Interviews Of Health Professionals Research Articles

A mixed-methods study to investigate feasibility and acceptability of an early warning score for preterm infants in neonatal units in Kenya: results of the NEWS-K study

Preterm birth (< 37 weeks gestation) complications are the leading cause of neonatal mortality. Early-warning scores (EWS) are charts where vital signs (e.g., temperature, heart rate, respiratory rate) are recorded, triggering action. To evaluate whether a neonatal EWS improves clinical outcomes in low-middle income countries, a randomised trial is needed. Determining whether the use of a neonatal EWS is feasible and acceptable in newborn units, is a prerequisite to conducting a trial. We implemented a neonatal EWS in three newborn units in Kenya. Staff were asked to record infants’ vital signs on the EWS during the study, triggering additional interventions as per existing local guidelines. No other aspects of care were altered. Feasibility criteria were pre-specified. We also interviewed health professionals (n = 28) and parents/family members (n = 42) to hear their opinions of the EWS. Data were collected on 465 preterm and/or low birthweight (< 2.5 kg) infants. In addition to qualitative study participants, 45 health professionals in participating hospitals also completed an online survey to share their views on the EWS. 94% of infants had the EWS completed at least once during their newborn unit admission. EWS completion was highest on the day of admission (93%). Completion rates were similar across shifts. 15% of vital signs triggered escalation to a more senior member of staff. Health professionals reported liking the EWS, though recognised the biggest barrier to implementation was poor staffing. Newborn unit infant to staff ratios varied between 10 and 53 staff per 1 infant, depending upon time of shift and staff type. A randomised trial of neonatal EWS in Kenya is possible and acceptable, though adaptations are required to the form before implementation.

Prevention of elder abuse during hospitalization: evaluation of health professional's work practices to better understand the risks

Elder abuse and neglect in institutions is frequent, but is still not studied enough. This study aims to better understand the risks of elder abuse, through daily experiences of health professionals. This is a monocentric, qualitative study, with semi-structured interviews of health professionals working in a geriatric hospital. Geriatrics is a specialty at risk of abuse and neglect. There is a real taboo around this issue. The difficulty for its reporting is multifactorial (tolerance, trivialization of abusive behaviors, isolation, and apprehension of caregivers...). The lack of human, material, and educational resources provided by health institutions does not enable professionals, whoever they may be, to care for patients humanely. The guidance and support of caregivers (training, increased team cohesion, and dedicated time for multidisciplinary reflection) are aimed at improving patient care and quality of care. All health professionals are concerned with elder abuse and neglect. It is necessary to break the taboo around mistreatment, to learn to talk about it among colleagues, and to recognize and evaluate oneself in order to change, evolve, and train others to treat patients the best way possible. Health professionals have to train and learn about the specificities of geriatrics early, repetitively, and continuously during their training. Health professionals must be able to work in a stable environment, with a supportive management. Their work must be valued in a sustainable way. Better working conditions should enable a more caring and compassionate approach by healthcare professionals toward their patients.

Factors perceived by health professionals to be barriers or facilitators to caries prevention in children: a systematic review

BackgroundConsidered the most prevalent noncommunicable disease in childhood, dental caries is both an individual and a collective burden. While international guidelines highlight prevention as a major strategy for caries management in children, health professionals still struggle to implement prevention into their clinical practice. Further research is needed to understand the gap between the theoretical significance of dental prevention and its lack of implementation in the clinical setting. This systematic review aims to identify and classify factors perceived by health professionals to be barriers or facilitators to caries prevention in children.MethodA systematic literature search was conducted in three electronic databases (Medline, Web of Science and Cairn). Two researchers independently screened titles, abstracts and texts. To be selected, studies had to focus on barriers or facilitators to caries prevention in children and include health professionals as study participants. Qualitative and quantitative studies were selected. The factors influencing caries prevention in children were sorted into 3 main categories (clinician-related factors, patient-related factors, and organizational-related factors) and then classified according to the 14 domains of the theoretical domains framework (TDF).ResultsA total of 1771 references were found by combining manual and database searches. Among them, 26 studies met the inclusion criteria, of which half were qualitative and half were quantitative studies. Dentists (n = 12), pediatricians (n = 11), nurses (n = 9), and physicians (n = 5) were the most frequently interviewed health professionals in our analysis. Barriers and facilitators to caries prevention in children were categorized into 12 TDF domains. The most frequently reported domains were Environmental Context and Resources, Knowledge and Professional Role and Identity.ConclusionThis systematic review found that a wide range of factors influence caries prevention in children. Our analysis showed that barriers to pediatric oral health promotion affect all stages of the health care system. By highlighting the incompatibility between the health care system’s organization and the implementation of caries prevention, this study aims to help researchers and policy-makers design new interventions to improve children’s access to caries prevention.Trial registrationPROSPERO CRD42022304545.

