Participant Interviews Research Articles

P066 HOW BLOOD PRESSURE DEVICES ARE OBTAINED FOR HOME BLOOD PRESSURE MEASUREMENT: A MIXED-METHODS STUDY AMONG AUSTRALIA ADULTS

Background and Objective. Only 20% of automated blood pressure (BP) devices available for purchase are validated. However, how consumers obtain devices for home BP measurement and whether their devices are validated remains unknown, which was the aim of this study. Methods. Surveys (n=225) and interviews (n=27) among adults who measure BP at home in Australia (June-December 2023). Survey questions included how the BP device was obtained, device details to determine validation status, and considerations in choosing a device. Interviews explored how and why BP devices were obtained in detail. Results. Most participants (n=216, 96%) used an upper-arm cuff device, of which 52% (n=118) were validated. Of 9 participants that used wrist cuff devices, 67% (n=6) were validated. Most participants purchased (n=176, 91%) their BP device, predominantly from pharmacy (n=126, 72%; 50% validated), followed by online (n=36, 16%; 52% validated). Validated BP devices were on average $38.53 AUD more expensive than non-validated devices (p<0.001). Although accuracy was the most important consideration when choosing a BP device (n=112, 50%), few interview participants cited device validation status as a consideration. “I just assumed that they were all accurate”. Most interview participants avoided cheaper BP devices, believing these were less accurate, and they were willing to “make an investment” in their BP device due to the importance of getting an accurate BP measurement. Interview participants rarely received recommendations from their GP about which BP device to use and reported pharmacy staff provided retail support based on in-store device availability rather than information about accuracy. Conclusion. This study found only 50% of devices used by consumers for home BP measurement have been validated. Devices that are validated are more expensive, but critically, consumers are willing to make an investment in an accurate BP device. However, little guidance is provided to support consumers when selecting a BP device. These findings demonstrate the need for credible information and resources that support consumers to obtain validated BP devices.

Patients’ experiences with ‘sludge’ (administrative burden) in the cancer screening process and its relationship with screening completion, experience and health system distrust

Objective‘Sludge’ refers to administrative burdens or frictions that preclude people from getting what they want or need (eg, duplicative forms, complicated instructions, long waiting times). This mixed methods study evaluated...

Retaining doctors in emergency medicine: an ethnographic study of emergency departments in England

ObjectivesTo gain a deep understanding of factors driving retention in emergency medicine. To understand in detail the day-to-day lived experience of emergency medicine doctors, to identify and explore factors influencing...

Advances and challenges in endoscopy training: A mixed methods study among endoscopy trainers in the Netherlands

Abstract Background and study aims Variation between trainers in providing traditional gastrointestinal endoscopy training, in which residents learn endoscopy by doing under the supervision of endoscopy trainers, may cause differences in endoscopy competence between residents. In this study, we explored endoscopy trainers’ views on the current status and desired future best practices regarding endoscopy training. Methods This mixed-methods study comprised quantitative survey data collected from 158 endoscopy trainers working in 26 gastroenterology teaching hospitals in the Netherlands and semi-structured interviews with 15 gastroenterology residency (associate) program directors (PDs). Survey data were analyzed using descriptive statistics and interview results with thematic analysis. Results There was considerable variability in endoscopy training practices between teaching hospitals in the structure of endoscopy supervision, criteria used to determine the level of supervision, and participation of trainers in endoscopy teaching courses. Interview participants agreed that an endoscopy training supervisor requires several teaching strategies, highlighting the importance of formal education in endoscopy teaching. Interview participants perceived self-regulated learning strategies as essential for residents to learn endoscopy effectively. The perceived main barriers to effective supervision were a lack of time and heavy workload. Participants expressed the desire for more standardization in endoscopy training programs between teaching hospitals. Conclusions Considerable variability in endoscopy training practices between gastroenterology teaching hospitals was identified. Formal education on endoscopy teaching, promotion of self-regulated learning, and standardization of endoscopy training programs and supervision practices have the potential to improve future endoscopy training.

