Mixed Focus Groups Research Articles

Household Economy and its Relation to Household Head and Women: A Study Among the Tangkhuls in Kangpokpi District, Manipur

The household economy is the collective sociocultural of managing resources and economic activities within households or families. A household economy is a fundamental unit of analysis in anthropological studies of economic systems, as it provides insights into how people manage their livelihoods within different cultural contexts. The present study attempted to investigate the relationship between household income and the role of household heads and women in income generation in the context of the Tangkhul of Kangpokpi District, Manipur. Using a mixed methods approach, including surveys, interviews and focus group discussions, the study examines the economic practices of households engaged in shifting cultivation and how household heads and women contribute to income generation. The finding reveals the significant contribution of women to household economic activities and the interplay between gender roles and household heads in the Tangkhul community. The Tangkhul is a patriarchal society, although women enjoy substantial freedom and play an important role in family and community life. The study highlights the need for a more detailed understanding of economic practices and the role of gender in shaping household income in rural communities. The insight gained from this research can inform policies and interventions aimed at livelihood and reducing poverty in rural areas.

Pathways Linking Online Physician–Patient Communication to Health Outcomes

ABSTRACT Online platforms have proliferated in response to the increasing demand for online medical services. However, the underlying mechanisms through which online physician‒patient communication are associated with better health outcomes are under-researched. We employed mixed focus groups and in-depth interviews to investigate the impact of online physician‒patient communication on health outcomes, including psychological and physical quality of life, as well as perceived diagnosticity. A modified pathway framework was subsequently generated to illustrate the relationship between online communication and health outcomes based on the clinician‒patient communication pathway model. Overall, we redefined the concept of perceived diagnosticity in online healthcare and identified an indirect pathway through which psychological quality of life affects physical quality of life mediated by perceived diagnosticity.

Approaches in care for people with variations of sex characteristics—focus groups in the European context on the strengths and challenges of multidisciplinary teams

Abstract Background New guidelines in the Consensus Statement on Management of Intersex Disorders by the Lawson Wilkins Pediatric Endocrine Society/European Society for Paediatric Endocrinology Consensus Group 2006 introduced multidisciplinary teams (MDTs) to provide care that involves collaboration between healthcare professionals, parents, and children with variations of sex characteristics (VSC). Aim The aim of this study was to examine a neglected but important field of collaboration among healthcare professionals and peer support groups who provide care for people with VSC. Outcomes The study outcome was the information obtained regarding the actual composition and collaboration of the multidisciplinary teams caring for children with VSC, including their collaboration with parents, peer support groups, and other care providers. Methods In this study we used an exploratory qualitative design based on mixed focus groups (in terms of professional background) and reflexive thematic analysis. Semi-structured focus group interview guides were used to obtain information about the participants’ viewpoints on the composition and challenges of, and collaboration between, peer support groups and members of multidisciplinary teams working to care for children with VSC and their parents. Seven focus groups were conducted with healthcare professionals and peer support groups in care teams in Central, Northern, and Western Europe. The data from the focus groups were examined using reflexive thematic analysis. Results The participants in the focus groups provided information regarding the use of multidisciplinary and interdisciplinary child- and family-oriented approaches and the strengths and challenges of collaboration and peer support groups. The results showed that the teams used a predominantly multidisciplinary approach and suffered from a lack of psychosocial providers, poor collaboration with peer support groups, and poor implementation of shared decision-making to address the clinical uncertainty of parents and people with VSC. Clinical Implications Clinicians should provide more psychosocial support and improve collaboration with peer support groups and nonmedical professionals. Strengths and Limitations This study is one of the first qualitative studies to provide information on the collaboration of multidisciplinary teams working to provide care for children with VSC and collaborate with their parents in the European context. However, due to language barriers, the dropout rate of participants, and the under-representation of peer support groups in the sample there was a lack of information on collaboration among healthcare professionals and peer support groups. Conclusions The collaboration between MDTs and parents does not involve adequate psychosocial and peer support or shared decision-making to address the uncertainty experienced by children and families when faced with information about variations of sex characteristics.

