Mixed-methods Observational Study Research Articles

Psychological Safety Competency Training During the Clinical Internship From the Perspective of Health Care Trainee Mentors in 11 Pan-European Countries: Mixed Methods Observational Study.

In the field of research, psychological safety has been widely recognized as a contributing factor to improving the quality of care and patient safety. However, its consideration in the curricula and traineeship pathways of residents and health care students is scarce. This study aims to determine the extent to which health care trainees acquire psychological safety competencies during their internships in clinical settings and identify what measures can be taken to promote their learning. A mixed methods observational study based on a consensus conference and an open-ended survey among a sample of health care trainee mentors from health care institutions in a pan-European context was conducted. First, we administered an ad hoc questionnaire to assess the perceived degree of acquisition or implementation and significance of competencies (knowledge, attitudes, and skills) and institutional interventions in psychological safety. Second, we asked mentors to propose measures to foster among trainees those competencies that, in the first phase of the study, obtained an average acquisition score of <3.4 (scale of 1-5). A content analysis of the information collected was carried out, and the spontaneity of each category and theme was determined. In total, 173 mentors from 11 pan-European countries completed the first questionnaire (response rate: 173/256, 67.6%), of which 63 (36.4%) participated in the second consultation. The competencies with the lowest acquisition level were related to warning a professional that their behavior posed a risk to the patient, managing their possible bad reaction, and offering support to a colleague who becomes a second victim. The mentors' proposals for improvement of this competency gap referred to training in communication skills and patient safety, safety culture, work climate, individual attitudes, a reference person for trainees, formal incorporation into the curricula of health care degrees and specialization pathways, specific systems and mechanisms to give trainees a voice, institutional risk management, regulations, guidelines and standards, supervision, and resources to support trainees. In terms of teaching methodology, the mentors recommended innovative strategies, many of them based on technological tools or solutions, including videos, seminars, lectures, workshops, simulation learning or role-playing with or without professional actors, case studies, videos with practical demonstrations or model situations, panel discussions, clinical sessions for joint analysis of patient safety incidents, and debriefings to set and discuss lessons learned. This study sought to promote psychological safety competencies as a formal part of the training of future health care professionals, facilitating the translation of international guidelines into practice and clinical settings in the pan-European context.

Evaluating the accuracy of International Classification of Disease Perinatal Mortality (ICD-PM) codes assigned on death certificates before and after expert panel review: a mixed methods observational study

IntroductionThe present study was conducted with the aim of evaluating the accuracy of International Classification of Disease Perinatal Mortality (ICD-PM) codes assigned on death certificates before and after an expert panel review.MethodThe present study was a mixed methods observational study conducted at Umm al-Benin Hospital, the sole specialized obstetrics and gynecology center affiliated with Mashhad University of Medical Sciences. The study comprised three distinct stages: (1) Collecting primary ICD-PM codes assigned to perinatal death certificates, along with other relevant information, from October 2021 to March 2022; (2) Examining the circumstances of each perinatal death case and re-identifying the causes of death through a consensus process involving a panel of experts comprising pediatricians, obstetrics and gynecology specialists, and nursing and midwifery experts; presenting the new ICD-PM code; (3) Comparing the ICD-PM codes assigned to perinatal death certificates before and after the expert panel’s evaluation.ResultDuring the study period, a total of seven specialized panels were conducted to examine perinatal deaths. Out of the 71 cases, 41 were carefully reviewed by experts. These cases included 32 stillbirths and nine neonatal deaths. The examination process followed specific inclusion and exclusion criteria. The findings revealed that there were no significant changes in the causes of neonatal deaths. However, it was notable that 80% of the previously unknown causes of stillbirths were successfully identified. Notably, the occurrence of stillbirths increased by 78% due to maternal causes and conditions.ConclusionConvening panels of experts to discuss the causes of perinatal deaths can effectively reduce the percentage of unknown causes, as classified by ICD-PM. This approach also guarantees the availability of essential data for implementing effective interventions to decrease preventable perinatal deaths.

Caregivers' burden of care during emergency department care transitions among older adults: a mixed methods cohort study.

Improving care transitions for older adults can reduce emergency department (ED) revisits, and the strain placed upon caregivers. We analyzed whether caregivers felt a change in burden following a care transition, and what may be improved to reduce it. This mixed-methods observational study nested within LEARNING WISDOM included caregivers of older patients who experienced an ED care transition. Burden was collected with the brief Zarit Burden Interview (ZBI-12), and caregivers also commented on the care transition. A qualitative coding scheme of patient care transitions was created to reflect themes important to caregivers. Comments were randomly analyzed until saturation and themes were extracted from the data. We followed both the SRQR and STROBE checklists. Comments from 581 caregivers (mean age (SD) 64.5 (12.3), 68% women) caring for patients (mean age (SD) 77.2 (7.54), 48% women) were analyzed. Caregivers overwhelmingly reported dissatisfaction and unmet service expectations, particularly with home care and domestic help. Communication and follow-up from the ED emerged as an area for improvement. Caregivers who reported an increased level of burden following a patient's care transition had significantly higher ZBI scores than caregivers who self-reported stable burden levels. Caregivers with increasing, stable, and improved levels of subjective burden all reported areas for improvement in the care transition process. Themes centering on the capacity to live at home and inadequate communication were most frequently mentioned and may represent serious challenges to caregivers. Addressing these challenges could improve both caregiver burden and ED care transitions.