Market Access Challenges and Solutions in Cell and Gene Therapy in The Netherlands.

With the increasing pipeline of cell and gene therapies (CGTs) and the expected surge in the number of approvals, understanding the market access landscape becomes crucial for timely patient access. This study evaluates the challenges Dutch stakeholders encounter in CGT market access, offering insights for improving time-to-patient access. A traditional literature review was conducted to identify market access challenges and solutions for CGTs. Based on the findings, participants for semi-structured interviews, designed using an interview guide adapted to the Dutch context, were selected to capture diverse perspectives on market access. This review included 124 relevant articles out of 2449, covering several aspects of market access of CGTs. Subsequently, interviews with 16 stakeholders from academia, patient advocacy groups, manufacturers, health insurers, payers, hospital pharmacists, healthcare practitioners, and the Association of Innovative Medicines were conducted. Stakeholders identified challenges and proposed solutions for reimbursement package management, clinical trials, health economics, payment models, and procedural and organisational aspects. Thematic analysis revealed unique country-specific challenges and solutions in the Netherlands. This research provides insights into these challenges and potential solutions, emphasising the need for collaborative efforts among stakeholders to develop practical and multidisciplinary measures to improve the market access landscape for CGTs in the country.

How Do Financial Obstacles Affect Decision-Making Among Potential Living Organ Donors?

Introduction: Living donation increases the organ supply, but associated non-medical expenses can disincentivize donation. Programs aimed at increasing living donation need to better understand how financial obstacles, including lost wages, impact the decision to pursue donation. Methods/Approach: Forty-eight interviews were conducted and analyzed using a grounded theory approach. Findings: Three key themes were identified that influenced decision-making: emotional attachment, temporal flexibility, and job security. These themes emerged when dividing interview participants into 3 groups: close relationship donors, broader network donors, and non-directed donors, representing donation to a family member or friend, a specific person they do not know well or at all, or a non-specified individual, respectively. Most close relationship donors wanted to donate regardless of personal financial cost, based on emotional attachment to the recipient. Wage reimbursement did not typically affect their decision-making but could reduce stress. Since non-directed donors did not donate to a specific individual, they could wait to achieve financial stability before donating, if needed. While wage reimbursement might create more proximate stability, non-directed donors had the flexibility to postpone donations until they could independently achieve financial stability. Lacking emotional attachment and temporal flexibility, broader network donors were particularly active decision-makers and most influenced by wage reimbursement. Across all groups, donors with job security were more resolute about donating. Conclusion: The findings underscore the importance of lost wage reimbursement to facilitate donation and reduce stress, and policies to protect donor job security.

Empowering Widowed Women with Sustainable Food Security in Tunyai Location, Tharaka Sub-County, Tharaka Nithi County, Kenya: A Qualitative Analysis of Their Roles, Challenges, and Resilience

Food security, a fundamental global concern, is intrinsically linked to the pivotal roles, women play in agricultural and food production. This qualitative research, conducted in Tunyai Location, Tharaka Sub-County, Tharaka Nithi County, Kenya, delves into the significant contributions of widowed women to food security by exploring their roles in agricultural and food production. The research aims to understand the experiences, challenges, and strategies of widowed women in enhancing the local food supply. Using a purposive sampling method, 50 widowed women actively engaged in agriculture were selected for participation in Key Informant Interviews. NVivo software facilitated the data analysis, enabling systematic exploration and thematic identification of patterns, challenges, and strategies employed by these women. The study findings underscore the profound contributions of widowed women to food security, with 56% actively engaged in agricultural activities. These women represent a cornerstone in sustaining local food security through diverse roles encompassing crop cultivation, livestock management, and food processing. Furthermore, the research underscores the need to address the 44% of widowed women not actively involved, emphasizing potential gender disparities and barriers. In conclusion, this study highlights the integral role of women in enhancing food security and the imperative to address gender-related challenges to ensure a resilient and sustainable local food supply in Tunyai Location.