Experience or perception: What healthcare providers need when using the Utrecht Symptom Diary—4 Dimensional, a mixed-methods study

Background: The Utrecht Symptom Diary—4 Dimensional (USD-4D), an adaptation of the Edmonton Symptom Assessment System, supports healthcare providers (HCPs) in identifying, monitoring, and exploring multidimensional symptoms and needs of patients in the palliative phase. For the USD-4D to be optimally implemented in clinical palliative care, it is essential to know and understand the needs of HCPs when using it. Objective: To identify and interpret the needs of HCPs when using the USD-4D in clinical palliative care, operationalized as perceived facilitators and barriers. Design: An explanatory mixed-methods study with a sequential design. Methods: Data were collected between October 2019 and September 2020. In phase I, quantitative data were collected through a survey targeting Dutch HCPs working in palliative care. Facilitators were identified as items answered positively by ⩾80% of participants, while barriers were identified as items answered negatively by ⩾20% of participants. In phase II, these identified facilitators and barriers were explored in depth through mixed composition focus groups. The Capability-Opportunity-Motivation-Behavior (COM-B) model was utilized to contextualize and interpret the perceived facilitators and barriers. Results: A total of 122 HCPs completed the survey, with 95% of the respondents being women with a mean age of 48 years and 72% being nurses. Additionally, 53% of the respondents had no prior experience with the USD-4D. In phase II, 21 HCPs participated in focus groups. 95% of the participants were women with a mean age of 49 years and 67% being nurses. HCPs pinpointed facilitators primarily related to the potential benefits of the USD-4D for daily patient care. Conversely, the identified barriers included issues related to HCPs’ behavior, knowledge gaps, uncertainty regarding their abilities and attitudes toward the USD-4D, and technical obstacles. Conclusion: Facilitators and barriers across all facets of the COM-B model were recognized, with a notable emphasis on motivational barriers. It should be acknowledged that facilitators and barriers can evolve throughout the implementation process, underscoring the importance of viewing implementation and integration as fluid and continuous endeavors. Facilitators and barriers are closely linked to HCPs’ reflective capacities, emphasizing the need for tailored intervention strategies that align with different stages of USD-4D implementation.

Broad Brush Surveys: a rapid qualitative assessment approach for water and sanitation infrastructure in urban sub-Saharan cities

IntroductionBroad Brush Surveys (BBS) are a rapid, qualitative assessment approach using four meta-indicators -physical features, social organization, social networks and community narratives - to gauge how local context interfaces with service/intervention options, implementation and uptake.MethodsIn 2021, responding to rapid urbanization and the accompanying need for water and sanitation services, BBS was innovatively applied by social scientists and engineers to assess water and sanitation infrastructure, both formal and informal, in two African cities - Lusaka and Cape Town. In four urban communities, identified with local stakeholders, BBS data collection included: four mapping group discussions with local stakeholders (participants = 24); eight transect walks/drives; 60 structured observations of water and sanitation options, transport depots, health facilities, weekends, nights, rainy days; seven mixed gender focus group discussions (FGDs) with older and young residents (participants = 86); 21 key-informant interviews (KII, participants = 21).ResultsFindings were rapidly summarized into community profiles, including narrative reports, maps and posters, and first discussed with community stakeholders, then at national/provincial levels. The meta-indicator framework and set sequence of qualitative activities allowed the detail on water and sanitation to gradually emerge. For example, the mapping discussion identified water sources considered a risk for waterborne infections, further observed in the transect walks and then structured observations, which compared their relative condition and social interactions and what local residents narrated about them. FGDs and KIIs elaborated on the control of these sources, with nuanced detail, including hidden sources and the use of different water sources for different activities also emerging.DiscussionWe demonstrated that despite some limitations, BBS provided useful insight to systems and social processes surrounding formal and informal water and sanitation infrastructure in and across designated urban areas. Furthermore, BBS had the potential to galvanize local action to improve infrastructure, and illuminated the value of informal options in service delivery.

