Mixed Methods Qualitative Study Research Articles

Development of a core outcome set for informed consent for therapy: An international key stakeholder consensus study

Background300 million operations and procedures are performed annually across the world, all of which require a patient’s informed consent. No standardised measure of the consent process exists in current clinical practice. We aimed to define a core outcome set for informed consent for therapy.MethodsThe core outcome set was developed in accordance with a predefined research protocol and the Core OutcoMes in Effectiveness Trials (COMET) methodology comprising systematic review, qualitative semi structured interviews, a modified Delphi process and consensus webinars to ratify outcomes for inclusion in the final core outcome set. (Registration—https://www.comet-initiative.org/Studies/Details/1024). Participants from all key stakeholder groups took part in the process, including patients and the public, healthcare practitioners and consent researchers.Results36 outcome domains were synthesised through systematic review and organised into a consent taxonomy. 41 semi-structured interviews were performed with all consent stakeholders groups. 164 participants from all stakeholder groups across 8 countries completed Delphi Round 1 and 125 completed Round 2. 11 outcomes met the ‘consensus in’ criteria. 6 met ‘consensus in’ all stakeholder groups and were included directly in the final core outcome set. 5 remaining outcomes meeting ‘consensus in’ were ratified over two consensus webinars. 9 core outcomes were included in the final core outcome set: Satisfaction with the quality and amount of information, Patient feeling that there was a choice, Patient feeling that the decision to consent was their own, Confidence in the decision made, Satisfaction with communication, Trust in the clinician, Patient satisfaction with the consent process, Patient rated adequacy of time and opportunity to ask questions.ConclusionThis international mixed-methods qualitative study is the first of its kind to define a core outcome set for informed consent for intervention. It defines what outcomes are of importance to key stakeholders in the consent process and is a forward step towards standardising future consent research.

Developing an intrauterine device self-removal guide: a mixed methods qualitative and small pilot study

BackgroundThe intrauterine device (IUD) is a highly effective form of long-acting reversible contraception (LARC) with few contraindications. Users, however, often encounter barriers to desired removal. IUD self-removal may mitigate these obstacles. We sought to develop a guide for IUD self-removal with the aim of increasing user control over the method.MethodsThis was a two-phase mixed-methods qualitative and small pilot study with the aim of developing an IUD self-removal guide. We conducted an online content analysis of advice for IUD self-removal as well as interviews with expert key informants to develop an IUD self-removal guide. We next recruited IUD-users who had previously attempted self-removal to participate in focus group discussion and individual interviews to further refine the guide. In the second phase of the study, we piloted the guide among eight IUD-users seeking removal interested in attempting self-removal.ResultsExpert key informants agreed that IUD self-removal was safe and low risk. The primary components of successful IUD self-removal elicited were ability to feel and grasp the strings, a crouched down position, and multiple attempts. A preference for presenting IUD self-removal as safe was emphasized. In the second phase, participants in the clinical pilot suggested more information for non-palpable strings, but liked the style and information provided. One participant successfully removed their IUD.ConclusionsIUD-users reported satisfaction with our guide. In our small pilot, the majority were unable to remove their own IUD. A larger study is needed to assess acceptability, feasibility, and efficacy in increasing successful self-removal.

Exploring the changes and challenges of COVID-19 in adult safeguarding practice: qualitative findings from a mixed-methods project

PurposeThe purpose of this paper is to present findings from a mixed-methods study on the impact that COVID-19 has had on adult safeguarding. The research sought to explore the challenges and opportunities presented by COVID-19 to both frontline and non-frontline professionals working in adult safeguarding.Design/methodology/approachA mixed-methods project was undertaken comprising a literature review, survey, semi-structured interviews and a small number of freedom of information requests. This paper presents the findings predominantly from the survey and interviews.FindingsUnsurprisingly, COVID-19 has presented a variety of challenges for professionals working in adult safeguarding. The themes that occurred most often were the day-to-day changes and challenges, relationships across sectors, information and navigating the ethical questions in safeguarding.Originality/valueTo the best of the authors’ knowledge, the findings represent the first focused qualitative mixed-method study aimed at understanding more about the impact the pandemic has had on adult safeguarding through the eyes of those professionals working in that field.

