Mixed Methods Assessment Research Articles

Staff experiences of diabetes care in residential care facilities for people with severe disabilities in Denmark: a mixed-methods assessment of access to screening for diabetes complications

ObjectivesTo identify the prevalence of diabetes among adults (>18 years) living in residential care facilities in Denmark and to identify the structural, practical, and individual barriers and drivers related to...

Low level of dengue infection and transmission risk in Hong Kong: an integrated analysis of temporal seroprevalence results and corresponding meteorological data

ABSTRACT Hong Kong is an Asia-Pacific City with low incidence but periodic local outbreaks of dengue. A mixed-method assessment of the risk of expansion of dengue endemicity in such setting was conducted. Archived blood samples of healthy adult blood donors were tested for anti-dengue virus IgG at 2 time-points of 2014 and 2018/2019. Data on the monthly notified dengue cases, meteorological and vector (ovitrap index) variables were collected. The dengue virus (DENV) IgG seroprevalence of healthy adults in 2014 was 2.2% (95%C.I. = 1.8–2.8%, n = 3827) whereas that in 2018/2019 was 1.7% (95%C.I. = 1.2–2.3%, n = 2320). Serotyping on 42 sera in 2018/2019 showed that 22 (52.4%) were DENV-2. In 2002–2019, importation accounted for 95.3% of all reported cases. By wavelet analysis, local cases were in weak or no association with meteorological and vector variables. Without strong association between local cases and meteorological/vector variables, there was no evidence of increasing level of dengue infection in Hong Kong.

Patient-mediated interventions in hospital: A systematic review.

To describe the characteristics of hospital-based, patient-mediated interventions and their impact on patient, clinician and organization outcomes. Systematic review. Health literature databases (MEDLINE, CINAHL and EMBASE) were searched in August 2021. Backward and forward citation searching was conducted. Studies investigating patient-mediated interventions, targeted at adult hospitalized patients were eligible. Data were extracted related to study and intervention characteristics. Narrative synthesis was used to understand intervention impact on patient, clinician and organization outcomes (as per a framework). Methodological quality was assessed using the Mixed Methods Assessment Tool. Thirty-three studies, reporting 18 interventions, were included. Twelve interventions prompted patients to report health information about their own health/needs/concerns and six interventions encouraged patients to provide feedback about clinical practice. Across all interventions, there was evidence that patients used patient-mediated interventions and that they may improve patient communication. Healthcare professional outcomes were mixed for actual/intended use, acceptability and usefulness of interventions; yet there was some evidence of healthcare professional behaviour change. Interventions that encouraged patients to report health information about their own health/needs/concernsappeared more successful than other types of interventions. There is some evidence that hospital-based patient-mediated interventions may influence patient communication and healthcare professional behaviour. Patient-mediated interventions that encourage patients to report patient data before a clinical encounter may be more impactful than interventions that encourage patient feedback during or post-encounter. To date, most patient-mediated intervention research has been conducted in primary care settings; we uncovered the types of patient-mediated interventions that have been trialled in hospitals. We found that patient communication and healthcare professional behaviour may be influenced by these patient-mediated interventions. Future researchers could explore the suitability and effectiveness of a wider range of hospital-based patient-mediated interventions. There was no funding to remunerate a patient/member of the public for this review.

Mixed-methods assessment of barriers to physical activity for middle school Latina girls

Meeting physical activity guidelines is associated with positive mental, physical, and social health. However, most adolescent girls do not meet the recommended level of physical activity, with Latina girls even less likely than white girls to do so. Partnership for Girls (PG) sought to improve physical activity (PA) and reduce sedentary behaviors to prevent obesity and obesity-related health disparities among low-income Latina adolescent girls attending Westside San Antonio schools. This study utilizes mixed-methods data—qualitative formative assessments with parents of adolescent girls to gain further insight on the PA needs of Latina girls, and standard quantitative survey assessments to examine barriers and facilitators to PA from the perspective of the Latina girls. Results from the parent focus groups identify safety, cost, and neighborhood structure, such as traffic, as salient barriers to physical activity. In alignment with the focus groups, the feasibility study found that the middle school Latinas’ neighborhood environment was a major barrier to physical activity. Policymakers and planners must address the structural obstacles, such as neighborhood structure and safety concerns, to address physical activity disparities among Latina middle school girls.