Access to Home- and Community-Based Services for Children with Disability: Academic Institutions’ Role and Areas for Improvement

ObjectiveThis project sought to describe provider- and parent-identified needs and barriers to obtaining home- and community-based services (HCBS) for children with disability (CWD) and to determine ways pediatric health care institutions can improve access to HCBS services. MethodsIn this exploratory sequential mixed methods evaluation, semi-structured interviews and focus groups were conducted with multidisciplinary providers and staff from an independent children’s hospital, followed by a survey of English and Spanish-speaking parents of CWD. Data from interviews and surveys were then triangulated for overarching common themes regarding how pediatric health care institutions can better support access to HCBS. ResultsAmong 382 parent respondents, 74.1% reported that their child needed a HCBS, most commonly physical/occupational/speech therapies, school-based support, and case management services. Two-thirds of parents reported at least one barrier to accessing HCBS and one-third experience >3 barriers. While multiple current institutional strengths were noted, internal weaknesses included lack of provider knowledge, staffing difficulties, and lack of protocols for identifying and tracking patients needing or receiving HCBS. External threats included requirements to entry for HCBS and transfer of care, with opportunities for improvement involving dissemination of information, funding support, and connection between providers/support staff and services. ConclusionsParents of CWD identified HCBS as necessary for the health of this population, but multiple barriers to HCBS were identified by both parents and providers. Multiple internal and external opportunities for improvement relative to pediatric health care institutions were identified, suggesting a need for a comprehensive approach to ensure that CWD receive necessary HCBS.

Partnering with a child welfare agency to design and deliver a BSW child welfare course: mixed results and lessons learned

ABSTRACT This paper describes a collaboration between a university and a local child welfare agency in the development and delivery of a Bachelor of Social Work (BSW) child welfare course featuring lived experience knowledge and learning situated in community-based child welfare sites. We present results of an exploratory mixed methods pre-post survey and focus group evaluation which examined changes in student general knowledge, perceptions of skills for decision- making and orienting beliefs about child welfare families. The results did not yield uniform significant results. The discussion delves into lessons learned about the importance of supporting students to develop skills for respectfully gathering and critically analyzing information and how to break through what we observed as student reluctance to learn about child welfare wrongdoings. We reflect on why, despite centering curriculum on lived experience knowledge, we were not successful in overturning students’ negative orienting beliefs about families and children receiving child welfare services. We conclude with considerations for new directions in BSW child welfare curriculum.

The Importance of Physical Education and Health Subjects for Students with Special Educational Needs in Malaysia

This article discusses the importance of physical and health education for students with special educational needs (SEN) in Malaysia. The study involved 200 respondents, including MBPK. This study uses a mixed methods approach, including surveys and focus group discussions with MBPK teachers and parents. Findings show that physical education can provide a variety of benefits, including improving physical fitness, social interaction, and emotional control. Participation in these classes can promote physical, social and emotional well-being, and help develop new physical skills. This study emphasizes the importance of providing equal access to physical education and health classes for MBPK and suggests that schools prioritize these subjects in their curriculum. However, this study has limitations in terms of sample size and generalizability to all MBPK. Further research is needed to explore the long-term effects of physical education and health classes on academic performance and social skills, as well as parents' and teachers' attitudes and beliefs towards inclusive physical education. The article suggests that the government should prioritize the inclusion of physical education and health in the curriculum for MBPK to promote their overall development and wellbeing. The study also highlighted the need for inclusive and adaptive physical education programs, as well as support for teachers and parents. Overall, the study shows that physical education and health classes have a significant positive effect on the academic, physical and psychological well-being of MBPK in Malaysia.

Development of an interprofessional person-centred care concept for persons with care needs living in their own homes (interprof HOME): study protocol for a mixed-methods study

IntroductionPeople receiving home care usually have complex healthcare needs requiring the involvement of informal caregivers and various health professionals. In this context, successful collaboration is an important element of person-centred...

Implementation of EPR-Youth, a Client-Accessible and Multidisciplinary Health Record; A Mixed-Methods Process Evaluation.