Toponymic politics and the role of heritagisation in multiethnic cities in Romania

ABSTRACT Although scholars have made considerable progress in understanding the dynamics of heritagisation and toponymic politics, research is yet to explore how these may interact with each other. Drawing on a mixed-methods comparative qualitative study, this paper explores the politics of place naming and multilingualism in the context of heritagisation in three multiethnic cities in Romania: Târgu Mureş, Oradea and Baia Mare. We argue that the recent trends of heritagisation introduce a new element in the politics of place naming in ethnically diverse cities. Heritage becomes inclusive when it loses its importance in the power struggle between minority and majority political representatives. Once the demographic weight of the minority decreases and the appearance of minority language in public space does not anymore pose a threat to the hegemony of the majority, heritagisation initiatives – including the display of multilingual signs – may develop. In cities where ethnic proportions remain balanced, however, ethnic rivalry continues to prevail as the dominant element of toponymic politics. Nonetheless, while the simultaneous heritagisation and political commodification of historical toponyms offers better visibility for autochthonous minority communities, they equally risk eroding minority language rights under an ambiguous regime of political and economic calculation.

Determining the knowledge, attitude and practice about the environment and recycling of individuals living in a public housing compound: A quantitative, qualitative mixed method study

Background: The environment is the physical, biological, social, economic and cultural environment in which people and other living things maintain their relationships and interact throughout their lives. In this study, it was aimed to determine the knowledge, attitudes and behaviors of individuals residing in a public housing estate towards the environment and recycling. Methods: The research was designed as cross-sectional and conducted with a mixed method including both quantitative and qualitative methods. 330 of 437 residents participated in the qualitative part of the study (participation rate 75.5%) in January 2021. The quantitative part of the study was attended by 10 apartment workers. Results: 51.5% of the participants (n=170) believe that they have sufficient knowledge about recycling. However, only 38.8% of the participants (n=128) stated that they collect recyclable waste separately. The environment-emotion level of men was found to be higher (Z=-2.242, p=0.025). A statistically significant difference was found between the general level average scores in terms of marital status. In terms of “knowledge sub-levels”, the mean environmental knowledge level scores of health workers were found to be significantly higher than other occupational groups (Z=-2,460, p=0.014). Apartment workers stated 202 flats (46.2%) collect recyclable waste separately. Conclusion: To prevent the climate crisis, it is important to recycle domestic waste to protect the environment. Individuals’ recycling behavior levels can be increased with practices that aim to inform, direct and encourage recycling. In parallel with all these practices, it is important for governments to be politically determined and implement legal regulations on waste recycling.

The future of sustainable digital infrastructures: A landscape of solutions, adoption factors, impediments, open problems, and scenarios

Background:Digital infrastructures, i.e., ICT systems, or system-of-systems, providing digital capabilities, such as storage and computational services, are experiencing an ever-growing demand for data consumption, which is only expected to increase in the future. This trend leads to a question we need to answer: How can we evolve digital infrastructures to keep up with the increasing data demand in a sustainable way? Objective:The goal of this study is to understand what is the future of sustainable digital infrastructures, in terms of: which solutions are, or will be, available to sustainably evolve digital infrastructures, and which are the related adoption factors, impediments, and open problems. Method:We carried out a 3-phase mixed-method qualitative empirical study, comprising semi-structured interviews, followed by focus groups, and a plenary session with parallel working groups. In total, we conducted 13 sessions involving 48 digital infrastructure practitioners and researchers. Results:From our investigation emerges a landscape for sustainable digital infrastructures, composed of 30 solutions, 5 adoption factors, 4 impediments, and 13 open problems. We further synthesized our results in 4 incremental scenarios, which outline the future evolution of sustainable digital infrastructures. Conclusions:From an initial shift from on-premise to the cloud, as time progresses, digital infrastructures are expected to become increasingly distributed, till it will be possible to dynamically allocate resources by following time, space, and energy. Numerous solutions will support this change, but digital infrastructures are envisaged to be able to evolve sustainably only by (i) gaining a wider awareness of digital sustainability, (ii) holding every party accountable for their sustainability throughout value chains, and (iii) establishing cross-domain collaborations.

"Using the same hand": The complex local perceptions of integrated one health based interventions in East Africa.