A Mixed-Methods Assessment of Coronavirus Disease of 2019–Era Telehealth Acute Care Visits in the Medical Home

To compare acute care virtual visits with in-person visits with respect to equity of access, markers of quality and safety, and parent and provider experience, before and during the coronavirus disease 2019 pandemic. We compared patient demographics, antimicrobial prescribing rates, emergency department (ED) use, and patient-experience scores for virtual visits and in-person care at 2 academic pediatric primary care practices using χ2 testing and interrupted time series analyses. Parent and provider focus groups explored themes related to virtual visit experience and acceptability. We compared virtual acute care visits conducted in March 2020-February 2021 (n=8868) with in-person acute care visits conducted in February 2019-March 2020 (n=24 120) and March 2020-February 2021 (n=6054). There were small differences in patient race/ethnicity across the different cohorts (P<.01). Virtual visits were associated with a 9.6% (-11.5%, -7.8%, P<.001) decrease in all antibiotic prescribing and a 13.2% (-22.1%, -4.4%, P<.01) decrease in antibiotic prescribing for acute respiratory tract infections. Unanticipated visits to the ED did not significantly differ among visit types. Patient experience scores were significantly greater (P<.05) for virtual acute care in overall rating of care and likelihood to recommend. Focus group themes included safety, distractibility, convenience, treatment, and technology. Providers were broadly accepting of virtual care while parental views were more mixed. Telehealth acute care visits may not have negative effects on quality and safety, as measured by antimicrobial prescribing and unanticipated ED visit rates. Efforts to increase parental acceptance and avoid creating disparities in access to virtual care will be essential to continued success of telehealth acute care visits.

Non-communicable disease policy implementation in Libya: A mixed methods assessment.

The Libyan Ministry of Health is keen to understand how it can introduce policies to protect its population from non-communicable diseases (NCDs). We aimed to perform an implementation research assessment of the current situation, including challenges and opportunities. We used an explanatory sequential mixed methods design. We started with a quantitative assessment of NCD policy performance based on review of the WHO NCD Progress Monitor Reports. Once we had identified Libya's NCD policy gaps we performed a systematic review to identify international lessons around barriers and successful strategies for the policies Libya has not yet implemented. Finally, we performed a series of key stakeholder interviews with senior policymakers to explore their perspectives around promising policy actions. We used a realist paradigm, methods triangulation, and a joint display to synthesise the interpretation of our findings and develop recommendations. Libya has not fully implemented any of the recommended policies for diet, physical activity, primary care guidelines & therapeutics, or data collection, targets & surveillance. It does not have robust tobacco policies in place. Evidence from the international literature and policymaker interviews emphasised the centrality of according strong political leadership, governance structures, multisectoral engagement, and adequate financing to policy development activities. Libya's complex political and security situation are major barriers for policy implementation. Whilst some policies will be very challenging to develop and deploy, there are a number of simple policy actions that could be implemented with minimum effort; from inviting WHO to conduct a second STEPS survey, to signing the international code on breast-milk substitutes. Like many other fragile and conflict-affected states, Libya has not accorded NCDs the policy attention they demand. Whilst strong high-level leadership is the ultimate key to providing adequate protections, there are a range of simple measures that can be implemented with relative ease.

Mixed-Methods Systematic Review to Identify Facilitators and Barriers for Parents/Carers to Engage Pre-School Children in Community-Based Opportunities to Be Physically Active.