Prevalence, predictors and outcomes of self-reported feedback for EMS professionals: a mixed-methods diary study

BackgroundProviding feedback to healthcare professionals and organisations on performance or patient outcomes may improve care quality and professional development, particularly in Emergency Medical Services (EMS) where professionals make autonomous, complex decisions and current feedback provision is limited. This study aimed to determine the content and outcomes of feedback in EMS by measuring feedback prevalence, identifying predictors of receiving feedback, categorising feedback outcomes and determining predictors of feedback efficacy.MethodsAn observational mixed-methods study was used. EMS professionals delivering face-to-face patient care in the United Kingdom’s National Health Service completed a baseline survey and diary entries between March-August 2022. Diary entries were event-contingent and collected when a participant identified they had received feedback. Self-reported data were collected on feedback frequency, environment, characteristics and outcomes. Feedback environment was measured using the Feedback Environment Scale. Feedback outcomes were categorised using hierarchical cluster analysis. Multilevel logistic regression was used to assess which variables predicted feedback receipt and efficacy. Qualitative data were analysed using content analysis.Results299 participants completed baseline surveys and 105 submitted 538 diary entries. 215 (71.9%) participants had received feedback in the last 30 days, with patient outcome feedback the most frequent (n = 149, 42.8%). Feedback format was predominantly verbal (n = 157, 73.0%) and informal (n = 189, 80.4%). Significant predictors for receiving feedback were a paramedic role (aOR 3.04 [1.14, 8.00]), a workplace with a positive feedback-seeking culture (aOR 1.07 [1.04, 1.10]) and white ethnicity (aOR 5.68 [1.01, 29.73]). Feedback outcomes included: personal wellbeing (closure, confidence and job satisfaction), professional development (clinical practice and knowledge) and service outcomes (patient care and patient safety). Feedback-seeking behaviour and higher scores on the Feedback Environment Scale were statistically significant predictors of feedback efficacy. Solicited feedback improved wellbeing (aOR 3.35 [1.68, 6.60]) and professional development (aOR 2.58 [1.10, 5.56]) more than unsolicited feedback.ConclusionFeedback for EMS professionals was perceived to improve personal wellbeing, professional development and service outcomes. EMS workplaces need to develop a culture that encourages feedback-seeking to strengthen the impact of feedback for EMS professionals on clinical decision-making and staff wellbeing.

Device-based 24-hour movement behaviours in adult phase III cardiac rehabilitation service-users during the COVID-19 pandemic: a mixed-methods prospective observational study

Purpose To examine changes in device-based 24-hour movement behaviours (MB), and facilitators and barriers to physical activity (PA) and exercise, during remotely-delivered cardiac rehabilitation (RDCR). Materials and methods This prospective observational study used wrist-worn GENEActiv accelerometers to assess MB of 10 service-users (63 ± 10 years) at the start, middle, and end of three-months of RDCR. Barriers and facilitators to PA and exercise were explored through self-report diaries and analysed using content analysis. Results At start, service-users were sedentary for 12.6 ± 0.7 h · day−1 and accumulated most PA at a light-intensity (133.52 ± 28.57 min · day−1) – neither changed significantly during RDCR. Sleep efficiency significantly reduced from start (88.80 ± 4.2%) to the end (86.1 ± 4.76%) of CR, with values meeting health-based recommendations (≥85%). Barriers to RDCR exercise included exertional discomfort and cardiac symptoms, and reduced confidence when exercising alone. Setting meaningful PA goals, self-monitoring health targets, and having social support, facilitated PA and exercise during RDCR. Conclusions Our RDCR programme failed to elicit significant changes in MB or sleep. To increase the likelihood of successful RDCR, it is important to promote a variety of exercise and PA options, target sedentary time, and apply theory to RDCR design, delivery, and support strategies.

Assessment of treatment expectations in people with suspected endometriosis: A psychometric analysis.