BackgroundNeglected Tropical Diseases (NTDs) such as soil transmitted helminths (STH) and human rabies represent a significant burden to health in East Africa. Control and elimination remains extremely challenging, particularly in remote communities. Novel approaches, such as One Health based integrated interventions, are gaining prominence, yet there is more to be learned about the ways in which social determinants affect such programmes.MethodologyIn 2015 a mixed method qualitative study was conducted in northern Tanzania to determine community perceptions towards integrated delivery of two distinct healthcare interventions: treatment of children for STH and dog vaccination for rabies. In order to assess the effectiveness of the integrated approach, villages were randomly allocated to one of three intervention arms: i) Arm A received integrated mass drug administration (MDA) for STH and mass dog rabies vaccination (MDRV); ii) Arm B received MDA only; iii) Arm C received MDRV only.Principle findingsIntegrated interventions were looked upon favourably by communities with respondents in all arms stating that they were more likely to either get their dogs vaccinated if child deworming was delivered at the same time and vice versa. Participants appreciated integrated interventions, due to time and cost savings and increased access to essential health care. Analysis of qualitative data allowed deeper exploration of responses, revealing why people appreciated these benefits as well as constraints and barriers to participation in integrated programmes.Conclusions/significanceAn interdisciplinary One Health approach that incorporates qualitative social science can provide key insights into complex local perceptions for integrated health service delivery for STH and human rabies. This includes providing insights into how interventions can be improved while acknowledging and addressing critical issues around awareness, participation and underlying health disparities in remote pastoralist communities.

Oral-care adherence. Service design for nursing homes - initial caregiver reactions and socio-economic analysis.

Background: Lack of proper oral care among elderly people in nursing homes is associated with increased morbidity and hospitalisation. The ability of the individual to maintain sufficient oral self-care is difficult for caregivers to assess, and thus, caregivers often risk providing suboptimal oral care. Sensor-based tools exist that can support the caregiving staff in achieving a better understanding of who among the elderly are able to perform proper self-care, and who cannot and thus need additional assistance from caregivers. How such systems should be designed and deployed in nursing homes, and how they will be perceived by caregivers has not been investigated sufficiently yet.Objectives: The aim of this study was to gain a better understanding of how caregiving staff perceives the introduction of sensor-based systems that allow the caregivers to automatically discover who among the elderly residents are able to adhere to the given recommendation on daily oral self-care, and who among them are in need of further assistance, as well as whether there is potential for saving costs.Methods: In a mixed methods qualitative study, we visited three nursing homes where we had recently deployed, or were about to deploy, electrical toothbrushes and a basic oral-care adherence aid system. Nursing home staff was interviewed during the field studies about their initial reactions to introducing such a system as part of their daily workflow. The field study was supported by a literature review.Results: Caregiving staff welcomed the introduction of a sensor-based oral-care adherence aid system, which would identify any elderly who could no longer achieve a sufficient level of oral self-care. Improving oral care for the elderly may not only prevent serious consequential diseases, but also generate considerable savings with a return on investment of at least 1:2.5.Conclusion: Sensor-based oral-care adherence aid systems that monitor oral-care adherence, meaning the ability of the individual elderly to properly perform teeth and/or denture brushing as part of normal self-care efforts, appear useful and relevant to introduce. More work is needed to provide a better understanding of the long-term user experience of both caregiving staff and elderly. There is also a need for more high-quality long-term clinical studies of further preventive effects of oral hygiene measures and their economic benefit.

Consumer acceptance and preference for brown rice-A mixed-method qualitative study from Nepal.

BackgroundBrown rice consumption reduces the risk of diabetes. The prevalence of diabetes is increasing in Nepal; however, dietary preference remains for white rice. This study aimed to understand the perception, enablers, barriers, and facilitators of acceptance brown rice at a worksite cafeteria.MethodsWe conducted a mixed‐method qualitative research among 42 employees of a hospital in central Nepal. The participants tasted and rated the qualities of five different combinations of brown and white rice on a hedonic scale. We conducted eight focus group discussions (FGDs)—four before and four after tasting rice combinations. FGDs were recorded, transcribed, and coded verbatim and analyzed manually using inductive–deductive thematic method.ResultsBefore tasting, the participants perceived brown rice as poor in quality. After tasting, the participants found that brown rice had better quality and were willing to switch gradually starting with a 25B ratio. Eighty‐three percent of participants liked a combination of 25B. Major barriers were poor perception of its quality, tradition, unavailability, lack of awareness of health benefits, and high price. Major facilitators were availability, self and family awareness about the health benefits, knowledge, the brown rice cooking process, serving with side dishes, prior tasting, and gradual substitution of brown rice.ConclusionWe found that brown rice should be promoted stepwise, first as a mixture with white rice and gradually increasing the proportion of brown rice. Brown rice acceptance can be increased by improved knowledge of its nutrition and health benefits, increasing availability, and affordability.