“My children will grow up more healthy than me because of the vaccinations they received”: Using the migrant health trajectory model to understand Vietnamese American parents’ attitudes towards vaccinations and the U.S. healthcare system

Previous studies have examined the rationales affluent white American parents give for distrusting vaccinations and the U.S. healthcare system; fewer studies have investigated the vaccine- and healthcare-related attitudes of foreign-born parents who have resettled in the U.S. Drawing on 40 in-depth interviews with Vietnamese American parents who emigrated from Vietnam and reside in Southern California, this study finds that these parents favor vaccinations and trust the U.S. healthcare system. However, contrary to the “good” refugee and “model” minority stereotypes, which racializes Asian Americans as blindly adhering to authority to assimilate, these Vietnamese Americans reported purposefully agreeing to vaccinations because they believe that vaccines are a privileged prevention strategy, ensured by the U.S. healthcare system to safeguard their and their children's livelihoods. Interview participants chronicled their social experiences as refugees, particularly their upbringing in Vietnam (where they witnessed vaccine and healthcare inequities) and their emigration to and resettlement in the U.S. (a social setting they believe has an abundance of advantageous health resources) as social factors influencing their vaccination and healthcare standpoints. By attending to Vietnamese American parents' unique emigration health trajectories, this study highlights how vaccination and healthcare attitudes are social acts shaped by interlinking socio-historical, -political, and -cultural contexts.

EEG correlates of static and dynamic face perception: The role of naturalistic motion

Much of our understanding of how the brain processes dynamic faces comes from research that compares static photographs to dynamic morphs, which exhibit simplified, computer-generated motion. By comparing static, video recorded, and dynamic morphed expressions, we aim to identify the neural correlates of naturalistic facial dynamism, using time-domain and time-frequency analysis. Dynamic morphs were made from the neutral and peak frames of video recorded transitions of happy and fearful expressions, which retained expression change and removed asynchronous and non-linear features of naturalistic facial motion. We found that dynamic morphs elicited increased N400 amplitudes and lower LPP amplitudes compared to other stimulus types. Video recordings elicited higher LPP amplitudes and greater frontal delta activity compared to other stimuli. Thematic analysis of participant interviews using a large language model revealed that participants found it difficult to assess the genuineness of morphed expressions, and easier to analyse the genuineness of happy compared to fearful expressions. Our findings suggest that animating real faces with artificial motion may violate expectations (N400) and reduce the social salience (LPP) of dynamic morphs. Results also suggest that delta oscillations in the frontal region may be involved with the perception of naturalistic facial motion in happy and fearful expressions. Overall, our findings highlight the sensitivity of neural mechanisms required for face perception to subtle changes in facial motion characteristics, which has important implications for neuroimaging research using faces with simplified motion.

Expectation, emotion and the built environment: experiences of occupying hospital spaces as a loved one nears the end of life

Following a 3-year long research project that gathered 146 views, including those of palliative care patients, family members, medical staff, administrators, architects and government representatives, this paper explores the hypothesis...

According to their own accounts: former child welfare involved youth recalling their participation in child protective services interviews that occurred at school

ABSTRACT This qualitative study collected the first-known responses from former child welfare-involved youth detailing their experiences of participating in child welfare interviews at school. Ten participants answered semi-structured interview questions about their school interview experiences in this phenomenological qualitative study. Five themes provided a shared understanding of participants having child welfare interactions introduced into their school life. The themes were not knowing how to prepare, difficulties interacting with the child welfare worker, expectations for support from school staff, dealing with the cognitive impact, and suggestions for improving child welfare interviews at school.