Background: Low physical activity levels in young children is a major concern. For children aged 0-5 years, engagement with opportunities to be physically active are often driven by the adults responsible for the child's care. This systematic review explores the barriers and facilitators to parents/caregivers engaging pre-school children in community-based opportunities for physical activity, within real-world settings, or as part of an intervention study. Methods: EBSCOhost Medline, CINHAL plus, EBSCOhost SPORTDiscus, Web of Science, ProQuest, and ASSIA were systematically searched for quantitative and qualitative studies published in English between 2015 and 16 May 2022. Data extracted from 16 articles (485 parents/carers; four countries) were quality-assessed using the Mixed Methods Assessment Tool and coded and themed via thematic analysis. Results: Nine themes (eight core, one minor) were identified and conceptualised into a socio-ecological model, illustrating factors over four levels: Individual-beliefs and knowledge (and parental parameters); Interpersonal-social benefits, social network, and family dynamic; Community-organisational factors and affordability; and Built and Physical Environment-infrastructure. Discussion: The findings provide valuable insights for practitioners and policy makers who commission, design, and deliver community-based physical activity opportunities for pre-school children. Developing strategies and opportunities that seek to address the barriers identified, as well as build on the facilitators highlighted by parents, particularly factors related to infrastructure and affordability, are imperative for physical activity promotion in pre-school children. The perspectives of fathers, socioeconomic and geographical differences, and the importance parents place on physical activity promotion all need to be explored further.

Impact of an Emergency Department Simulation on Pharmacy Students' Interprofessional Team Skills and Attitudes.

Objective: To evaluate the impact of an emergency department simulation on pharmacy students' interprofessional team skills and attitudes as measured by a novel mixed methods approach. Methods: A simulated emergency department encounter was executed by interprofessional teams consisting of pharmacy and medical students. Two rounds of the same encounter were separated by a short debriefing session facilitated by pharmacy and medical faculty. A full, comprehensive debriefing session occurred after conclusion of the second round. Pharmacy faculty evaluated pharmacy students using a competency-based checklist after each round of the simulation. Pharmacy students completed a baseline self-assessment of their interprofessional skills and attitudes pre-simulation, and again post-simulation. Results: Pharmacy students demonstrated significant improvement in providing clear and concise verbal interprofessional communication and using shared decision making to develop a collaborative plan of care, based upon student self-assessment and faculty observational ratings. Student self-assessments also showed significant perceived growth in contributing to the team's plan of care, and demonstrating active listening skills within the interprofessional team. Through qualitative analysis, pharmacy students noted perceived self-improvement in a variety of team-based skills and attitudes including confidence, critical thinking, role identification, communication, and self-awareness. Conclusion: This simulation provided a learning opportunity for pharmacy students to improve their skills related to teamwork and interprofessional collaboration. Based upon a novel a mixed methods assessment, both student self-assessment and faculty observational ratings were associated with significant growth in interprofessional skills and attitudes. This simulation provides a template experience for colleges/schools to meet, at least in part, ACPE Standards related to interprofessional education in collaboration with medical students.

Mixed-method assessment of caregiver feeding practices in early care and education centres during COVID-19.

The COVID-19 pandemic changed early care and education (ECE) mealtimes. Feeding practices that support children's emerging autonomy may support children's healthy eating, but it is unknown whether and how COVID-19 changed feeding practices. This paper describes caregiver feeding practices in ECE centres in Florida during COVID-19. A mixed-methods design was used to understand mealtime feeding practices. Survey and interview questions were developed based on the Trust Model. More than 7000 surveys were sent to ECE centres. Analysis included descriptive statistics for survey data and thematic analysis for interview data. This statewide study included teachers in all licensed and license-exempt ECE centres. Four hundred and thirty-one teachers completed a survey, and twenty-nine participated in follow-up interviews. Surveys showed most teachers engaged in autonomy-supportive behaviours, such as letting children eat until they were finished (90 %). The most common controlling behaviour was praising children for cleaning their plates (70 %). The most common responses about changes to mealtimes were keeping physical distance and serving healthy food. Interview themes were Autonomy Support, Controlling Feeding Practices, Interactions are the Same, Interactions are Different, Physical Distancing and Healthy Eating. Mealtimes are a central part of the day for young children and teachers in ECE environments. COVID-19 continues to influence ECE routines as behaviour change remains the primary method of reducing the risk of COVID-19 in the absence of a vaccine for young children. Understanding teachers' practices and perspectives is important for reducing the risk of COVID-19 and supporting children's autonomy and healthy eating.