Identifying actions to foster cross-disciplinary global health research: a mixed-methods qualitative case study of the IMPALA programme on lung health and tuberculosis in Africa.

ObjectivesTo identify actions for fostering cross-disciplinary research (CDR) skills and collaborations in global health, and to produce recommendations for improving the design, implementation and management of cross-disciplinary global health research programmes.DesignUsing a North–South global health research programme as a case study—and following an adapted framework—we conducted qualitative research using document reviews, semi-structured interviews (purposive sampling) and participatory observation. We used baseline survey findings to identify potential interviewees and tailor interview guides.SettingOur case study was a 4.5-year (2017–2021) programme, namely, the International Multidisciplinary Programme to Address Lung Health and Tuberculosis in Africa (IMPALA). Led by a UK research institute, IMPALA spanned 22 partner organisations from 13 countries (10 in sub-Saharan Africa), and involved five research discipline groups: clinical science, social science, health systems, health economics and policy/research capacity.ParticipantsThirty-one IMPALA members were interviewed (July 2018–November 2019), with interviewees evenly split by gender (16 female and 15 male) and by Global North/South institution (15 non-African and 16 African). Twenty-five (81%) were researchers, comprising 18 senior researchers (professors, readers, associate professors and senior lecturers) and seven early career researchers (assistant professors, lecturers, research fellows, postdocs, research assistants and PhD students). Twenty-four programme events were observed (September 2018–April 2020) and 49 documents were reviewed (December 2017–April 2020). All 66 IMPALA staff were sent the baseline survey, receiving 51 responses (43/56 researchers and 8/10 non-researchers).ResultsFourteen themes emerged, which suggested that CDR—while valued by many—is not universally understood, and the time it requires is often underestimated. We found that fostering CDR and managing tensions needs planning and continuous discussions and interactions. A shared vision with explicitly agreed goals and roles and active management of cross-disciplinary activities is essential.ConclusionsActive planning, implementation and management of cross-disciplinary activities are essential for the success of cross-disciplinary global health research and should be separate from the primary research activities.

‘Real men’ doing dirty work: implications for change

ABSTRACT Police organisations in Canada and other parts of the world, have recently undertaken efforts to address misconduct arising from high-profile reports of internal discrimination and harassment and/or instances of excessive use of force. However, these actions tend to be pursued through traditional approaches without fully understanding the contextual factors that contribute to these harmful behaviours. Through a sequential, qualitative mixed-methods study involving Canadian police officers, this paper highlights how symbolic meanings attached to police work contribute to perceptions that the work is more suitable for some individuals than others. The findings also illustrate how officers respond to identity threats from stigmatised officers or from external sources. Finally, the findings suggest that the prototypical image of a police officer may be changing with recent criticisms of the police presented as possibilities for change.

Patients\u2019 experiences treated with open-label placebo versus double-blind placebo: a mixed methods qualitative study

BackgroundThere is increasing evidence suggesting that open-label placebo (OLP) is an effective treatment for several medical conditions defined by self-report. However, little is known about patients’ experiences with OLP, and no studies have directly compared patients’ experiences in double-blind placebo (DBP) conditions.MethodsThis study was nested in a large randomized-controlled trial comparing the effects of OLP and DBP treatments in individuals with irritable bowel syndrome (IBS). We randomly selected 33 participants for interviews concerning their experiences in the parent trial. The data were qualitatively analyzed using an iterative immersion/crystallization approach. We then compared the qualitative interview data to the quantitative IBS severity data assessed during the parent trial, using a mixed methods approach.ResultsTwo prominent interview themes were identified: (1) the participants’ feelings about their treatment allocation and (2) their reflections about the treatment. Both OLP and DBP participants mentioned hope and curiosity as major feelings driving them to engage with their treatment. However, while DBP participants tended to be more enthusiastic about their allocation, OLP participants were more ambivalent. Furthermore, OLP participants reflected more on their treatment, often involving noticeable cognitive and emotional processes of self-reflection. They offered a variety of explanations for their symptom improvement and were significantly less likely to attribute it to the treatment itself than DBP participants (Χ2 [3] = 8.28; p = .041). Similarly, the participants’ retrospective narratives of symptom improvement were significantly correlated with their corresponding quantitative IBS severity scores only in DBP (p’s ≤ .006) but not in OLP (p’s ≥ .637).ConclusionOLP and DBP participants share feelings of hope, uncertainty and curiosity but differ in the extent of conscious reflection. The counter-intuitive OLP prompts more self-examination, ambivalent feelings and active engagement compared to DBP. At the same time, OLP participants are more reluctant to attribute symptom improvement to their treatment. Our findings substantially add to the emerging picture of factors that distinguish OLP and DBP and their potential mechanisms.