Client-accessible interdisciplinary health records potentially contribute to integrated care by facilitating collaboration and enhancing clients' involvement in care. To achieve this, three Dutch organizations providing 'care for youth' developed a fully client-accessible electronic patient record (EPR-Youth). To evaluate the implementation of EPR-Youth and to determine barriers and facilitators. A mixed methods design combined system data, process observations, questionnaires and focus group interviews. Target groups were parents, adolescents, professionals using EPR-Youth, and implementation stakeholders. Client-portal acceptability was high among all clients. Client-portal adoption rate was high and differed between age groups and educational levels. Professionals' doubts about acceptability, appropriateness and fidelity were partly due to lack of system knowledge. Implementation barriers were the complexity of co-creation, lack of clear leadership, and concerns about legal issues. Facilitators were clarifying vision and legal context, setting deadlines, and a pioneering spirit. The early implementation of EPR-Youth, the first Dutch client-accessible interdisciplinary electronic health record in 'care for youth' was successful. To enhance adoption among clients, group-specific barriers for portal-use should be determined. Professionals need additional training. Further research is needed to gain insight into client-portal access barriers. To benefit more from co-creation, an organizational change towards situational leadership is necessary.

Determining the Impact of Lifestyle on the Health of Primary School Children in Slovenia Through Mixed Membership Focus Groups

Lifestyle choices made by children and adolescents can lead to a variety of health problems. It is therefore crucial to evaluate the state health-related lifestyles of primary school children’s and identify areas for improvement. The aim of this study was to investigate the experiences and perspectives of those involved in educating current generations of primary school children about their lifestyle and the associated health implications of their behavior. Four focus groups were formed, comprising parents, primary school teachers, health professionals, and leisure activity teachers, with five participants in each group. Semi-structured interviews were conducted with each group as part of the qualitative research paradigm of the study. The study revealed three central themes, emphasizing the need to promote health and educate children about healthy behaviors, environmental influences, and health literacy. Community nurses need to take a proactive role in promoting school health. Although adults, peers, and the environment exert a strong influence on children’s lifestyles, they often fail to live up to their responsibilities and allow harmful habits to form. To instill positive behaviors and an optimistic attitude towards a healthy lifestyle, all those involved in a child’s education need to collaborate. Health-related topics should be included or reinforced in primary school curricula, and parents and school staff should receive appropriate training.

Management of Pain and Cachexia in Pancreatic Cancer: Protocol for Two Systematic Reviews, Network Meta-Analysis, Surveys, and Focus Groups

Approximately 75% of people with pancreatic cancer experience pain, and >50% of them have cachexia (weakness and wasting of the body). However, there is considerable uncertainty regarding the management of these distressing symptoms. Our primary objectives are to compare the relative benefits and harms of different interventions for pain in people with unresectable pancreatic cancer and for prevention and treatment of cachexia due to pancreatic cancer, through systematic reviews and network meta-analysis. Our secondary objectives are to develop an evidence-based clinical care pathway to manage pain and prevent and treat cachexia in people with pancreatic cancer through surveys and focus groups involving patients, carers, and health care professionals. We will perform 2 systematic reviews of the literature related to pain and cachexia in people with pancreatic cancer using searches from Cochrane Library, MEDLINE, Embase, Science Citation Index, and trial registries. Two researchers will independently screen for eligibility and identify randomized controlled trials (no language or publication status restriction), comparing interventions for pain or cachexia based on full-texts for articles shortlisted during screening. We will assess risk of bias in the trials using the Cochrane risk of bias tool (version 2.0) and obtain data related to baseline prognostic characteristics, potential effect modifiers and outcome data related to overall survival, health-related quality of life, treatment-related complications, and resource utilisation. We aim to conduct network meta-analysis on outcomes with multiple treatment comparisons where possible, otherwise, meta-analysis with direct comparisons, or narrative synthesis. We will perform various subgroup and sensitivity analyses. Using information obtained from both systematic reviews, we will conduct 2 surveys: one directed to patients or carers to assess acceptability of interventions, and the other to health care professionals to assess feasibility of delivery in the National Health Service. Four mixed focus groups will be conducted to evaluate findings and foster consensus in the development of the care pathway. Funding was awarded from April 2022 (NIHR202727). Both systematic review protocols were prospectively registered on PROSPERO in May 2022. Formal searches began thereafter. Approval by the University College London Research Ethics Committee (23563/001) was received in December 2022. Data collection began in January 2023; data analysis will begin in May 2023 (completion expected by October 2023). This study will comprehensively encompass major interventions for management of pain in people with unresectable pancreatic cancer, and prevention and treatment of cachexia in people with pancreatic cancer. Key stakeholders will facilitate the development of an evidence-based care pathway, ensuring both acceptability and feasibility. The project ends in April 2024 and published results are expected within 12 months of completion. We aim to present the findings through patient group websites, conferences, and publications, irrespective of the findings, in a peer-reviewed journal. DERR1-10.2196/46335.