A qualitative descriptive study exploring clinicians’ perspectives of the management of older trauma care in rural Australia

BackgroundFor older trauma patients who sustain trauma in rural areas, the risk of adverse outcomes associated with advancing age, is compounded by the challenges encountered in rural healthcare such as geographic isolation, lack of resources, and accessibility. Little is known of the experience and challenges faced by rural clinicians who manage trauma in older adults. An understanding of stakeholders’ views is paramount to the effective development and implementation of a trauma system inclusive of rural communities. The aim of this descriptive qualitative study was to explore the perspectives of clinicians who provide care to older trauma patients in rural settings.MethodWe conducted semi-structured interviews of health professionals (medical doctors, nurses, paramedics, and allied health professionals) who provide care to older trauma patients in rural Queensland, Australia. A thematic analysis consisting of both inductive and deductive coding approaches, was used to identify and develop themes from interviews.ResultsFifteen participants took part in the interviews. Three key themes were identified: enablers of trauma care, barriers, and changes to improve trauma care of older people. The resilience of rural residents, and breadth of experience of rural clinicians were strengths identified by participants. The perceived systemic lack of resources, both material and in the workforce, and fragmentation of the health system across the state were barriers to the provision of trauma care to older rural patients. Some changes proposed by participants included tailored education programs that would be taught in rural centres, a dedicated case coordinator for older trauma patients from rural areas, and a centralised system designed to streamline the management of older trauma patients coming from rural regions.ConclusionsRural clinicians are important stakeholders who should be included in discussions on adapting trauma guidelines to the rural setting. In this study, participants formulated pertinent and concrete recommendations that should be weighed against the current evidence, and tested in rural centres.

#2620 WHY DIALYSIS PATIENTS CHOOSE OR REFUSE KIDNEY TRANSPLANTATION AS RENAL REPLACEMENT THERAPY: A QUALITATIVE STUDY

Abstract Background and Aims Kidney transplantation is considered the best renal replacement therapy (RRT) for patients with end-stage renal disease, nevertheless, some dialysis patients refuse to be transplanted. Many patients are concerned about their quality of life as a patient on dialysis compared to life with a new, functioning kidney. The results from many studies have shown that patients who have been living with a transplanted kidney for 10 years demonstrate a greater likelihood of still being alive than those on dialysis. For every 10 patients receiving a new kidney, eight will still have that kidney working three years after the operation. So, considering survival alone, individuals receiving a new kidney do better than those on dialysis. But not all the CKD and CKD on HD share the same opinion and a number refuse kidney transplantation. The aim of this paper is to identify the reasons for choosing or refusing kidney transplantation as renal replacement therapy among patient with Chronic Kidney Disease (CKD). Method We used purposeful sampling because it was more relevant to identify and to select the individuals who seemed in-keeping with the social facts we wanted to study. We wanted to retrace participants’ paths of care to identify the reasons for their choice. Patients who were treated using hemodialysis as well as those who opted for peritoneal dialysis were interviewed. We also interviewed health professionals (doctors, nurses, a psychologist) for their opinions on the nature of their relationship with patients in the decision making process regarding kidney transplantation. Results Data were collected through interviews with CKD patient and CKD patient treated by dialysis. Health professionals, medical doctors and nurses were also interviewed. A thematic analysis was used to analyze the data. The collected data showed that various reasons account for CKD patients’ refusal replacement therapy without positive outcome, refusal to have an allograft. There are also situations such as the lack of organ, the age factor, contraindications to kidney transplantation that not allow some CKD patients to have a kidney transplant. Among the patients who choose kidney transplantation, lots of them have lack of information about transplantation process others see kidney transplantation as a cure which will finally make them machine dependent and a small group see it as a normal process. Conclusion This paper shows that the choice of kidney transplantation depends on patients’ perceptions of its outcomes. Some circumstances, such as the lack of an available organ or specific medical criteria including age factor and malignancy, reduce CKD patients’ participation in the decision-making process.