Exploring Study of Yogyakarta Physical Fitness Athletes in Indonesia

Background: Physical fitness training is very important for sports performance. The objective is to assess the different capacities of athletes like speed, strength, flexibility, leg muscle power, and VO₂max. The purpose of this study was: (1) to determine the current status of physical fitness of Yogyakarta athletes, (2) to compare the physical fitness performance on the standard's physical fitness value, (3) to show the effects of physical fitness on the athlete's performance. Research methodology: this is exploring research with a mixed-method qualitative and quantitative study. The sample of this study was 39 subjects from Yogyakarta. The subjects were taken randomly. The subjects were aged between 13-18 years, and they were from many various parties of Yogyakarta. The content of the training was squat jumps: 10 to 15 repetitions, standard push-ups: 10 to 15 repetitions, calf raises 15 to 20 repetitions, bench dips: 10 to 15 repetitions, abdominal crunches: 15 to 20 repetitions, jump rope: 60 seconds, plyometric exercise, sit-ups, press-ups, squats, lunges, and step-ups within three times per week for six weeks. The facts series technique was a physical battery test on the playground. Data were analyzed with descriptive statistics. The result showed that Yogyakarta athletes still have low physical fitness with a P-value of 0.000. Conclusion: Yogyakarta athletes still hold low physical fitness like speed, VO₂Max, flexibility, explosive strength, power, and coordination.

Toward Designs of Workplace Stress Management Mobile Apps for Frontline Health Workers During the COVID-19 Pandemic and Beyond: Mixed Methods Qualitative Study.

BackgroundIn recent years, mobile apps have been developed to prevent burnout, promote anxiety management, and provide health education to workers in various workplace settings. However, there remains a paucity of such apps for frontline health workers (FHWs), even though FHWs are the most susceptible to stress due to the nature of their jobs.ObjectiveThe goal of this study was to provide suggestions for designing stress management apps to address workplace stressors of FHWs based on the understanding of their needs from FHWs’ own perspectives and theories of stress.MethodsA mixed methods qualitative study was conducted. Using a variety of search strings, we first collected 41 relevant web-based news articles published between December 2019 and May 2020 through the Google search engine. We then conducted a cross-sectional survey with 20 FHWs. Two researchers independently conducted qualitative analysis of all the collected data using a deductive followed by an inductive approach.ResultsPrevailing uncertainty and fear of contracting the infection was causing stress among FHWs. Moral injury associated with seeing patients die from lack of care and lack of experience in handling various circumstances were other sources of stress. FHWs mentioned 4 coping strategies. Quick coping strategies such as walking away from stressful situations, entertainment, and exercise were the most common ways to mitigate the impact of stress at work. Peer support and counseling services were other popular methods. Building resilience and driving oneself forward using internal motivation were also meaningful ways of overcoming stressful situations. Time constraints and limited management support prevented FHWs from engaging in stress management activities.ConclusionsOur study identified stressors, coping strategies, and challenges with applying coping strategies that can guide the design of stress management apps for FHWs. Given that the pandemic is ongoing and health care crises continue, FHWs remain a vulnerable population in need of attention.

From a View of the Hospital as a System to a View of the Suffering Patient.