Rollout of the Oral Health Literacy Toolkit in California: A Mixed-Methods Analysis

Background: Formative assessment of the rollout process of the California Oral Health Literacy (OHL) toolkit uses a mixed-methods approach. The OHL toolkit is an educational resource for dental professionals to improve communication with patients. This study was intended to obtain user feedback and suggestions for improvement.Methods: This mixed-methods assessment of the OHL toolkit rollout included anonymous post-training surveys distributed at regional dental societies in California and 1:1 interviews with dental champions who would work with the research team on toolkit rollout. Anonymous and deidentified data were analyzed using R and Dedoose.Results: From surveys (n = 37), the OHL toolkit components of highest interest to respondents were teach-back, increasing health literacy awareness among staff and learning to use plain language communication. Perceived implementation barriers were time constraints, insufficient staffing and a need for more training on communication techniques. Impressions, implementation prospects and recommendations for the OHL toolkit were obtained from qualitative interviews (n = 6). Overall, participants had positive impressions of the training presentation, OHL toolkit and implementation prospects.Conclusion: This study identified interest areas and implementation barriers, data that can be used to further improve the OHL toolkit and reduce barriers faced by practitioners. Further assessments at clinician and patient levels will be helpful for outcomes evaluation.Practical implications: The OHL toolkit is perceived positively by dental practitioners in California. Facilitators and barriers identified by dental providers and champions can be addressed through changes to the OHL toolkit and training. Rollout at the national level is being considered.

Postsurgical Remote Patient Monitoring Outcomes and Perceptions: A Mixed-Methods Assessment.

ObjectiveTo determine how postsurgical remote patient monitoring (RPM) influences readmissions and emergency visits within 30 days of discharge after operation and to understand patient and surgeon perspectives on postsurgical RPM.Patients and MethodsThis study was conducted at a US tertiary academic medical center between April 1, 2021, and December 31, 2021. This mixed-methods evaluation included a randomized controlled trial evaluation of RPM after operation and a qualitative assessment of patients’ and surgeons’ perceptions of RPM’s acceptability, feasibility, and effectiveness.ResultsA total of 292 patients participated in the RPM trial, and 147 were assigned to the RPM intervention. Despite a good balance between the groups, results indicated no difference in primary or secondary outcomes between the intervention and control groups. The qualitative component included 11 patients and 9 surgeons. The overarching theme for patients was that the program brought them peace of mind. Other main themes included technological issues and perceived benefits of the RPM platform. The major themes for surgeons included identifying the best patients to receive postsurgical RPM, actionable data collection and use, and improvements in data collection needed.ConclusionAlthough quantitative results indicate no difference between the groups, postsurgical RPM appears well-accepted from the patient’s perspective. However, technological issues could eliminate the benefits. Hospitals seeking to implement similar programs should carefully evaluate which populations to use the program in and seek to collect actionable data.

Mixed-Methods Assessment of Incivility During Surgical Mortality and Morbidity Conference

INTRODUCTION: A psychologically safe environment at Surgical Mortality and Morbidity Conference is critical for open discussion to improve care. This study sought to assess incivility during Mortality and Morbidity (M&M) Conference in an academic Department of Surgery. METHODS: We used a convergent mixed methods design to collect quantitative data through standardized survey instruments and qualitative data through non-participant observations. The Positive and Negative Affect Schedule Short-Form (PANAS) and the Uncivil Behavior in Clinical Nursing Education (UBCNE) survey instruments were distributed to all the Department of Surgery faculty and residents with three reminders. RESULTS: Among 147 eligible participants, 54 (36.7%) responded (residents: 27.5%, faculty: 37.6%). Junior faculty had a 2.60 higher Negative Affect score (p value = 0.02), a 4.13 higher Exclusion Behavior score (p value = 0.03), and 7.68 higher UBCNE score (p value = 0.04) compared to senior faculty. Females had a 2.71 higher Negative Affect score compared to males (p Value = 0.04). We observed 11 M&Ms, involving 30 cases, over 4 months. Cases were presented virtually detailing the clinical scenario, decision making, operative management, complications, and complication management. There was no standard structure for case discussion such as root cause analysis. Uncivil communications observed implied the treating team was incompetent or blamed the team for the complication. This was demonstrated by comments that categorically stated decision-making or management were unequivocally wrong (Fig. 1). Other examples were questions posed highlighting only part of the clinical story supporting a contrary view.Figure 1CONCLUSION: Unstructured discussion led to biased, uncivil comments. Structuring discussion to shift focus to improving care may create more generative comments.

