Mixed-methods Observational Study Research Articles

Supporting children's wellbeing through outdoor time: opportunities to integrate consistent outdoor time into the elementary school day.

Time in nature supports cognitive, psychological, academic, and health benefits. Outdoor time during school can provide young people with equitable access to these benefits, however, there are within-school constraints. Understanding if and how teachers can frequently and consistently incorporate outdoor time in the schoolyard into their classroom activities can inform broader implementation. A mixed-methods observational study was conducted with 17 teachers from five elementary schools. Teachers reported on how they incorporated outdoor time into their classes over an eight-week period. Data on outdoor time, activities, locations, barriers, motivations, and facilitators were collected through surveys on 15 randomly pre-selected days, and through a post-survey. On the 15 randomly selected days surveyed, classes went outside 78% of the time, ranging from 6-15 outdoor days per class, and 0-285 min per day. Time, activities, locations, motivations, barriers, and facilitators varied across classes and days. The most common activities were free play (n = 138) and intentional engagement with nature (n = 57). Health benefits (n = 68) and having time (n = 58) were the most common motivations teachers reported for incorporating outdoor time. Consistent outdoor time in the school day can support students' wellbeing and academic success. Encouraging free play, highlighting the health benefits, using a systems approach, and flexible implementation may help teachers increase their use of outdoor time during the school day. Teachers consistently incorporated outdoor time, but implementation varied across classes and days. Implementation findings from this district could help inform practices at other schools.

Group text messaging as a residency teaching tool in outpatient neurology and headache: A mixed-methods observational study.

To assess the feasibility and efficacy of group text messaging as a teaching tool to improve neurology resident knowledge and clinical pearl dissemination in an outpatient setting enriched with headache encounters, and to evaluate if learning points from this teaching method would influence resident care of subsequent patients. Inpatient neurology teaching during training is most often accomplished in team settings during rounds or conferences such as morning report, but outpatient teaching where headache is more likely encountered may be less consistently performed in such a setting where learning points may be shared. Few studies have evaluated whether group text messaging can be an innovative tool for teaching in residency training. Neurology residents in a continuity clinic pod at New York Presbyterian-Weill Cornell were included in this cohort from December 2020 through March 2024. Group text messages deidentified of any patient information were sent to the resident pod by their preceptor after each clinic session featuring one text message regarding a takeaway learning point pertaining to each patient encounter. Residents were surveyed on their satisfaction with this teaching method and whether these text messages improved their outpatient neurology knowledge. A total of 230 text messages were sent to a cohort of 21 residents across 4 academic years. Text message topics covered a variety of neurological subspecialties, most commonly headache and facial pain (44.8%), general neurology (15.7%), and neuromuscular (14.3%). In our survey, 93% of resident respondents reported that receiving clinical pearls improved their outpatient neurology knowledge and changed how they cared for subsequent patients. Reinforcement of traditionally one-on-one learning points in a teaching outpatient setting to engage a group of residents was feasible across visit types. There was an overall very positive response to this teaching method, and residents reported improved knowledge, which influenced their care of subsequent patients.

Usability of an automated medication dispensation device and adherence dashboard: A study protocol.

Non-adherence to prescribed medication regimens can lead to suboptimal control of chronic health conditions and increased hospitalizations. Older adults may find it particularly challenging to self-manage medications due to physical and cognitive limitations, resulting in medication non-adherence. While automated medication dispensing technologies may offer a solution for medication self-management among older adults, these technologies must demonstrate usability before effectiveness can be investigated and products made available for widespread use. This study will aim to measure usability, workload, and unassisted task completion rates of an automated medication dispenser and medication adherence dashboard on the Medipense portal with older adults and their clinicians, respectively. This study is designed as a convergent parallel mixed-methods observational study with older adults and their clinicians. Usability will be examined with the use of the System Usability Scale (SUS) while NASA Load Index (NASA-TLX) will be utilized to assess the workload of both the device and the adherence monitoring platform. Cognitive walkthrough will be utilized prior to usability testing to identify series of steps required to use the automated dispenser and adherence dashboard. The study will assess the unassisted task completion rates to successfully operate the device. Semi-structured interviews with both types of participants will provide qualitative data with which to comprehensively gauge the automated dispenser user experience. The results of this study will allow us to examine usability of both the automated medication dispensing system and the adherence monitoring dashboard from older adult and health-care provider perspectives. The results of this study will highlight and address the challenges with usability that older adults and health-care providers may face with this device and dashboard. The results of this study will be used to optimize the usability of both the automated medication dispenser and the adherence dashboard. In clinical practice, usability of technology is important to establish prior to full-scale implementation. Products that are not user friendly, add to workload, impact workflow, or are difficult to navigate by both clinicians and population in general may not be adopted. Usability permits an evaluation of the products, to identify problems that must be addressed prior to implementation and to ensure products are useful in clinical practice.