Purpose: Hospitals aspire to provide patient-centered care but are far from achieving it. This qualitative mixed methods study explored the capacity of hospital directors to shift from a hospital systemic-view to a suffering patient-view applying the Salutogenic theory.Methods: Following IRB, we conducted in-depth narrative interviews with six directors of the six Israeli academic tertiary public hospitals, focusing on their managerial role. In a second meeting we conducted vignette interviews in which we presented each director with a narrative of a suffering young patient who died at 33 due to medical misconduct, allowing self-introspection. Provisional coding was performed for data analysis to identify categories and themes by the three dimensions of the sense-of-coherence, an anchor of Salutogenics: comprehensibility, manageability, and meaningfulness.Results: While at the system level, directors reported high comprehensibility and manageability in coping with complexity, at the patient level, when confronted with the vignette, directors acknowledged their poor comprehensibility of patients' needs and patient's experience during hospitalizations. They acknowledged their poor capacity to provide patient-centered care. Meaningfulness in the narrative interview focused on the system while meaningfulness in the vignette interview focused on providing patient care.Conclusions: The evident gaps between the system level and the patient level create lack of coherence, hindering the ability to cope with complexity, and are barriers to providing patient-centered care. To improve the delivery of patient-centered care, we suggest ways to consolidate the views, enabling the shift from a systemic-view to a patient-view.

Stakeholders’ Perceptions of the Linkage Between Reproductive Rights and Environmental Sustainability

The fulfilment of reproductive health and rights may have a synergistic relationship to environmental sustainability because it leads to lower fertility levels. With this in mind, and with the objective of increasing the legitimacy, funding and acceptance of reproductive health and rights, I conducted a mixed-methods qualitative study consisting of an online survey followed by in-depth interviews. I reached out to two groups of participants: stakeholders of the reproductive health and rights movement, and stakeholders of the environmental sustainability movement. I explored how stakeholders perceived the linkages between family planning, population growth and environmental sustainability. Results indicate that these stakeholders overwhelmingly support the integration of the reproductive health and rights ideological framework in a wider sustainability frame reflecting environmental considerations. I identified three barriers to both addressing and implementing the linkage: responsibility allocation injustice, colonialism and discrimination, and marginalisation. Environmental sustainability and reproductive health and rights stakeholders appear in favour of applying what could be considered ‘environmental mainstreaming’ to the reproductive health and rights field. Environmental sustainability stakeholders were more likely than reproductive health and rights stakeholders, who were more divided on this issue, to endorse the linkage and related concepts.

Perception, concern, competency: children's understanding of physical and non-physical aspects of urban environment in Iran

ABSTRACT This study explores how Iranian children perceive urban settings, what concerns they have in these environments, and examines their competency to accurately read or understand their lived urban environment. To achieve this, primary school students were invited to participate in a mixed-methods qualitative study. The findings present children's perceptions of physical and non-physical aspects of urban settings, each of these consisting of sub-themes relevant to the concerns and competency of participants. Findings include children's understanding of deficiencies in access to urban spaces, meeting children's needs, their experiences of city flows, their perceptions of socio-cultural features of their society, their need to be present in urban spaces, and the sense of belonging and feeling valued in their community. The findings also highlight that some priorities of children are consistent with UNICEF child-friendly city characteristics, but others exceed UNICEF guidelines. The results convey a message to urban decision-makers to provide more space in the urban development process for young citizens since children show competence in comprehending urban spaces.

Building a Sustainable Learning Cycle: The Role of ‘the Formative Use of Summative Tests’ (FUST) in Promoting Students’ Developments

The study employed a descriptive mixed-methods qualitative case study approach. Material and interview-based data were collected from two EFL classes in a private international school in central China. Findings from RQ1 suggest that teacher-made summative tests were largely dependable to the extent that the tests reflect the syllabus-based construct and address students’ affective factors. Findings from RQ2 suggest that facilitating factors including in-school continuous professional development (CPD) and teacher collegiality practices may enhance FUST’s prospective role.