Family Engagement in Services During COVID-19: A Mixed-Methods Study of Caregiver and Staff Perspectives

Introduction: We examined changes in family engagement before vs. during the pandemic in pediatric and family services as well as perceived facilitators and barriers to family engagement.Methods: We employed a mixed-method assessment of staff and caregiver perspectives related to pediatric and family medicine clinics and family resource centers in rural northern New England. We used narrative synthesis to analyze qualitative interviews (n=29) and descriptive statistics for quantitative surveys (n=108).Results: Staff felt they were not doing as well at engaging families during vs. pre-pandemic, identifying numerous facilitators and barriers. We found differences in resources used by families before vs. during the pandemic. We identified discordant perspectives between caregivers and staff regarding how well clinics and centers were identifying and responding to family needs.Discussion: Leaders in pediatrics, advanced practice nursing, and related fields can draw upon our findings to make decisions about what services and modalities they provide post-pandemic.

Key population-led community-based same-day antiretroviral therapy (CB-SDART) initiation hub in Bangkok, Thailand: a protocol for a hybrid type 3 implementation trial

BackgroundSame-day antiretroviral therapy (SDART) initiation, in which people living with HIV (PLHIV) who are antiretroviral therapy (ART)-naïve, willing, and clinically eligible start ART on the same day of HIV diagnosis, has been implemented in several healthcare facilities in Thailand since 2017. This evidence-based practice has demonstrated increased ART uptake, virologic suppression, and retention in care. However, linkage to care gaps exist in community-based organizations (CBOs) in Bangkok whereby as much as 20% of key populations (KP), mainly men who have sex with men and transgender women, living with HIV were lost to follow-up pre-ART initiation. To increase access to and uptake of ART among these populations, this study proposes that trained KP lay providers should lead community-based ART (CB-SDART) initiation service. This protocol describes the combined use of the Proctor’s implementation outcome framework and the Consolidated Framework for Implementation Research to guide and evaluate the CB-SDART implementation.MethodsThis study follows the hybrid design type 3: it is an implementation trial that secondarily assesses service and client outcomes by comparative interrupted time series analysis. Five strategies have been formulated to meet three implementation outcomes (i.e., feasibility, fidelity, and sustainability): (1) developing stakeholder relationships by engaging the CBO leaderships, (2) training and educating KP lay providers, (3) adapting and tailoring SDART to CBO-specific context, (4) using evaluative and iterative strategies to assess adherence to standard operating procedures, and (5) developing stakeholder relationships by engaging external stakeholders. Teleconsultation with physicians and ART home delivery will be integrated as another ART initiation option for clients and allow service provision during the COVID-19 pandemic. A mixed-method assessment will be conducted on key stakeholders and PLHIV diagnosed at two implementing CBOs, Rainbow Sky Association of Thailand and Service Workers in Group Foundation, in Bangkok, Thailand.DiscussionThis implementation research may be the first to provide robust data at the implementation, service, and client levels to inform how to successfully task-shift SDART initiation service to trained KP lay providers and facilitate the expansion of CB-SDART in the future.Trial registrationThis trial was registered with the Thai Clinical Trial Registry as TCTR20210709004 on July 9, 2021.

Benefits of support groups for patients living with implantable cardioverter defibrillators: a mixed-methods systematic review and meta-analysis

BackgroundPatients with implantable cardioverter defibrillators (ICD) experience anxiety, depression and reduced quality of life (QoL).ObjectivesThis mixed-methods systematic review evaluates whether ICD support groups have a beneficial effect on mental well-being.MethodsLiterature...

Clinical care in hepatocellular carcinoma: A mixed methods assessment of experiences and challenges of oncology professionals.