Treatment expectations influence clinical outcomes in various physical and psychological conditions; however, no studies have explored their role in endometriosis treatment. It is necessary to understand how these expectations can be measured to study treatment expectations and their effects in clinical practice. This study aimed to psychometrically analyze and compare different treatment expectation measurements and describe treatment expectations in women with suspected endometriosis. Analysis of cross-sectional baseline data of a mixed-method clinical observational study of N=699 patients undergoing laparoscopy in Germany. Descriptives, bivariate associations, convergent and discriminant validity of four expectation measurements (Treatment Expectation Questionnaire (TEX-Q); Generic rating scale for previous treatment experiences, treatment expectations, and treatment effects (GEEE); numerical rating scales (NRS) assessing improvement and worsening of endometriosis symptoms, expected Pain Disability Index (PDI); range: 0 to 10) were estimated. A cluster analysis was performed on the three GEEE items. Most participants expected high improvement ( M=6.68 to 7.20, SD=1.90 to 2.09) and low worsening ( M=1.09 to 2.52, SD=1.80 to 2.25) of disability from laparoscopy. Participants who expected greater worsening expected more side effects ( r=.31 to .60, p<.001). Associations between the positive and negative expectation dimensions, including side effects, were small to non-significant ( r =|.24| to .00, p<.001 to.978). Four distinct clusters, described as'positive', 'no pain, no gain', 'diminished', and 'uniform' were found, with a total PVE of 62.2%. Women with suspected endometriosis reported positive expectations concerning laparoscopy, but wide ranges indicated interindividual differences. Treatment expectations seem to be a multidimensional construct in this patient group. The investigated measurements did not correlate to the extent that they measured exactly the same construct. The selection of measurements should be carefully considered and adapted for the study purposes. Clusters provide initial indications for individualized interventions that target expectation manipulation. ID NCT05019612 ( ClinicalTrials.gov).

Current experience and future potential of facilitating access to digital NHS primary care services in England: the Di-Facto mixed-methods study.

Current National Health Service policy in England encourages enhanced digital access in primary care service provision. In this study, we investigate 'digital facilitation' - that range of processes, procedures and personnel which seeks to support National Health Service primary care patients in their uptake and use of online services. Identify, characterise and explore the potential benefits and challenges associated with different models of digital facilitation currently in use in general practice which are aimed at improving patient access to online services in general practice in England. Use the resulting intelligence to design a framework for future evaluations of the effectiveness and cost effectiveness of such interventions. Explore how patients with mental health conditions experience digital facilitation and gauge their need for this support. Observational mixed-methods study (literature review, surveys, ethnographic observation and interviews); formal synthesis of findings. General practice in four regions of England. Practice survey: 156 staff. Patient survey: 3051 patients. Mental health survey: 756 patients. General practitioner patient survey: 3 million responders. Ethnographic case-studies: 8 practices; interviews with 36 staff, 33 patients and 10 patients with a mental health condition. Stakeholder interviews: 19 participants. Digital facilitation as undertaken in general practice. Patient and practice staff reported use of, and views of, digital facilitation. Surveys, qualitative research; national General Practitioner Patient Survey (2019-22). Scoping-review methodology applied to academic and grey literature published 2015-20. While we did find examples of digital facilitation in routine practice, these often involved using passive or reactive modes of support. The context of COVID, and the necessary acceleration (at that time) of the move to a digital-first model of primary care, shaped the way digital facilitation was delivered. There was lack of clarity over where the responsibility for facilitation efforts lay; it was viewed as the responsibility of 'others'. Patients living with mental health conditions had similar needs and experiences regarding digital facilitation to other patients. The context of the COVID pandemic placed limitations on the project. Fewer practices responded to the practice survey than anticipated; reconfiguration of general practices to support COVID measures was a key consideration during non-participant observation with social distancing and other measures still in place during fieldwork. Digital facilitation, while not a widely recognised concept, is important in supporting the move to a National Health Service with enhanced digital opportunities and enhanced digital access. General practice staff are allocating resources to provide such efforts in general practices in England. The establishment of clear lines of responsibility, the development of digital tools and platforms that work for patients and practice staff, and investment in staff time and training are needed if digital facilitation is to support the intended digital revolution. We did not find one single dominant or preferred model of digital facilitation which might reasonably be considered to form the basis of an intervention to be tested. Rather, there is a need to co-develop such an intervention with patients, general practice staff and relevant policy experts. We outline a framework for a future evaluation of such an intervention. This study is registered as ResearchRegistry6523 (www.researchregistry.com/browse-the-registry#home/?view_2_search=Di-Facto&view_2_page=1) and PROSPERO CRD42020189019 (www.crd.york.ac.uk/prospero/display_record.php?RecordID=189019). This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128268) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 32. See the NIHR Funding and Awards website for further award information.