Clinician’s perspectives on the feasibility of patient controlled analgesia in emergency departments: A qualitative descriptive study

BackgroundDespite pain being the most common reason for patients to visit the emergency department (ED), conventional pain management methods are often inadequate. Patient controlled analgesia (PCA), which allows patients to self-administer intravenous analgesia, is widely used across many hospital wards, however, is not routinely used in ED. We aimed to identify clinicians’ perceptions of PCA use in the ED setting. MethodsA qualitative descriptive approach was employed using semi-structured individual interviews conducted with ED clinicians from two hospitals in Western Australia. Interviews were recorded and transcribed. Data was analysed using qualitative content analysis. ResultsData saturation was achieved after 20 participant interviews. Five themes emerged from the interview data: sustainability and choosing the right patient; time; safety concerns and side effects; anticipating the patient’s perspective (staff perception); facilitating PCA use in ED. ConclusionMost participants perceived that patients would experience several benefits from PCA use in ED. Several perceived barriers and facilitators were also identified. To facilitate the use of PCA in ED, there is a need for staff education on PCA use, patient selection guidelines and effective change management strategies. Further research about the time it takes to administer analgesia via PCA compared with conventional methods is needed.

"It Empowers You to Empower Them": Health Professional Perspectives of Care for Hyperglycaemia in Pregnancy Following a Multi-Component Health Systems Intervention.

The Northern Territory (NT) and Far North Queensland (FNQ) have a high proportion of Aboriginal and Torres Strait Islander women birthing who experience hyperglycaemia in pregnancy. A multi-component health systems intervention to improve antenatal and postpartum care in these regions for women with hyperglycaemia in pregnancy was implemented between 2016 and 2019. We explored health professional perspectives on the impact of the intervention on healthcare. The RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance) underpinned this mixed-methods evaluation. Clinicians were surveyed before (n = 183) and following (n = 137) implementation. The constructs explored included usual practice and satisfaction with care pathways and communication between services. Clinicians, policymakers and the implementation team were interviewed (n = 36), exploring the impact of the health systems intervention on practice and systems of care. Survey and interview participants reported improvements in clinical practice and systems of care. Self-reported glucose screening practices improved, including the use of recommended tests (72.0% using recommended first-trimester screening test at baseline, 94.8% post-intervention, p < 0.001) and the timing of postpartum diabetes screening (28.3% screening at appropriate interval after gestational diabetes at baseline, 66.7% post-intervention, p < 0.001). Health professionals reported multiple improvements to care for women with hyperglycaemia in pregnancy following the health systems intervention.

English as a foreign language learners' metacognitive experiences and writing development: Unraveling the process of learning EFL writing

Much research has investigated students' metacognitive growth focusing on their metacognitive knowledge and metacognitive strategies as individual differences in learning to write in a second/foreign language (L2). Yet to date, changes in metacognitive experiences when learning to write, a subcategory of metacognition, have been insufficiently scrutinized. To bridge this gap, we employed a mixed-methods approach to examine learners' development in English as a foreign language (EFL), capturing their metacognitive experiences longitudinally. Specifically, we investigated the changes in 390 EFL learners' metacognitive experiences in writing and their writing development over one semester. A questionnaire was used to measure these learners' metacognitive experiences over two writing tasks, capturing metacognitive judgments, metacognitive feelings, online task-specific metacognitive knowledge, and online task-specific metacognitive strategies. We selected 12 participants for follow-up semi-structured interviews. We processed the quantitative data using Latent Profile Analysis (LPA) to identify these EFL learners' metacognitive experience profiles. Findings of LPA using Mplus 8.3 revealed two metacognitive experiences profiles, characterized by intensive and less intensive metacognitive experiences. Further quantitative analysis using paired samples t-tests in SPSS 24.0 indicated that EFL learners' metacognitive experiences changed in alignment with their writing development in terms of lexical complexity, syntactic complexity, fluency, and overall writing scores. Qualitative findings from thematic analysis using NVivo 12 identified two factors affecting the changes in EFL learners' metacognitive experiences, including their involvement in writing and development in linguistic competence. As is evident, the quantitative and qualitative findings point to a more nuanced and precise understanding of the changes in these EFL learners' metacognitive experiences in learning to write.