Assessing Risk among Frail Older Adults in Ontario, Canada, during the COVID-19 Pandemic: A Mixed Methods Evaluation of a Telephone Outreach Program

We developed a pandemic telephone outreach protocol to identify risk for social isolation, health destabilization, medication issues, inadequate services and supports, and caregiver stress among older adults at high risk of destabilization. Screening, conducted between April 1, 2020, and May 8, 2020, was targeted to those who had previously been screened as frail or who were identified as vulnerable by their family physician. This study describes the implementation and results of this risk screening protocol and describes patient, caregiver, and health professional perceptions of this outreach initiative. Mixed methods included satisfaction surveys and interviews completed by patients/caregivers (N = 300 and N = 26, respectively) and health professionals (N = 18 and N = 9, respectively). A medical record audit collected information on patient characteristics and screening outcomes. A total of 335 patients were screened in the early weeks of the pandemic, of whom 23% were identified with at least one risk factor, most commonly related to the potential for health destabilization and medication risk. Follow-up referrals were made most frequently to physicians, a pharmacist, and a social worker. The outreach calls were very well received by patients and caregivers who described feeling cared for and valued at a time when they were socially isolated and lonely. The outreach calls provided access to trusted COVID-19 information and reassurance that health care was still available. The majority of health professionals (&gt;86%) were “very” or “extremely” satisfied with the ease of completing the screening via telephone and value for time spent; for 79% the protocol was “very” or “extremely” feasible to implement. Health professional interviews revealed that patients were unaware they could access care during the pandemic lockdown but were reassured that care was available, potential crises were averted, and they supported future implementation. Risk screening provides a significant opportunity to provide information, support, and mitigate potential risks and is an important and feasible component of pandemic planning in primary care.

Community-Based Participatory Research: Partnering with College Students to Develop a Tailored, Wellness-Focused Intervention for University Campuses

College students face unique challenges with leading healthful lifestyles. Using a community-based participatory research approach, college student research partners at two land-grant universities collected data and developed a tailored intervention to improve the well-being of college students. To inform the design of the program, college students were trained to conduct a needs assessment that included a campus-wide survey on the health behaviors of college students, environmental audits of health policies and food pantries on campus, and stakeholder interviews with campus health professionals. Outcomes of the needs assessment data highlighted university students ranked their health as "good" but nutrition health as "fair/poor." Low or very low food security was self-reported by 36.9% of participants and had an overall diet quality score of 47.6 ± 10.1 out of 100. Health professional interview data indicated campuses provide healthful resources to students, but students are not aware those resources exist. Utilizing the needs assessment data previously mentioned, the nominal group technique was then used for student research partners to collaboratively determine the best intervention approaches and develop a wellness program. Student partners identified (1) education, (2) sharing of campus resources, and (3) incentives as important areas of intervention. Using the data collected, the student research partners developed a program titled, The College Cooking Connection, to address health-related quality of life in college students. Using a community-based participatory research approach to program planning, educators and researchers have a greater likelihood of addressing the current needs of the population they are targeting and developing a successful intervention to meet those health concerns. This study aims to partner with young adult university students to understand the college environment and allow the target community to be involved with the development of intervention programs for their campus.