Crisis checklist for critical event debriefings: Findings from a mixed-methods study

BackgroundPerioperative critical events (e.g., anaphylaxis, cardiac arrest) are common life-threatening emergencies across health systems but may be infrequent at the level of the individual clinician. Proximal debriefing shortly after such events has been promoted in the medical literature and via simulation, however the gap between principle and practice is poorly understood. We sought to study the patterns and components of these debriefs based on real-life events. MethodsIn this observational mixed-methods study, anesthesia providers in perioperative care areas and intensive care units from an academic medical center who recently experienced a perioperative critical event were queried regarding patterns of critical event debriefing and invited to participate in a semi-structured interview. We measured the types and location of critical events, rate of debriefing, and supporting themes surrounding the event. ResultsOver a six-month period, 81 critical events were queried, of which 28 (35 %) were debriefed. Common events included significant/prolonged hypotension and/or hypoxemia (33 %), cardiac arrest (27 %), and massive hemorrhage (21 %). Common event locations included operating room (70 %), nonoperating room anesthesia (10 %), and intensive care unit (7 %). Of the events queried, 51 events had a semi-structured interview. The themes for an ideal debriefing aligned with the themes of performing a Welfare check, assessing Acute corrections, soliciting Team reactions, allowing for medical Education, and providing supportive Resources. ConclusionOne-third of perioperative critical events were proximally debriefed. Themes from involved anesthesiology personnel revealed desirable components of a practical and brief real-time proximal debriefing. A checklist encompassing a review of the literature, multidisciplinary expertise, and lessons from this mixed-methods work has the potential to improve the quantity and quality of debriefing that is often absent in the aftermath of a perioperative critical event.

O-109 Reproductive health education: collaborative design of a learning platform for secondary school education involving reproductive health experts, pupils, and teachers

Abstract Study question Which reproductive health information do pupils miss in their education and what is the optimal way of building a learning platform to close that gap? Summary answer Teachers and students alike would welcome a novel fertility education platform. Ideally, the platform should organize information based on the educational objectives for enhanced usability. What is known already Research on fertility awareness in the general population reveals lack of understanding among young people regarding crucial aspects of reproductive health, for example the age-related impact on fertility. Literature suggests that this knowledge gap should be addressed through diverse channels, including schools. Presently, school sexual education predominantly concentrates on preventing unwanted pregnancies and sexually transmitted diseases. Notably, the updated educational objectives in Flemish Secondary Education have recently incorporated the influence of lifestyle factors on fertility. Consequently, teachers have been urged to create novel instructional materials centered on this crucial theme. Study design, size, duration This mixed-method observational study encompassed a baseline measurement with open and closed questions among 1700 third-grade secondary education pupils. Additionally, it involved focus group discussions with 6 teachers and 24 pupils. The baseline measurement occurred between February and April 2022, while the focus group interviews took place in April and May 2022. Participants/materials, setting, methods A baseline measurement examined the knowledge of secondary school pupils aged between 15 and 19 years in Flanders (Belgium), explored current sexual education topics, their evaluations, and preferences for future reproductive health education. Focus group discussions investigated optimal delivery methods and structural frameworks for fertility learning materials. Main results and the role of chance Survey results revealed that most pupils desired more information on reproductive issues, with some expressing a preference for a dedicated weekly course. Over 50% noted the absence of discussions about infertility, IVF, and egg freezing topics in school and expressed a desire for more information, a sentiment that was echoed in the focus groups with pupils. Teachers, in their focus groups, favored an online platform with structured teaching materials aligned with learning goals. With anticipated new learning goals by September 2023, teachers welcomed fertility-specific learning materials. Their preference went out to versatile resources (videos, quizzes, infographics) rather than ready-made courses or presentations, providing flexibility in lesson integration. Considering these insights, the following platform was developed: www.allesovervruchtbaarheid.be/en. Ongoing refinement occurred through workshops where teachers provided feedback for further enhancements to meet their instructional needs. Limitations, reasons for caution A limited number of motivated teachers participated in the focus group discussions. Structured feedback collection has not taken place yet but is scheduled for February 2024. Wider implications of the findings Implementing fertility education in secondary schools poses challenges due to an overloaded curriculum. The introduction of new learning goals, including one on the impact of lifestyle on fertility, provided an opportune momentum to integrate a fertility education learning platform. Trial registration number not applicable

Exploring the Potential of an Eye Tissue Donor Reporting App in Enhancing the Procurement of Corneal Donors: Mixed Methods Observational Study.