Healthcare providers (HCPs) may face numerous dilemmas in optimally screening, diagnosing, and treating patients with, and/or at risk for, hepatocellular carcinoma (HCC). This study aimed to achieve a greater understanding of the challenges in HCC care which in turn could delineate HCP educational opportunities within this oncologic sub-specialty. A mixed-methods approach was used to identify practice gaps and clinical barriers experienced by US-based medical oncologists, hepatologists, oncology physician assistants, oncology nurse practitioners, and interventional radiologists involved in HCC care. The qualitative (semi-structured interview) and quantitative (survey) data collection approaches were deployed sequentially with findings subsequently triangulated. A total of 214 HCPs participated in this study. Analysis revealed challenges related to screening and diagnosing HCC, specifically in applying appropriate screening guidelines, and the optimal use and decisions related to diagnostic imaging and biopsy. Issues related to treatment selection included the application of existing HCC guidelines in treatment decision-making, weighing risk/benefit ratios of various antineoplastics regimens (i.e., tyrosine kinase inhibitors-TKIs, immunotherapy agents, chemotherapy), sequencing therapies, potential toxicity management, and optimally educating patients about their HCC. These findings highlight the educational needs of those involved in HCC care and provide a starting point for clinicians to both reflect on their practice and identify opportunities to enhance communication within the HCC team and between provider and patient. There is an opportunity to optimize continuing professional development interventions that address the identified gaps in clinical practice specifically related to teamwork and interdisciplinary communication.

Implementation of the 'Kimberley Mum's Mood Scale' across primary health care services in the Kimberley region of Western Australia: A mixed methods assessment.

The Kimberley Mum’s Mood Scale (KMMS) was co-designed with Aboriginal women and healthcare professionals to improve culturally appropriate screening practices for perinatal depression and anxiety. This paper describes the implementation of the KMMS across the remote Kimberley region of Western Australia from January 2018 to December 2021. We used the Dynamic Sustainability Framework to progress the implementation and assess at the intervention, practice setting and ecological system level using a mixed methods approach to analyse implementation. Rates of administration and results of screening were described using a retrospective audit of electronic medical records. Analyses of KMMS training registry, stakeholder engagement and sustainability initiatives were descriptive. KMMS acceptability was assessed using qualitative descriptive approaches to analyse patient feedback forms (n = 39), healthcare professional surveys (n = 15) and qualitative interviews with healthcare professionals (n = 6). We found a significant increase in overall recorded perinatal screening (pre-implementation: 30.4% v Year 3: 46.5%, P < 0.001) and use of the KMMS (pre-implementation: 16.4% v Year 3: 46.4%, P < 0.001). There was improved fidelity in completing the KMMS (from 2.3% to 61.8%, P < 0.001), with 23.6% of women screened recorded as being at increased risk of depression and anxiety. Most healthcare professionals noted the high levels of perinatal mental health concerns, stress, and trauma that their patients experienced, and identified the KMMS as the most appropriate perinatal screening tool. Aboriginal women reported that it was important for clinics to ask about mood and feelings during the perinatal period, and that the KMMS was appropriate. Aboriginal women consistently reported that it was good to have someone to talk to. This study demonstrates that innovation in perinatal depression and anxiety screening for Aboriginal women is possible and can be implemented into routine clinical care with the support of a sustained multi-year investment and strong partnerships.

A Mixed Methods Assessment of the Management Role of Physicians.

IntroductionPhysicians are increasingly confronted with new requirements in their daily job, which go beyond the mere treatment of patients. The aim of this Mixed-Method-Study is to better understand management as it relates to physicians’ daily work, to clarify the physicians’ perception of their management role and to examine physician’s self-assessed competence in these functions.MethodsWe used three different instruments: Semi-structured interviews, a self-assessment survey and direct observations to evaluate managerial activities performed by residents. Both latter were based on instruments established for management research.ResultsInterviewed residents were familiar with the term “Management” but had difficulties in defining it. Concerning managerial functions in context of their daily work, we identified three main categories: Self-management, Patient-management and Management of the ward. In this context, physicians named numerous examples of management tasks and for which they felt ill prepared. Eighty-eight residents participated in the self-assessment survey and rated the majority of the management tasks as necessary for the residents’ work. Although physicians estimated the proportion of managerial work to comprise only 40.6%, a much higher number of mere management tasks could be identified through direct observations (n = 12). Activities related to management were more often observed than genuine physician tasks.DiscussionThis study illustrates the prominent role of management activities in context of the residents’ work, while at the same time showing that residents do not feel sufficiently educated, prepared nor competent in management tasks.