Midwives as trainers for a neonatal clinical decision support system at four rural health facilities in eastern Uganda: a mixed-methods observational study

ObjectivesTo evaluate acceptability and effectiveness of midwives as trainers for NoviGuide, a neonatal clinical decision support system (CDSS).DesignA 20-months, mixed-methods open cohort study.Settings and participantsNurse-midwives at four rural health facilities...

Exploring accessibility, user experience and engagement of digital media among older patients with depression: a pilot and observational screening study protocol of the DiGA4Aged study

IntroductionThe prevalence of mental health problems is increasing worldwide, particularly in the vulnerable group of older people. The limited availability of therapists, long wait periods and increasing shortage of healthcare...

Virtual Hospitals and Patient Experience: Protocol for a Mixed Methods Observational Study.

Virtual care is increasingly incorporated within routine health care settings to improve patient experience and access to care. A patient's experience encompasses all the interactions an individual has with the health care system. This includes a greater emphasis on actively involving carers in the decisions and activities surrounding a patient's health care. This study aimed to investigate the variety of health care delivery challenges encountered in a virtual hospital and explore potential ways to improve the patient experience. Focusing on acute respiratory, this protocol outlines a mixed methods study exploring the patient experience of a virtual hospital in Australia, Royal Prince Alfred Virtual Hospital (rpavirtual). We will use an exploratory mixed methods approach comprising of secondary data analysis, observations, interviews, and co-design focus groups. Participants will include patients, their carers, and health care workers who are involved in the acute respiratory virtual hospital model of care. Together, the data will be triangulated to explore views and experiences of using this model of care, as well as co-designing recommendations for further improvement. Findings from this study will identify current barriers and facilitators to implementing virtual care, such as work-as-done versus work-as-imagined, equity of care, the role of carers, and patient safety during virtual care. As of August 2024, a total of 25 participants have been interviewed. This protocol outlines a mixed methods case study on the acute respiratory model of care from Australia's first virtual hospital, rpavirtual. This study will collect the experiences of patients, carers, and health care workers to co-design a series of recommendations to improve the patient experience. DERR1-10.2196/58683.

Examining the complex dynamics influencing acute malnutrition in Turkana and Samburu counties: Study protocol.

Acute malnutrition in children under 5 years is persistent in Eastern Africa's arid and semiarid lands. This study aimed to identify the drivers of acute malnutrition in Turkana and Samburu counties, Kenya. This was a population-based longitudinal mixed-methods observational study. Qualitative and quantitative data were collected at Wave 1, but only quantitative data were collected during follow-up. Participants were a representative sample of children and their primary caregivers from households with children under 3 years at Wave 1. Anthropometric measurements of all children under 5 years in the sampled households were taken at Wave 1 (May to July 2021), and one child under 3 years was randomly selected for follow-up about every 4 months over 2 years for six data collection waves. The study also collected data on sociodemographics; child feeding practices and morbidity; household water and food insecurity; shocks; coping strategies, social safety nets and economic safeguards; water, sanitation and hygiene; women's decision-making and food consumption. Qualitative data were collected through community dialogues, focus group discussions, in-depth interviews, photovoice and key informant interviews with mothers and fathers with children under 5 years, community leaders, county officials and staff of nongovernmental organisations. Data collection is complete and analysis is ongoing. The analysis includes thematic analysis of qualitative data and descriptive and multi-variable regression analyses of quantitative data.

Improved macronutrient composition of meals delivered to people with diabetes in hospital: a pre-post, mixed-methods observational study.

Providing meals which meet diverse needs of hospital inpatients is complex, contributing to challenges in optimising glycaemia. We developed menus that improved the appropriateness of macronutrient composition of meals for inpatients with diabetes. Qualitative feedback from patients and healthcare professionals prompted the implementation of two new menus: 'diabetes lifestyle' and 'diabetes high energy'. Quantitative nutrition analysis of meals provided to inpatients using new menus was compared to the regular menu. Qualitative surveys were repeated after the implementation of the new menus. Nutrition analysis demonstrated that meals ordered from the diabetes lifestyle menu (mean energy: 7.85 MJ) comprised less total fat (71 vs. 74 vs. 64 g, p < 0.001), saturated fat (34 vs. 36 vs. 31 g, p < 0.001), carbohydrate (246 vs. 249 vs. 217 g, p < 0.001) and sugar (125 vs. 121 vs. 102 g, p < 0.001) compared to the regular (mean energy: 8.46 MJ) and diabetes high energy menus (mean energy: 8.70 MJ). Meals ordered from the diabetes lifestyle menu provided greater protein (91 g) than the regular (85 g) and diabetes high energy (88 g) menus (p < 0.001) and equivalent fibre (33 vs. 31 vs. 33 g, respectively). After implementation of the new menus, more patients reported that meals met their nutritional needs (19 [95%] vs. 14 [70%], p = 0.04), and more healthcare professionals reported menus for inpatients with diabetes were appropriate (16 [100%] vs. 11 [41%], p < 0.001). Using the diabetes lifestyle menu improved the macronutrient composition of meals for inpatients with diabetes not at risk of malnutrition.

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.