The availability of donated eye tissue saves and enhances vision in transplant recipients; however, the current demand for tissue surpasses the available supply. Corneal donor shortages lead to increased wait times, delayed surgeries, prolonged visual impairment, and increased inconvenience to patients requiring eye tissue transplantation. A web-based application was previously developed to facilitate easy and intuitive submission of potential donor information. The primary objectives of this study were to assess health care professionals' attitudes toward the potential application and evaluate its effectiveness based on user feedback and donor registrations through the application. Researchers used a mixed methods approach, commencing with a literature review to identify challenges associated with donor procurement. Stakeholder interviews were conducted to gauge health care professionals' perspectives regarding the application. User feedback was collected through questionnaires, surveys, and interviews to assess the application's usability and impact. An assessment of the reported potential donors and questionnaire responses were analyzed. The final version of the application successfully reported 24 real cornea donors. Among 64 health care providers who used the application to communicate about potential donors, 32 of them submitted trial entries exclusively for testing purposes. The remaining 8 health care professionals reported potential donors; however, these individuals did not meet the donor qualification criteria. The majority of participants found the application user-friendly and expressed their readiness to use it in the future. Positive ratings were assigned to the layout, appearance, purpose, and specific features of the application. Respondents highlighted the automatic sending of notifications via SMS text messages and the integration of all necessary documents for donor qualification and tissue collection as the most valuable functions of the application. The study indicates that donor reporting applications offer promising solutions to enhance tissue donor procurement. This application streamlined the reporting process, reduced paperwork, facilitated communication, and collected valuable data for analysis.

Feasibility and acceptability of measuring positivity resonance in nurse-patient telehealth videoconferencing visits: A mixed-methods observational study.

To investigate the feasibility and acceptability of the training process, procedures, measures and recruitment strategies necessary for a future investigation to test the reliability and validity of using positivity resonance measures in health care encounters. Although the measurement of positivity resonance is promising, and non-participant observation is considered effective, their approaches to studying nurse-patient relationships have not been fully explored. A mixed-methods observational study. Video recordings of 30 nurse-patient dyads completing telehealth video visit encounters were edited and coded using behavioural indicators of positivity resonance. A post-visit survey gathered data on the participants' perceptions of positivity resonance and the study procedures. The research team completed memos and procedural logs to provide narrative data on the study's training, coding, recruitment and operational procedures. The study included 33 persons with cancer and 13 oncology nurses engaging in telehealth video visit encounters at an academic oncology ambulatory care center located in the southeastern United States. Study procedures were found to be feasible and acceptable to participants. An adequate sample of participants (N = 46) were enrolled and retained in the study. Interrater reliability, as evidenced by Cohen's weighted kappa, ranged from .575 to .752 and interclass correlation coefficients >.8 were attainable within a reasonable amount of time and with adequate training. Behavioural indicators of positivity resonance were observed in all telehealth visits and reported by the participants in the perceived positivity resonance survey. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist guided reporting. Designing research around the concept of positivity resonance is an innovative and feasible approach to exploring how rapport is cultivated within nurse-patient relationships. Measuring positivity resonance may hold promise for exploring patient and nurse outcomes including trust, responsiveness, health-related behaviours, well-being, resilience and satisfaction. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist guided the reporting of results to ensure that adequate details of the study were provided to ensure an accurate and complete report. Planning of the research design and study procedures was done in consultation with nurse clinicians with experience with telehealth and managers responsible within the practice setting where the study was conducted. This ensured the study procedures were ethical, safe, secure and did not create unnecessary burden to the study participants. The study included collecting data from nurse and patient participants about the acceptability of the study procedures.

Legal Services for Veterans (LSV): Protocol for evaluating the grant-based LSV initiative supporting community organizations' delivery of legal services to veterans.

1.8 million Veterans are estimated to need legal services, such as for housing eviction prevention, discharge upgrades, and state and federal Veterans benefits. While having one's legal needs met is known to improve one's health and its social determinants, many Veterans' legal needs remain unmet. Public Law 116-315 enacted in 2021 authorizes VA to fund legal services for Veterans (LSV) by awarding grants to legal service providers including nonprofit organizations and law schools' legal assistance programs. This congressionally mandated LSV initiative will award grants to about 75 competitively selected entities providing legal services. This paper describes the protocol for evaluating the initiative. The evaluation will fulfill congressional reporting requirements, and inform continued implementation and sustainment of LSV over time. Our protocol calls for a prospective, mixed-methods observational study with a repeated measures design, aligning to the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) and Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) frameworks. In 2023, competitively selected legal services-providing organizations will be awarded grants to implement LSV. The primary outcome will be the number of Veterans served by LSV in the 12 months after the awarding of the grant. The evaluation has three Aims. Aim 1 will focus on measuring primary and secondary LSV implementation outcomes aligned to RE-AIM. Aim 2 will apply the mixed quantitative-qualitative Matrixed Multiple Case Study method to identify patterns in implementation barriers, enablers, and other i-PARIHS-aligned factors that relate to observed outcomes. Aim 3 involves a mixed-methods economic evaluation to understand the costs and benefits of LSV implementation. The LSV initiative is a new program that VA is implementing to help Veterans who need legal assistance. To optimize ongoing and future implementation of this program, it is important to rigorously evaluate LSV's outcomes, barriers and enablers, and costs and benefits. We have outlined the protocol for such an evaluation, which will lead to recommending strategies and resource allocation for VA's LSV implementation.

