. Existing patient experience measures used within VA fail to address several aspects of experience highlighted by our study, including bodily autonomy, the influence of past military experiences and trauma on healthcare, and discrimination. Understanding distinct factors that influence women and gender-diverse Veterans' experiences with VA care is critical to advance efforts by VA to measure and improve the quality and equity of care for all Veterans.

Current status of electronic health literacy among pregnant women with gestational diabetes mellitus and their perceptions of online health information: a mixed-methods study

BackgroundWomen diagnosed with gestational diabetes mellitus often rely on internet-based health information for managing their condition. This study aims to investigate the present state of electronic health literacy among women with gestational diabetes mellitus, analyze the influencing factors, and explore their experiences regarding accessing, comprehending, evaluating, and applying online health information pertinent to gestational diabetes mellitus.MethodsA sequential explanatory mixed methods research design was adopted in this study. Initially, 235 women with gestational diabetes mellitus participated in a cross-sectional survey. The research tools included general information and the Chinese version of the electronic Health Literacy Scale (eHEALS). Descriptive analyses were conducted to describe the characteristics of the sample, and multiple linear regression analyses were used to explore the factors influencing electronic health literacy among women with gestational diabetes mellitus. Secondly, 11 women with gestational diabetes mellitus joined semi-structured in-depth interviews to obtain their perceptions about online health information. The data were analyzed using inductive content analysis to develop themes.ResultsThe median score of eHEALS in the Chinese version among 235 women diagnosed with gestational diabetes mellitus was 29 (interquartile range [IQR], 26 to 32). Factors influencing electronic health literacy among these women included accessing health information from medical professionals (β = 0.137, p = 0.029) and utilizing health information from applications (β = 0.159, p = 0.013). From the qualitative phase of the study, four thematic categories emerged: reasons and basis for accessing health information from the Internet; address barriers to accessing and applying online health information; desires for a higher level of online health information services; outcomes of accessing and applying online health information.ConclusionThe electronic health literacy of women diagnosed with gestational diabetes mellitus remains suboptimal and warrants improvement. The sources of access to health information affect electronic health literacy in women with gestational diabetes mellitus. Moreover, women facing gestational diabetes encounter numerous impediments when attempting to access health-related information online, underscoring the necessity for enhanced online health information services to meet their needs.