Implementing surgical mentorship in a resource-constrained context: a mixed methods assessment of the experiences of mentees, mentors, and leaders, and lessons learned

BackgroundA well-qualified workforce is critical to effective functioning of health systems and populations; however, skill gaps present a challenge in low-resource settings. While an emerging body of evidence suggests that mentorship can improve quality, access, and systems in African health settings by building the capacity of health providers, less is known about its implementation in surgery. We studied a novel surgical mentorship intervention as part of a safe surgery intervention (Safe Surgery 2020) in five rural Ethiopian facilities to understand factors affecting implementation of surgical mentorship in resource–constrained settings.MethodsWe designed a convergent mixed-methods study to understand the experiences of mentees, mentors, hospital leaders, and external stakeholders with the mentorship intervention. Quantitative data was collected through a survey (n = 25) and qualitative data through in-depth interviews (n = 26) in 2018 to gather information on (1) intervention characteristics including areas of mentorship, mentee-mentor relationships, and mentor characteristics, (2) organizational context including facilitators and barriers to implementation, (3) perceived impact, and (4) respondent characteristics. We analyzed the quantitative and qualitative data using frequency analysis and the constant comparison method, respectively; we integrated findings to identify themes.ResultsAll mentees (100%) experienced the intervention as positive. Participants perceived impact as: safer and more frequent surgical procedures, collegial bonds between mentees and mentors, empowerment among mentees, and a culture of continuous learning. Over 70% of all mentees reported their confidence and job satisfaction increased. Supportive intervention characteristics included a systems focus, psychologically safe mentee-mentor relationships, and mentor characteristics including generosity with time and knowledge, understanding of local context, and interpersonal skills. Supportive organizational context included a receptive implementation climate. Intervention challenges included insufficient clinical training, inadequate mentor support, and inadequate dose. Organizational context challenges included resource constraints and a lack of common understanding of the intervention.ConclusionWe offer lessons for intervention designers, policy makers, and practitioners about optimizing surgical mentorship interventions in resource-constrained settings. We attribute the intervention’s success to its holistic approach, a receptive climate, and effective mentee-mentor relationships. These qualities, along with policy support and adapting the intervention through user feedback are important for successful implementation.

Implementing screening for hypertension in archetypal HIV primary care: a mixed-methods assessment

BackgroundHigh prevalence of HIV and hypertension in sub-Saharan Africa puts adults living with HIV (ALWH) at high risk of end-organ complications. Both World Health Organization (WHO) and national guidelines recommend screening and treatment of hypertension among ALWH on antiretroviral therapy (ART). We evaluated the implementation of hypertension screening among adults on ART at three Uganda Cares Primary care facilities.MethodsUsing a sequential explanatory mixed-methods approach, we reviewed patient records, and interviewed both patients and providers during 2018 and 2019. We obtained demographics, clinical and blood pressure (BP) measurements via records review. We estimate the period prevalence of screening and use adjusted modified Poisson regression models to evaluate predictors of screening. In-depth interviews were analysed using a thematic approach to explain the observed prevalence and predictors of BP screening.ResultsRecords for 1426 ALWH were reviewed. Patients had a median age of 35 years and 65% of them were female. Most were on ART (89% on first-line) with a median duration of 4 years. Only 262 (18%) were overweight or obese with a body mass index (BMI) > 25 Kg/M2. In 2017 or 2018 patients made a median of 3 visits and 783 patients had a BP recorded, hence a period prevalence 55%. Older age, male sex, more clinic visits, and clinic site were associated with screening in the adjusted analyses. Erratic BP screening was corroborated by patients’ and providers’ interviews. Challenges included; high patient numbers, low staffing, provider apathy, no access to treatment, and lack of functioning of BP equipment.ConclusionAlmost half of regular HIV clinic attendees at these prototypical primary care HIV clinics were not screened for hypertension for a whole year. Improving BP screening requires attention to address modifiable challenges and ensure local buy-in beyond just providing equipment.