Diversities in the place of delivery choice: a study among expectant mothers in Ghana

BackgroundIn this study, the factors that influence the choice of place of delivery among expectant mothers in both rural and urban settings in the northern part of Ghana were identified and compared using the conceptual framework provided by Thaddeus and Maine.MethodsA mixed-method study was used to examine expectant mothers and their responses related to factors that affect their choice of place of delivery through a concurrent triangulation using health professional interviews and a detailed participant survey. The sample consisted of 552 expectant mothers between the ages of 15 and 49 years. Individual interviews were conducted with 8 health professionals. There was also a focus group discussion with randomly selected pregnant women and lactating mothers. Themes were generated through open coding of the interview data, while multiple regression was performed to identify the factors associated with choice of place of delivery.ResultsMajor preference (60.1%) was for home delivery among rural dwellers compared to 20.7% for urban participants. Statistically significant variables affecting the choice of place of delivery among study participants were found to be educational background, the experience of previous deliveries, the attitude of hospital staff toward pregnant women during labor, and frequency of accessing antenatal care.ConclusionMajority of rural women prefer home delivery to facility delivery which is the opposite of the trend observed among urban women. The study’s implications may lead to positive change where stakeholders develop and implement policies to promote health facility delivery for expectant mothers in Ghana.

Evaluation of the intention to use the electronic medical record (EMR) by health professionals in healthcare facilities of Libreville and Owendo in Gabon.

Health systems in several countries have integrated information and communication technologies into their operations. Electronic medical records (EMRs) are at the core of patient care. The working of these EMRs requires their acceptance and use by medical and paramedical personnel. The objective of this study was to empirically evaluate the intention of health professionals to use these EMRs. A questionnaire on the intention of health professionals to use the EMR was developed following a Likert scale. The survey was done via in-person interviews of health professionals in major health facilities in the cities of Libreville and Owendo in Gabon. The technology acceptance model (TAM) was tested using a step-down logistic regression analysis to identify the main factors explaining the intention of health professionals to use the EMR. A total of 218 health professionals responded to the questionnaire. Thirty-eight percent (38%) of respondents were male. The average age was 41.33 years (±8.98 years) and the average length of service at work in the system was 12.02 years (±8.47 years). The integrated model showed that the intention to use the EMR was significantly associated with the perceived usefulness, the subjective standard, and experience. No socio-demographic variables explained the intention to use the EMR. The perceived ease, familiarity with the computer, and motivation are not associated with the intention to use the EMR. Actions should be taken to raise awareness and train health professionals to motivate them to accept and use EMRs in their medical practices.

Co-designing Improved Communication of Newborn Bloodspot Screening Results to Parents: Mixed Methods Study.

BackgroundEach year in England, almost 10,000 parents are informed of their child’s positive newborn bloodspot screening (NBS) results. This occurs approximately 2 to 8 weeks after birth depending on the condition. Communication of positive NBS results is a subtle and skillful task, demanding thought, preparation, and evidence to minimize potentially harmful negative sequelae. Evidence of variability in the content and the way the result is currently communicated has the potential to lead to increased parental anxiety and distress.ObjectiveThis study focused on the development of co-designed interventions to improve the experiences of parents receiving positive NBS results for their children and enhance communication between health care professionals and parents.MethodsAn experience-based co-design approach was used to explore experiences and co-design solutions with 17 health professionals employed in 3 National Health Service Trusts in England and 21 parents (13/21, 62% mothers and 8/21, 38% fathers) of 14 children recruited from the same 3 National Health Service Trusts. Experiences with existing services were gathered via semistructured interviews with health professionals. Filmed narrative interviews with parents were developed into a composite film. The co-design process identified priorities for improving communication of positive NBS results through separate parent and health professional feedback events followed by joint feedback events. In total, 4 interventions were then co-designed between the participants through a web-based platform.ResultsParents and health professionals provided positive feedback regarding the process of gathering experiences and identifying priorities. Themes identified from the parent interviews included impact of initial communication, parental reactions, attending the first clinic appointment, impact of health professionals’ communication strategies and skills, impact of diagnosis on family and friends, improvements to the communication of positive NBS results, and parents’ views on NBS. Themes identified from the health professional interviews included communication between health professionals, process of communicating with the family, parent- and family-centered care, and availability of resources and challenges to effective communication. In response to these themes, 4 interventions were co-designed: changes to the NBS card; standardized laboratory proformas; standardized communication checklists; and an email or letter for providing reliable, up-to-date, condition-specific information for parents following the communication of positive NBS results.ConclusionsParents and health professionals were able to successfully work together to identify priorities and develop co-designed interventions to improve communication of positive NBS results to parents. The resulting co-designed interventions address communication at different stages of the communication pathway to improve the experiences of parents receiving positive NBS results for their children.International Registered Report Identifier (IRRID)RR2-10.1186/s40814-019-0487-5