Self-stigma, career development and employment in young adults with ASD in Chile.

IntroductionStigma describes prejudicial attitudes, negative stereotypes, and discrimination targeting a subgroup. Various forms of stigma have been identified in the literature, including self-stigma. Self-stigma or internalized stigma occurs when stigmatized individuals become aware of the negative stereotypes and apply these to themselves. Self-stigma may be a barrier to career development and employment in individuals with Autism Spectrum Disorder (ASD). However, there are few data available on the presence of self-stigma among young adults with ASD in Chile to inform local interventions and policies.ObjectivesTo analyze self-stigma and its relation with career development and employment in young adults with ASD in Chile.MethodsA mixed-method observational study was conducted to analyze self-stigma and its association with career development and employment among young adults with ASD in two regions of Chile. For the quantitative analysis, self-stigma was assessed using the Internalized Stigma of Mental Illness (ISMI) scale, and employment information was collected. For the qualitative analysis, in-depth interviews were conducted. Data from the interviews were digitalized and transcribed, and the analysis was conducted using ATLAs.ti following the principles of Glaser and Strauss’s Grounded Theory. All participants provided written informed consent, and the study was approved by the local Institutional Review Board.ResultsOverall, 356 participants were included in the quantitative analysis (mean age: 27.8 [SD 6.2] years, 44.7% women, 14.8% with regular employment). The mean ISMI for the total sample was 2.34 (SD = 0.62). By triangulating this information with the qualitative analysis (n=27), it was observed that young adults with ASD frequently experience self-stigma attitudes. Through the in-depth interviews, we identified barriers and facilitators for the development of self-stigma. Also, we identified that negative self-perceptions among young adults with ASD may be a barrier to seeking career development opportunities and employment in this population.ConclusionsThe current study shows self-stigma is present in young adults with ASD in Chile, and this may impact negatively their career development and employment.Disclosure of InterestNone Declared

Complications Rate and a Multidimensional Analysis of Their Causes of Tube Thoracostomy: A Mixed-Methods Study.

Tube thoracostomy (TT) complications are common in respiratory medicine. However, the prevalence of complications and risk factors is unknown, and data on countermeasures are lacking. This was a mixed-methods retrospective observational and qualitative study. This retrospective observational study included TT performed on patients admitted to the Department of Respiratory Medicine at our University Hospital between January 1, 2019, and August 31, 2022 (n=169). The primary endpoint was the incidence of TT-related complications. We reviewed the association between complications and patient- and medical-related factors as secondary endpoints. In this qualitative study, we theorized the background of physicians' susceptibility to TT-related complications based on the grounded theory approach. Complications were observed in 20 (11.8%) of the 169 procedures; however, they were unrelated to 30-day mortality. Poor activities of daily living (odds ratio 4.3, p=0.007) and regular administration of oral steroids (odds ratio 3.1, p=0.025) were identified as patient-related risk factors. Physicians undergoing training caused the most complications, and the absence of a senior physician at the procedure site (odds ratio 3.5, p=0.031) was identified as a medical risk factor. Based on this qualitative study, we developed a new model for TT complication rates consistent with the relationship between physicians' professional skills, professional identity, and work environments. Complications associated with TT are common. Therefore, it is necessary to implement measures similar to those identified in this study. Particularly, a supportive environment should be established for the training of physicians.

An exploration of patient and pharmacist willingness to utilize a food insecurity screening tool in supermarket-based pharmacies

BackgroundFood insecurity (FI) is a disturbance of eating patterns due to lack of resources, preventing consistent access to healthy foods. FI negatively impacts health outcomes and increases care cost. ObjectivesThe primary objective was to (a) explore patient willingness to screen with the 2-question Hunger Vital Sign tool and (b) accept education regarding food assistance programs at their community pharmacy. The secondary objective was to gauge pharmacy personnel’s comfort with utilizing the screener and providing education. Practice descriptionScreenings occurred from February to May 2023 at supermarket-based pharmacies in counties above state average FI prevalence. Practice innovationThis study evaluated responses to a 9-item FI screening questionnaire that was offered to patients presenting to the pharmacy. Personnel offered patients education about resources and documented responses. Pharmacies provided survey responses to detail their experiences. Evaluation methodsThis mixed-methods observational pilot study received approval from Idaho State University’s institutional review board. Objective 1(a) was assessed by recording the number of patients agreeing or declining to participate. Objective 1(b) was evaluated by recording the number of patients who accepted education. The secondary objective was appraised by gathering survey responses from personnel. Results were analyzed with descriptive statistics. ResultsOf patients asked to participate, 163 (73.1%) agreed. Forty-one agreed but did not submit responses. Of patients agreeing, 123 (75.5%) accepted education. Of patients submitting responses, 56 (49.5%) screened as at-risk for FI. Regarding comfort engaging in the innovation, 4 pharmacies (50.0%) reported being comfortable, 3 (37.5%) neither comfortable nor uncomfortable, and 1 (12.5%) uncomfortable. Qualitative information collected from personnel highlighted meaningful interactions and how this will change their approach to pharmacy practice. ConclusionSupermarket-based pharmacists may be able to detect and educate on FI. Patients in the study screened at a higher rate of at-risk for FI than their counties reported. Many patients accepted education regardless of screening results.