Home-based exercise program for adolescents with juvenile dermatomyositis quarantined during COVID-19 pandemic: a mixed methods study

BackgroundExercise has been suggested to prevent deterioration of health-related quality of life (HRQL) and overall health in pediatric rheumatologic diseases during the COVID-19 pandemic. Herein we describe the effects of a 12-week, home-based, exercise program on overall health and quality of life among quarantined patients with juvenile dermatomyositis (JDM).MethodThis prospective, quasi-experimental, mixed methods (qualitative and quantitative) study was conducted between July and December 2020, during the most restricted period of COVID-19 pandemic in Brazil. The home-based exercise program consisted of a 12-week, three-times-a-week, aerobic and strengthening (bodyweight) training program. Qualitative data were systematically evaluated. Strengths and Difficulties Questionnaire (SDQ), Pediatric Quality of Life Inventory (PedsQOL) and Pittsburgh Sleep Quality Index (PSQI) evaluate symptoms of mental health disorder, HRQL, and quality of sleep.Findings11 patients (out of 27) met the inclusion criteria (91% female; mean ± SD age: 13.5 ± 3.2 years). Adherence to the intervention was 72.6%. Barriers to exercise involved poor internet connectivity, excessive weekly sessions, and other commitments. Even though not statistically significant, Self-report SDQ subscales Total Difficulties Score, Emotional Problems Score, and PedsQOL School Functioning Score improved after intervention (− 2.4; 95%confidence interval [CI] -5.1; 0.2, p = 0.06; − 1.0; 95%CI -2.2; 0.2, p = 0.09 and; 11.7; 95%CI -2.5; 25.8, p = 0.09, respectively). Remaining SDQ subscales were not altered. Six themes emerged from patients’ and parents’ comments (qualitative results). Patients engaged in exercise reported other health-related benefits including increased motivation, concentration and strength.InterpretationA home-based exercise program was associated with qualitative perceptions of improvements in overall health and HRQL by quarantined adolescents with JDM during COVID-19 pandemic. Lessons from this trial may help developing interventions focused on tackling physical inactivity in JDM.

The Barriers, Challenges, and Strategies of COVID-19 (SARS-CoV-2) Vaccine Acceptance: A Concurrent Mixed-Method Study in Tehran City, Iran.

Acceptance and willingness to receive the vaccine are among the main factors in the success or failure of a health system in implementing the vaccination program. The present study was conducted in Tehran, the political and economic capital of Iran, to determine the acceptance of the COVID-19 vaccine and identify its associated factors, and explain the most important barriers and acceptance strategies for vaccination. This research was a concurrent quantitative and qualitative mixed-method study. In the quantitative part, 1200 individuals aged more than 18 years were selected from the households in 22 districts of Tehran City, with a multistage stratified cluster sampling method. Two questionnaires were used to evaluate the acceptance of the COVID-19 vaccine and vaccine acceptance determinants. The qualitative content analysis method addressed the influencing factors, as well as challenges and strategies related to the acceptance of the COVID-19 vaccine in four groups of Tehran inhabitants: the elderly, people with underlying diseases, healthcare workers, and the general population. The related data were simultaneously collected by applying in-depth semi-structural interviews and a data analysis process. Furthermore, we used the Graneheim and Lundman method for data analysis. We analyzed the data of 1200 people with a mean (SD) age of 46.4 (11.1) years, and approximately 58% of them were men. The vaccine acceptance was 83.6% (95% CI: 81.3–85.9). Among those who welcomed vaccination, 58% preferred the imported vaccines, 25% the Iranian ones, and 17% both. There was a significant association between the variables of age (adjusted odds ratio [AOR] = 1.72, 95% CI: 1.01–2.93), being single (AOR = 0.54, 95% CI: 0.41–0.91), moderate pharmacotherapy adherence (AOR = 0.58, 95% CI: 0.4–0.85), and the willingness to receive COVID-19 vaccine. Qualitative study after interviewing 45 people from four study groups showed an insufficient social trust in healthcare system officials, pharmaceutical and vaccine production companies; distrust in the effectiveness of the vaccines, concerns about the vaccine adverse effects, being tracked by microchips after vaccination, traditional anti-vaccination movements, the feeling the inessentiality of vaccination, and uncertainty about the fair distribution of the vaccine. These concerns were the main challenges addressed by the study groups. A good proportion of Tehran residents reported their willingness to receive the COVID-19 vaccine. Additionally, they expressed their critical concerns, such as insufficient trust in the healthcare system, vaccine safeties, and adverse effects that were the significant barriers to vaccine acceptance. It seems that conflicts raised by the shortage of vaccines and their import due to the sanctions have led to intense desire and demand in the general population, and especially the elderly, for vaccination. Besides, vaccination phobia in some individuals requires further investigations.