Reflections on the Value of Mixed Focus Groups with Adult Learner Research Participants: Exploring Gender Disparities and Gendered Relationships

The purpose of this article is two-fold. Firstly, we consider whether the setting up of mixed-gender focus group sessions has the potential as a research process to contribute to transforming people’s understandings of their gendered relationships. Secondly, we relate our discussion to the question of the mutability of stereotypical thinking in the context in question, taking into account the idea that cultures in different contexts can be seen as “in the making” through the way in which people together create meaning. We explain how the first author of the article organized focus groups which were mixed in terms of gender with the purpose that the adult learner participants could develop their perceptions as they related to each other around the topic of gender inequalities.). The sessions were conducted in two adult learning Centers located in a rural and an urban area respectively – Xola and Zodwa – within the Cacadu District of the Eastern Cape, South Africa. Two mixed focus groups took place in 2016 (one in each Center, with 19 females and 5 males altogether), and a follow up took place in 2018, to further discuss recommendations. In 2022, another set of focus group sessions was arranged in the same Centers, with 10 females and 6 males who were asked to participate and agreed. As part of a related discussion on gendered relationships, they were asked specific questions regarding how they understood the value of the mixed-gender conversations. Results from the various sets of groups suggest that focus groups can indeed help people to explore and rethink gender disparities and to think of ways forward in terms of enriched understandings. We recommend that mixed-gender focus group sessions should be regarded by researchers as a potential space to fruitfully set up a way for people to develop their sense of interdependence in their social relations.

Development of an mHealth App-Based Intervention for Depressive Rumination (RuminAid): Mixed Methods Focus Group Evaluation.

Depression is a common mental health condition that poses a significant public health burden. Effective treatments for depression exist; however, access to evidence-based care remains limited. Mobile health (mHealth) apps offer an avenue for improving access. However, few mHealth apps are informed by evidence-based treatments and even fewer are empirically evaluated before dissemination. To address this gap, we developed RuminAid, an mHealth app that uses evidence-based treatment components to reduce depression by targeting a single key depressogenic process-rumination. The primary objective of this study was to collect qualitative and quantitative feedback that could be used to improve the design of RuminAid before the software development phase. We reviewed empirically supported interventions for depression and rumination and used the key aspects of each to create a storyboard version of RuminAid. We distributed an audio-guided presentation of the RuminAid storyboard to 22 individuals for viewing and solicited user feedback on app content, design, and perceived functionality across 7 focus group sessions. The consumer-rated quality of the storyboard version of RuminAid was in the acceptable to good range. Indeed, most participants reported that they thought RuminAid would be an engaging, functional, and informational app. Likewise, they endorsed overwhelming positive beliefs about the perceived impact of RuminAid; specifically, 96% (21/22) believed that RuminAid will help depressed ruminators with depression and rumination. Nevertheless, the results highlighted the need for improved app aesthetics (eg, a more appealing color scheme and modern design). Focus group members reported that the quality of information was quite good and had the potential to help adults who struggle with depression and rumination but expressed concern that poor aesthetics would interfere with users' desire to continue using the app. To address these comments, we hired a graphic designer and redesigned each screen to improve visual appeal. We also removed time gating from the app based on participant feedback and findings from related research. These changes helped elevate RuminAid and informed its initial software build for a pilot trial that focused on evaluating its feasibility and acceptability.