Assessment of treatment expectations in women with suspected endometriosis: A psychometric analysis

Background Treatment expectations influence clinical outcomes in various physical and psychological conditions; however, no studies have explored their role in endometriosis treatment. It is necessary to understand how these expectations can be measured to study treatment expectations and their effects in clinical practice. This study aimed to psychometrically analyze and compare different treatment expectation measurements and describe treatment expectations in women with suspected endometriosis. Method Analysis of cross-sectional baseline data of a mixed-method clinical observational study of N=699 patients undergoing laparoscopy in Germany. Descriptives, bivariate associations, convergent and discriminant validity of four expectation measurements (Treatment Expectation Questionnaire (TEX-Q); Generic rating scale for previous treatment experiences, treatment expectations, and treatment effects (GEEE); numerical rating scales (NRS) assessing improvement and worsening of endometriosis symptoms, expected Pain Disability Index (PDI); range: 0 to 10) were estimated. A cluster analysis was performed on the three GEEE items. Results Most participants expected high improvement (M=6.68 to 7.20, SD=1.90 to 2.09) and low worsening (M=1.09 to 2.52, SD=1.80 to 2.25) of disability from laparoscopy. Participants who expected greater worsening expected more side effects (r=.31 to .60, p&lt;.001). Associations between the positive and negative expectation dimensions, including side effects, were small to non-significant (r =|.24| to .00, p&lt;.001 to.978). Four distinct clusters, described as’positive’, ‘no pain, no gain’, ‘diminished’, and ‘uniform’ were found, with a total PVE of 62.2%. Conclusions Women with suspected endometriosis reported positive expectations concerning laparoscopy, but wide ranges indicated interindividual differences. Treatment expectations seem to be a multidimensional construct in this patient group. The investigated measurements did not correlate to the extent that they measured exactly the same construct. The selection of measurements should be carefully considered and adapted for the study purposes. Clusters provide initial indications for individualized interventions that target expectation manipulation. Trial Registration Number ID NCT05019612 (ClinicalTrials.gov)

Barriers, Facilitators of Iron and Folic Acid Supplementation, and Deworming Program among School-Going Adolescents of Deoghar, Jharkhand, India: A Mixed-Methods Study.

This study aimed to identify barriers and facilitators of iron and folic acid supplementation and deworming programs among school-going adolescents. A mixed-method observational study was conducted among adolescents in the 8th to 10th standards and their teachers across four schools in Deoghar, Jharkhand, India, using simple random sampling. The study included a questionnaire on socio-demographics, knowledge (34 items) (α=0.894), attitudes (2 items) (α=0.711) toward iron deficiency anemia, awareness of the Weekly Iron and Folic Acid Supplementation (WIFS) program and deworming (20 items) (α=0.783), and practices related to iron folic acid supplementation (IFS) and deworming, along with qualitative components. Data were analyzed using jamovi. Compliance rates for IFS and deworming were 27.5% and 67.9%, respectively. The multivariable logistic regression analysis showed that sex, religion, caste, father's educational status, per capita monthly family income (PCMI), diet type, adequate knowledge, and positive attitude toward anemia influenced IFS compliance. Religion, PCMI, and prior information on the importance of deworming facilitate compliance. Implementation barriers included irregular medication supply and a lack of student awareness. Periodic evaluation, regular sensitization, and a consistent drug supply are necessary to effectively implement WIFS and deworming programs in the study area.

Assessment of acceptability of black wheat flour products and factors affecting it among Anganwadi beneficiaries and workers: A mixed-method prospective observational study.