Professional views on priorities for cervical cancer policy in Uganda: a qualitative study

BackgroundCervical cancer incidence in Uganda is three-times that of the global average, and is a leading cause of mortality for women. The main cause is human papillomavirus (HPV). Women living with HIV have a greater risk of acquiring HPV and need better cervical cancer care than their HIV-negative counterparts. Although funding and infrastructure exist for HIV control, they are not in place for cervical cancer. We aimed to assess Ugandan health professionals' knowledge of and perspectives regarding cervical cancer among women with HIV to identify perceived barriers and facilitators, and to guide potential interventions to reduce the burden of cervical cancer. MethodsWe used qualitative interviews to obtain primary data from professionals working in the HIV field in Uganda, identified through purposive and snowball sampling, and through consultation with colleagues at The AIDS Support Organisation (TASO) and Makerere University in Kampala. Inclusion criteria required the respondent to be a provider, researcher, community health worker, or other authority on cervical cancer and HPV and to be conversant in English. Exclusion criteria included being younger than 18 years. Written and verbal informed consent were obtained in accordance with the Medical College of Wisconsin and Makerere University human subjects protection protocols. Virtual, 1 h-long interviews were conducted and recorded. Interviews consisted of open-ended questions exploring perspectives on, knowledge about, and practices surrounding HPV and cervical cancer among women with HIV in Uganda. Institutional review board approval was obtained from TASO, the Uganda National Council for Science and Technology, and Medical College of Wisconsin. Transcripts were analysed and coded via MaxQDA software for common themes; emerging codes were generated from meaningful quotes as used in specific interviewee contexts of facilitators and barriers to HPV vaccination, cervical cancer screening, and treatment. FindingsTo date, we have conducted 50 interviews of health professionals with experience across Uganda. Common themes regarding barriers to cervical cancer control include misconceptions about treatment cost and effectiveness, scarce access to and distance to cervical cancer services, transient funding for cervical cancer screening and treatment supplies, and fears of social exclusion and death. Potential solutions offered by participants include decentralising care through integration with existing health programmes, and prioritising education that targets misconceptions surrounding cervical cancer. InterpretationProfessionals indicated numerous misconceptions and fears held by women with HIV and inaccessibility of care due to lack of funding and integration of services. Priorities should include increasing mass media campaigns that target misconceptions, decentralising care through integration with existing health-care infrastructure and HIV screening and treatment programmes, and training more professionals in rural areas. FundingMedical College of Wisconsin Cancer Center and Dr Elaine Kohler Global Health Research.

Mobile technologies for palliative cancer care in Uganda: Qualitative secondary analysis of health professional perspectives

IntroductionIn sub-Saharan Africa (SSA) cancer care is characterised by limited funding, restricted access to curative therapies and 80% of cancers are advanced at the time of detection and diagnosis. Palliative care need in SSA is significant, however, most countries in the region have limited provision. mHealth (i.e. medical and public health practice supported by mobile devices) is an approach that may support increased access and communication with palliative care services. However, there is a limited understanding of health professionals’ views and perceptions on its use in the delivery of cancer care. MethodsWe sought to understand health professionals’ views and perceptions of the use of mHealth as part of palliative care delivery. Transcripts from interviews of health professionals in Uganda (n = 20) were analysed thematically. ResultsThe majority of participants were female (75%, n = 15). Average duration of experience was 15.8 years as healthcare providers and 8.2 years as palliative care providers. Four overarching themes were derived from the analysis: (i) current use of mHealth in palliative cancer care provision; (ii) advantages of using mHealth in palliative cancer care; (iii) challenges to providing palliative cancer care using mHealth, and; (iv) preferences for mHealth use in palliative cancer care. ConclusionsmHealth is considered advantageous for the provision of palliative cancer care. There is a need to adapt training to improve competencies of palliative care professionals in delivery of care that leverages digital technologies. Development of mHealth initiatives needs to consider how best to maintain patient privacy and ensure inequities in access to care are not worsened.