What motivates radiographers to start working with research?

IntroductionThis study aimed to investigate the motivation and barriers of clinical radiographers to work with research in a Danish clinical setting. MethodsThe project was designed as a mixed method explorative study, including survey and focus group interviews. A paper based survey was distributed to clinical radiographers, with a bachelor's degree (few with a diploma in Radiography), at three departments of radiology. The survey collected data on motivation, challenges, and barriers in relation to research in clinical practice. Thematic analyses were performed according to the nature of the survey and used to categorize statements. The focus group interview included five managing radiographers (3 with a bachelor's degree) who formed part of the clinical management at their respective departments. ResultsThe survey resulted in 39 responses with an overall response rate of 56%. The majority of clinical radiographers were female (69%, n = 27) and 12 were male.Most radiographers (77%, n = 30) reported interest in research projects and 89% of them (n = 27) found it difficult to dedicate time to research projects next to the clinical work. ConclusionThe study increases the understanding of the motivation and current barriers to start working with research in clinical settings including dependent and independent projects. Clinical radiographers reported to have interest in research. Improvements should focus on department culture, skills, and management support. Clinical Radiographers can be motivated when the departments offer training and support, the projects are relevant to clinical practice and research working hours are provided. Implications for practiceThe study offers an insight into current perspectives and obstacles for clinical radiographers in relation to research. The literature on the perception and interest in research by clinical radiographers and managers is limited and further investigation of the field is warranted.

Rice: Seed Systems, Production Characteristics, and Fungal Infections of Stored Grains in Major Production Zones of Liberia

The inadequacy of information on rice farmers' situations, particularly their access to propagation materials and grain storage and the impact thereof on Liberia's food security scenario, curtails the development of strategies and interventions meant to optimize rice production. This study investigated the rice seed systems, storage methods of the harvested rice grains, and degree of fungal contamination of stored rice seeds in the major rice-producing counties of Liberia: Lofa, Bong, Montserrado, and Nimba. A mixed data collection method, comprising interviews and focus group discussions (FGDs) was adopted. Five hundred (500) farmers were purposefully selected for one-on-one interviews, and 12 FGDs were held (three in each county). The results indicated that 94.7% of farmers source seeds through informal channels. Grain for use as seed in the subsequent farming season is mainly stored in kitchen attics, a practice reported by 83.8% of the farmers, while 7.8%, 3.8%, and 4.6% of farmers stored seeds in plastic containers, nylon sacks, and jute bags, respectively. Land size was identified as the primary factor determining rice yield across the studied counties, R2 = 0.944, p = 0.001. Farmers in high-rainfall regions had a high likelihood of experiencing fungal infections on their stored grains; however, only 19.6% of farmers were aware of the health implications of consuming affected grains. Therefore, policies and support frameworks should be directed towards actualizing modern seed channels and extension services and creating awareness of the different nodes of the rice value chain.

‘Being treated like an actual person’: attitudinal accessibility on the bus

Whilst the essential nature of built environment accessibility has been well established in transport research, attitudinal, behavioural, and communication barriers experienced by transport users remain largely overlooked. Subtle and insidious, repetitive negative attitudes, behaviour, and communication can force disabled passengers out of the most affordable transport option available. Applying the Disability Justice Framework and a Mobility Justice approach, this study investigated disabled passengers’ reported experience of bus driver attitudes, behaviours, and communication methods, and the impact of these encounters. A mixed methods cross-sectional survey and focus groups with disabled adults and support persons were conducted. An Advisory Working Group of transport accessibility advocates, all with lived experience, were engaged to oversee the study design. Participants reported that some bus drivers demonstrated ableist attitudes, discriminatory behaviour, and communication methods. Many passengers had reduced or stopped catching buses altogether due to these negative encounters, restricting their community mobility, which further impacted their quality of life. Participants’ recommendations for drivers, operators, and transport authorities were thematically integrated into one statement, reinforcing the power of attitudinal access—‘treat me like the person I am, who is valid; with a right to time, space and safety; listen to me, and prove you care’.