Malnutrition is very common in India and black wheat might be an acceptable solution to this problem. The aim of the study was to assess acceptability of black wheat flour products and factors affecting it among Anganwadi beneficiaries and workers. This was a mixed-method prospective observational study. All the family members enrolled for supplementary nutrition and Anganwadi workers/helpers of three randomly selected Anganwadi centers were taken in the study. For qualitative data, in-depth interview was done, and for quantitative data, 9-point hedonic scale was administered. Braun and Clarke's six-phase data analysis framework was used for qualitative data. A total of 16 pregnant females, 14 lactating females, 16 children, 2 Anganwadi workers, and 3 Anganwadi helpers participated in the study. Thematic analysis of the data revealed five significant themes. It included characteristics of black wheat flour, the process of making the product (experience of making the product), family acceptability, availability, and hygiene. Participants expressed that the black color appearance is one of the negative influencers in the acceptability of black wheat flour. Most of the participants liked the taste as well as the texture. However, kneading, rolling, and puffing were more challenging than traditional wheat flour. On the hedonic scale, the mean rank of acceptability is lowest for color (3.03), followed by puffing (3.49) and highest for texture (4.87) and taste (4.60). Our study results revealed that black wheat is acceptable to the Anganwadi beneficiaries and workers.

Kaumātua needs and perspectives regarding urban papakāinga: a mixed methods observational study

ABSTRACT Safe, secure, suitable housing is often an unattainable reality for kaumātua (older Māori aged 55 years and over in this study) in Aotearoa New Zealand. Kaumātua, unfortunately, are at the forefront of the housing crisis, and struggle to find housing which meets their most basic needs. Therefore, many organisations are considering the development of urban papakāinga to meet their needs. The purpose of this study is to assess the needs of kaumātua currently in temporary, emergency or state housing situations to understand their perspectives about what factors enable successful urban papakāinga. The research design and methodology in this article apply a multi-method observational approach, guided by the He Pikinga Waiora (HPW) Implementation Framework. The main findings in this study include five cultural characteristics necessary within urban papakāinga developments; whanaungatanga (connections); kaitiakitanga (environmental care/ guardianship); manaakitanga (care for others); rangatiratanga (leadership, autonomy, or control); and haumarutanga (safety/security). In addition, key correlates of wellbeing indicators included housing suitability, community connection and a safe neighbourhood. These key needs and perspectives have important theoretical and practical implications for kaumātua wellbeing, and successful housing developments for Māori. Glossary of Kupu Māori words: Aotearoa: Māori name of New Zealand; haumarutanga: security, safety, or peace of mind; kaitiakitanga: environmental care, guardianship, or stewardship; kaumātua: older Māori aged 55 years and over; kaupapa Māori: Māori approach; koroua: older male; kuia: older female; manaakitanga: generosity, cherish, respect, care and hospitality; Māori: Indigenous people of Aotearoa-NZ; papakāinga: traditional Māori housing/community complex; Papatūānuku: Earth Mother; rangatiratanga: leadership, self-determination, autonomy, or control; Te Puāwaitanga o Ngā Waka: The Blossoming of Aspirations for All; tikanga: correct custom, procedure, or protocol; tūrangawaewae: a place of strength, belonging, connection, a place to stand; urban papakāinga: modern Māori housing/urban intergenerational village; wairuatanga: spirituality; whakapapa: decent, lineage, ancestor, or genealogy; whānau: family or closely connected kin group; whanaungatanga: connectedness, kinship, or relationships

Perceived potentially inappropriate treatment in the PICU: frequency, contributing factors and the distress it triggers.

Potentially inappropriate treatment in critically ill adults is associated with healthcare provider distress and burnout. Knowledge regarding perceived potentially inappropriate treatment amongst pediatric healthcare providers is limited. Determine the frequency and factors associated with potentially inappropriate treatment in critically ill children as perceived by providers, and describe the factors that providers report contribute to the distress they experience when providing treatment perceived as potentially inappropriate. Prospective observational mixed-methods study in a single tertiary level PICU conducted between March 2 and September 14, 2018. Patients 0-17 years inclusive with: (1) ≥1 organ system dysfunction (2) moderate to severe mental and physical disabilities, or (3) baseline dependence on medical technology were enrolled if they remained admitted to the PICU for ≥48 h, and were not medically fit for transfer/discharge. The frequency of perceived potentially inappropriate treatment was stratified into three groups based on degree of consensus (1, 2 or 3 providers) regarding the appropriateness of ongoing active treatment per enrolled patient. Distress was self-reported using a 100-point scale. Of 374 patients admitted during the study, 133 satisfied the inclusion-exclusion criteria. Eighteen patients (unanimous - 3 patients, 2 providers - 7 patients; single provider - 8 patients) were perceived as receiving potentially inappropriate treatment; unanimous consensus was associated with 100% mortality on 3-month follow up post PICU discharge. Fifty-three percent of providers experienced distress secondary to providing treatment perceived as potentially inappropriate. Qualitative thematic analysis revealed five themes regarding factors associated with provider distress: (1) suffering including a sense of causing harm, (2) conflict, (3) quality of life, (4) resource utilization, and (5) uncertainty. While treatment perceived as potentially inappropriate was infrequent, provider distress was commonly observed. By identifying specific factor(s) contributing to perceived potentially inappropriate treatment and any associated provider distress, organizations can design, implement and assess targeted interventions.