Situational Awareness and Safety: Using Weather Information to Inform Decision-Making in Antarctic Environments

Abstract To avoid hazards, manage risks, and successfully conduct their outdoor activities, people in Antarctica make weather-related decisions every day. Research on Antarctic weather information use and related decision-making, services, and user needs is limited. In a mixed-methods study, we explored how people use weather information to manage activities and weather in Antarctic regions. Survey (n = 62) and interview (n = 35) participants were deployed with National Antarctic Programs and tourism operators across a range of roles, activities, and locations. How and when weather information was used depended on people’s decision contexts, location, activities, previous experience and knowledge. Experienced participants used weather information, their experience, and local knowledge to form and maintain their situation awareness. Situation awareness influenced participant's decision-making, risk assessment, and planning processes and enabled people's adaptation to changing circumstances, hazards, and weather conditions. As a part of these processes, forecasts were used primarily for pre-activity planning and scheduling decisions. Tasks were prioritized and planned based on suitable weather conditions, experience, and safety. During activities, real-time weather data, personal observations, and experience were important for updating situation awareness, risk judgments, decision-making, and maintaining safety. Levels of weather service provision and training varied and were often not fit-for-purpose, which may adversely impact people's safety in Antarctic regions. Results contribute to our understanding of polar weather user needs, and how we may support people to develop the experience, knowledge, and non-technical skills necessary for identifying and avoiding hazards and safe, efficient, and successful outdoor activities.

Understanding enjoyment within the context of the children-to-youth sport transition in Norwegian soccer: A mixed methods study

Enjoyment has emerged as a critical factor in understanding dropout and participation in the Norwegian youth soccer context (Persson et al., 2020; Solstad et al., 2022). Moreover, the children-to-youth sport transition within this context represents a shift in underlying values and aims (Hjelseth, 2016). The purpose of this mixed methods study was thus to investigate youth soccer players’ enjoyment within the children-to-youth sport transition context. The quantitative phase consisted of 214 soccer players (28.2 % girls, Mage = 12.56 years) who completed a questionnaire, and structural equation modeling was used to analyze the data. The quantitative data informed the selection of participants for qualitative interviews in the next phase. A total of 10 soccer players (6 boys and 4 girls) who had reported different levels of enjoyment were interviewed. Coding reliability thematic analysis was applied to analyze the qualitative data. The results indicated that expectation of success and the mastery-approach goal had a positive relationship with enjoyment. The qualitative data further revealed that love for the sport, being with friends, and learning and mastery were sources of enjoyment for the players. A key finding was that players experienced increased seriousness in the transition, which may have a negative impact on their enjoyment. In conclusion, coaches should emphasize players’ expectations of success, learning, and intrapersonal mastery, while creating a team culture that values friendship and passion for the sport. These strategies can enhance enjoyment, potentially sustaining youth participation in soccer during the children-to-youth sport transition.

Heart Failure With Reduced Ejection Fraction Polypill Implementation Strategy in India: A Convergent Parallel Mixed Methods Study.

A polypill-based implementation strategy has been proposed to increase rates of guideline-directed medical therapy (GDMT) in patients with heart failure with reduced ejection fraction. This has the potential to improve mortality and morbidity in India and undertreated populations globally. We conducted a convergent parallel mixed methods study integrating quantitative data from stakeholder surveys using modified implementation science outcome measures and qualitative data from key informant in-depth interviews. Our objective was to explore physician, nurse, pharmacist, and patient perspectives on a HFrEF polypill implementation strategy in India from January 2021 to April 2021. Quantitative and qualitative data were integrated to develop an Implementation Research Logic Model. Among 69 respondents to the stakeholder survey, there was moderate acceptability (mean [SD] 3.8 [1.0]), appropriateness (3.6 [1.0]), and feasibility (3.7 [1.0]) of HFrEF polypill implementation strategy. Participants in the key-informant in-depth interviews (n = 20) highlighted numerous relative advantages of the HFrEF polypill innovation including potential to simplify medication regimens and improve patient adherence. Key relative disadvantages elucidated, include concerns about side effects and interruption of multiple GDMT medications due to polypill discontinuation for side effects or hospitalizations. Based on this data, the proposed implementation strategies in the Implementation Research Logic Model include 1) HFrEF polypills, 2) HFrEF polypill initiation, titration, and maintenance protocols, and 3) HFrEF polypill laboratory monitoring protocols for safety which we postulate will lead to desired clinical and implementation outcomes through multiple mechanisms including increased medication adherence to a single pill. This study demonstrates that a HFrEF polypill-based implementation strategy is considered acceptable, feasible, and appropriate among healthcare providers in India. We identified contextually relevant determinants, strategies, mechanism, and outcomes outlined in an Implementation Research Logic Model to inform future research to improve heart failure care in South Asia.