Protocol of Process Evaluation of Secondary Prevention by Structured Semi-Interactive Stroke Prevention Package in India (SPRINT INDIA)Trial

Background and aimsSecondary Prevention by Structured Semi-Interactive Stroke Prevention Package in India (SPRINT India) is a complex intervention delivered across 30 centres in 16 Indian states. The study delivers intervention in 12 languages in the form of workbook, videos and short messaging using cellular device and internet as a tool. Objectives of process evaluation are to assess whether trial was implemented as planned (fidelity and dose); whether, how and why the intervention is effective by looking at the stakeholders’ experiences (effectiveness); to assess reach of intervention in population (reach); how intervention fits into treatment plan to cause behavioural change when adopted (adoption); usefulness for target population and bring behaviour change (maintenance).MethodsSPRINT India process evaluation is a prospective, multicentre study conducted with mixed-methods approach. Sample size of centres and stakeholders will be selected by maximum variance purposive sampling strategy. Centres will be stratified primarily for representing the 11 regional language in which the intervention is delivered. Qualitative data will comprise of interviews of patients, care givers and health professionals at these centres using semi structured interview guide. Quantitative data will comprise of all the randomised patients. Process evaluation framework is based on Realist and RE-AIM evaluation models presented according to Medical Research Council’s guidance. The four sections of the framework are context, trial implementation, mechanisms of impact and trial outcomes.ResultsInterviews of approximately 100 stakeholders and focus group interviews of health professionals and SPRINT India study central coordinating staff will be conducted. Analysis will be done using triangulation methodology. It will incorporate use of both quantitative and qualitative data, data collection techniques, data sources, evaluation models, stakeholders and researchers.ConclusionsProcess evaluation will identify efficacious factors in intervention package and consolidate use of secondary stroke semi-interactive stroke prevention package into practice and policy to prevent recurrent stroke.

A Política Nacional de Humanização no SUS: a palavra como “dádiva” na subjetivação da atenção e gestão em saúde

O ensaio resulta de estudo qualitativo acerca da “Política Nacional de Humanização/PNH” e seu método da tríplice inclusão e participação social de gestores, trabalhadores e usuários do/no SUS. Aborda aspectos conceituais a partir dos pressupostos teóricos sociológicos, antropológicos e históricos de Simmel, Mauss e Foucault. Partindo das categorias “inclusão” e participação social preconizadas pela PNH, efetuou-se análise hermenêutico-dialética das entrevistas de profissionais de saúde, gestores e usuários, em atividades de humanização em duas unidades hospitalares federais no Rio de Janeiro. Analisa-se a construção social da atenção e gestão da saúde, particularmente os processos comunicacionais de diferentes protagonistas da PNH/HumanizaSUS. Como resultado da análise qualitativa das entrevistas, ancoradas nas teorias referidas, o ensaio postula a correlação teórico-prática entre o método da PNH e a circulação triádica – dar-receber-retribuir – ­da palavra como dádiva em práticas da humanização no/do SUS.

La atención sanitaria a pacientes con multimorbilidad. La percepción de los profesionales

ObjectiveTo explore the perceptions of health professionals about the characteristics of health care for patients with multimorbidity. DesignQualitative study of phenomenological trajectory made between January and September 2015 through 3 group interviews and 15 individual interviews. LocationAragonese Health Service. ParticipantsMedical and nursing professionals of the Aragon Health Service belonging to various services: Internal Medicine, Primary Care, Emergency and Management. A pharmacist was also included. MethodsA non-probabilistic intentional sampling was carried out that allowed for the selection of professionals in terms of discourse representation criteria, allowing to know and interpret the phenomenon studied in depth, in its different visions. We interviewed health professionals with different profiles who knew in depth the characteristics of care provided to patients with multimorbidity. The interviews were recorded, transcribed literally and interpreted, through the social analysis of the discourse. ResultsProfessional culture oriented to individual pathologies, lack of coordination among professionals, high prevalence of multi-prescriptions, Clinical Practice Guidelines oriented to individual pathologies and specialist training focused on individual diseases. ConclusionsBoth the professional culture and the organization of the healthcare system have been oriented towards the attention to individual pathologies, which results in the difficulty to offer a more integrated care to patients with multimorbidity.