A qualitative exploration of the mental health challenges and therapeutic needs of Canadian correctional workers.

Correctional work is described as a high-stress environment associated with increased prevalence of mental health disorders in employees. Identifying appropriate healthcare services necessitates investigating the mental health challenges and needs of correctional workers (CWs). Individual interviews (n = 9; 5 M and 4 W) and a mixed gender focus group (n = 6; 3 M and 3 W) were conducted to gather a general sense of the mental health landscape. Data were analyzed to develop a targeted and comprehensive question guide for gender-specific focus groups (n = 14 unique participants; 6 M and 8 W). Eight themes emerged from the gender-specific focus groups. Themes focusing on work culture described the negative repercussions of job stress and the inability to discuss challenges openly due to confidentiality concerns and feelings of seclusion associated with the CW profession. Men were more likely to be subjected to physical violence and women to emotional and sexual harassment from staff and inmates. Themes related to mental health care described the benefits and limitations of the current services and digital mental healthcare. Stigma and accessibility were notable treatment barriers. Lastly, sector-specific therapy was seen as an important component in enhancing engagement and therapist interaction. The study demonstrates the interconnection between work culture and CW mental health that needs to be acknowledged when addressing mental health care.

‘Accidental’ procedural justice: The Finnish approach to policing

At a time when policing agencies are coming under increased scrutiny, the Finnish police are, reportedly, achieving very high levels of public trust. This article reports on the findings of research conducted into the Finnish approach to policing and considers whether and to what extent Finnish policing shows tendencies towards procedural justice. A mixed methods survey and focus groups approach was used to collect primary data that provided novel insight into the nature of policing in Finland from the perspective of police officers. The key findings of this research indicate that the Finnish police are operating in an apparently ‘accidental’ procedurally just manner. Rather than a fully planned implementation of procedural justice theory, a combination of cultural, legal and operational elements seems to have aligned to produce a form of policing that reportedly inspires high levels of trust and/or legitimacy in the general public. However, it was found that Finnish police officers are currently operating under high levels of fatigue and stress. Indeed, this may be compounded by the reported dissatisfaction with certain elements of the management structure and internal communication methods. Although many of the participants in this research appeared to have intentions very similar to those of procedural justice, it would seem that these are coincidental rather than an institutional application of procedural justice theory.

Crisis Preparedness: A Systems-Based Framework for Avoiding Harm in Surgery.

Highly performing healthcare organizations benefit from robust failure management systems. This involves the ability to respond and recover from critical events, as well avoiding harm in the first place (crisis preparedness). Currently, the surgical community may lack an integrated toolbox for crisis readiness. The study aims to create a practical framework for crisis preparedness in surgery. A multimethod qualitative study was designed to identify and translate crisis preparedness interventions from high-reliability industries to clinical practice. The tools and strategies identified were subsequently developed and clinically adapted for healthcare use. The study used (1) observational fieldwork in commercial aviation; (2) semi-structured interviews with senior airline pilots, and (3) mixed focus groups with healthcare and aviation safety experts. A crisis preparedness framework was derived by thematic analysis using the framework method. Clinical adaptation was achieved using expert consensus methodology. Twenty-two aviation and healthcare experts participated in 17 interviews and 3 focus groups. A framework for crisis preparedness was derived, consisting of 6 behavioral interventions: (1) anticipate threats and errors by building situational awareness using cognitive tools; (2) brief teams about goals, deviations, operational risks, and contingency plans; (3) implement standard operating procedures using checklists; (4) rehearse emergency drills before critical phases of work; (5) set the tone for a positive working environment by establishing cultural norms and empowering individuals to speak up about safety issues; and (6) debrief performance outcomes to derive learning lessons. Surgical crisis preparedness requires integrated systems rather than isolated safety interventions. This study provides a framework and the tools to achieve this.