Health professional's perception about the use of human colostrum, as preventive measure for necrotizing enterocolitis in preterm newborns

In Chile, necrotizing enterocolitis (NEC) mainly affects preterm infants, with an incidence of 0.3 to 2.4 per 1,000 live births, and 8 to 12% in preterm infants weighing less than 1,500 grams. To describe health professionals perceptions on the use of human colostrum as a preventive measu re against necrotizing enterocolitis in preterm newborns. Qualitative study, using 18 semi-structured individual interviews of health professionals in three public hospitals of the Valparaíso Region. The interview included 3 topics: Knowledge, Perception of early colostrum supply and Opinion about the extent of the measure, and 6 subtopics, 2 for each topic respectively: Self-perception of knowledge level and Sources of information; Experience: positive aspects/adverse events and Opinion of colostrum as a protective factor for enterocolitis; Facilitating or hindering aspects and Opinion about the measure as national policy. Data were processed through qualitative content analysis. Two of the three high-complexity neonatal units of the Valparaíso Re gion have a protocol for administrating colostrum in premature infants. Participants have a positive opinion about the preventive results of this measure. Even in the third hospital where there is no protocol, they have a favorable perception of its potential benefit and its low cost of implementa tion. However, we observed that this procedure requires more evidence and an application protocol. Other limitations would be the lack of staffing and training and the need for equipment and supplies. Professionals who have applied a colostrum administration protocol in preterm infants in the Valparaíso Region report good health outcomes and promote team motivation towards this practice. However, it is relevant to the dissemination and discussion of national and international protocols, as well as the development of local research. Given the ongoing experiences in Chile and the international debate, we considered appropriate to address and discuss the topic within the na tional health community.

Testing Consultation Recordings in a Clinical Setting With the SecondEars Smartphone App: Mixed Methods Implementation Study.

BackgroundHealth care systems are increasingly looking to mobile device technologies (mobile health) to improve patient experience and health outcomes. SecondEars is a smartphone app designed to allow patients to audio-record medical consultations to improve recall, understanding, and health care self-management. Novel health interventions such as SecondEars often fail to be implemented post pilot-testing owing to inadequate user experience (UX) assessment, a key component of a comprehensive implementation strategy.ObjectiveThis study aimed to pilot the SecondEars app within an active clinical setting to identify factors necessary for optimal implementation. Objectives were to (1) investigate patient UX and acceptability, utility, and satisfaction with the SecondEars app, and (2) understand health professional perspectives on issues, solutions, and strategies for effective implementation of SecondEars.MethodsA mixed methods implementation study was employed. Patients were invited to test the app to record consultations with participating oncology health professionals. Follow-up interviews were conducted with all participating patients (or carers) and health professionals, regarding uptake and extent of app use. Responses to the Mobile App Rating Scale (MARS) were also collected. Interviews were analyzed using interpretive descriptive methodology; all quantitative data were analyzed descriptively.ResultsA total of 24 patients used SecondEars to record consultations with 10 multidisciplinary health professionals. In all, 22 of these patients used SecondEars to listen to all or part of the recording, either alone or with family. All 100% of patient participants reported in the MARS that they would use SecondEars again and recommend it to others. A total of 3 themes were identified from the patient interviews relating to the UX of SecondEars: empowerment, facilitating support in cancer care, and usability. Further, 5 themes were identified from the health professional interviews relating to implementation of SecondEars: changing hospital culture, mitigating medico-legal concerns, improving patient care, communication, and practical implementation solutions.ConclusionsData collected during pilot testing regarding recording use, UX, and health professional and patient perspectives will be important for designing an effective implementation strategy for SecondEars. Those testing the app found it useful and felt that it could facilitate the benefits of consultation recordings, along with providing patient empowerment and support. Potential issues regarding implementation were discussed, and solutions were generated.Trial RegistrationAustralia and New Zealand Clinical Trials Registry ACTRN12618000730202; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373915&isClinicalTrial=False

PO 8578 THE ROLE OF CLINICAL RESEARCH IN EDUCATING THE HEALTH WORKFORCE IN GUINEA-BISSAU

BackgroundThe World Health Organisation estimates a global deficit of approximately 4.3 million health workers, particularly doctors, nurses and midwives. Guinea-Bissau is among the 36 countries that suffer from a critical need for human resources (less than 23 health professionals per 10.000 inhabitants). The present research investigates the impact of clinical trials on health worker’s capacity and training.MethodsThis is a qualitative study. I interviewed health professionals who assisted in clinical trials during the past five years and obtained assistance to attend health-related courses. The interviews collected data about the professional’s technical capacity, clinical practices, work conditions, their qualification for their work and socio-economic variables. Additionally, documents about clinical trials conducted in Guinea-Bissau through North-South cooperation, were analysed.ResultsInterviews were held with 35 health professionals (21 female, 14 male) who participated in clinical trials with the Bandim Health Project (Guinea-Bissau) as research assistants and who received subsidies to realise undergraduate or graduate degrees. Among those interviewed, 28 (80%) received support to realise an undergraduate degree in nursing, 4 (11%) a laboratory course, and 3 (9%) a postgraduate course. Twenty-four (24; 69%) stated that they experienced significant improvements in their working conditions within the institutions where they worked after their clinical trials; 7 (20%) declared that they have progressed in their career after being placed in a health center or a hospital; 29 (83%) stated that the participation in clinical trials significantly strengthened their technical capacity and had a positive impact on their careers.ConclusionI observed a positive impact of the involvement in clinical research on the development of health professionals’ capacity. However, the quantity of clinical research in Guinea-Bissau is insufficient to train all health practitioners in this area.

Exploring the value of social network 'care maps' in the provision of long-term conditions care.

There is renewed attention to the role of social networks as part of person-centred long-term conditions care. We sought to explore the benefits of 'care maps' - a patient-identified social network map of their care community - for health professionals in providing person-centred care. We piloted care maps with 39 patients with long-term conditions in three urban and one rural general practice and two hospital wards. We interviewed the health professionals (n = 39) of these patients about what value, if any, care maps added to patient care. We analysed health professional interview data using thematic analysis to identify common themes. Health professionals all said they learned about their patients as a person-in-context. There was an increased understanding of patients' support networks, synthesising what is known and unknown. Health professionals understood patients' perceptions of health professionals and what really mattered to patients. There was discussion about the therapeutic value of care maps. The maps prompted reflection on practice. Care maps facilitated a broader focus than the clinical presentation. Using care maps may enable health professionals to support self-management rather than feeling responsible for many aspects of care. Care maps had 'social function' for health professionals. They may be a valuable tool for patients and clinicians to bridge the gap between medical treatment and patients' lifeworlds.

The Development and Validation of the CARe Burn Scale-Adult Form: A Patient-Reported Outcome Measure (PROM) to Assess Quality of Life for Adults Living with a Burn Injury.

Patient-Reported Outcome Measures (PROMs) identify vital information about patient needs and therapeutic progress. This paper outlines the development and validation of the CARe Burn Scale-Adult Form: a PROM that assesses quality of life in adults living with a burn injury. Eleven patients, 10 family members and 4 health professional interviews, and a systematic review informed the development of a conceptual framework and a draft measure. Cognitive debriefing interviews conducted with three adult burn patients, one family member, and eight health professionals provided feedback to ascertain content validity of the measure. The measure was then field tested with 304 adult burn patients. Rasch psychometric analysis was conducted for scale reduction, and traditional psychometric analyses provided a comparison with other measures. Further psychometric testing with an additional 118 adult burn patients tested the shortened CARe Burn Scale in relation to other quality of life PROMs. The conceptual framework outlined 14 domains; 12 of which fulfilled Rasch and traditional psychometric analyses. Two individual scales did not fulfill the Rasch criteria and were retained as checklists. Individual CARe Burn Scales correlated moderately-to-highly with other quality of life scales measuring similar constructs, and had low-to-no correlations with dissimilar constructs and the majority of sociodemographic factors, indicating evidence of concurrent and divergent validity. The CARe Burn Scale-Adult Form can help identify patient needs and provides burns-specialist health professionals with a tool to assess quality of life and therapeutic progress after a burn event and related treatment.