Simulation Model for a Sustainable Food Supply Chain in a Developing Country: A Case Study of the Banana Supply Chain in Malawi

Background: Sustainability in food supply chains is desired for production, logistics, and waste management. However, food supply chains (SCs) have complex systems that differ from other SCs. Managing such complexities is challenging for small and medium-sized enterprises (SMEs) due to their heightened constraints, such as limited resources and inadequate awareness. Despite the challenges, there is fragmented research, understanding, and approaches to assist SMEs. SC designs need to be adapted so that SMEs can navigate the challenges and avert high wastage. The main objective of this research was to identify the practices influencing sustainable SC designs in a developing country and create a simulation model to illustrate the potential benefits and challenges of promoting sustainability in the banana SC in Malawi. Methods: Mixed-methods research was utilised, employing a literature review, participant interviews, observations, and survey data collected from 353 participants from three districts in Malawi to gain insight into the banana SC problem, establish objectives, and develop a simulation model complemented by design science research. Results: The research identified awareness, collaboration, efficiency, governance, knowledge sharing, and resilience as sustainability practices in the case study banana SC, thus forming a sustainability model. Simulation results showed improvements in key performance indicators like shelf-life, lead-time, quality, throughput, and waste through SC operation reorganisation. Conclusions: Sustainable models must be tailored to the specific challenges inherent in developing food supply chains in developing nations. The development of the models has significant managerial implications, notably enhancing strategic planning, operational efficiency, risk management, alignment of sustainability goals, performance monitoring, stakeholder engagement, and resource optimisation.

The Lived Experience of Patients with Chronic Kidney Disease: Insights From DISCOVER CKD

Introduction: Chronic kidney disease (CKD) can have a profound impact on patients’ lives. However, multinational data on patients’ lived experience with CKD are scarce. Methods: Individuals from the prospective cohort of DISCOVER CKD (NCT04034992), an observational cohort study, were recruited to participate in one-to-one telephone interviews to explore their lived experience with CKD. A target of 100 participant interviews was planned across four countries (Japan, Spain, the UK, and the USA). These qualitative interviews, lasting ∼60–90 min, were conducted in the local language by trained interviewers with specific experience in CKD, between January and June 2023. Transcribed interviews were translated into English for coding and analysis. Data were coded using qualitative research software. Results: Of the 105 participants interviewed, 103 were included in the final analysis. The average time since CKD diagnosis was 9.5 years, and at least half (50.5%) of participants had CKD stage 3A or 3B. CKD diagnosis was an emotional experience, driven by worry (n = 29/103; 28.2%) and shock (n = 26/103; 25.2%), and participants often reported feeling inadequately informed. Additional information was frequently sought, either online or via other healthcare providers. The proportion of participants reporting no impacts of CKD on their lives was highest in those with CKD stage 1 and 2 (64.3%). Conversely, every participant in the CKD stage 5 on dialysis group reported some impact of CKD on their lives. Across all participants, the most reported impacts were anxiety or depression (37.9%) or ability to sleep (37.9%). The frequency of the reported impacts appeared to increase with disease severity, with the highest rates observed in the dialysis group. In that group, the most frequently reported impact was on the ability to work (80.0%). Conclusion: Findings from this multinational qualitative study suggest that patients may experience symptoms and signs of disease prior to diagnosis; however, these are often nonspecific and may not be directly associated with CKD. Once diagnosed, the burden of CKD can have a diverse, negative impact on various aspects of patients’ lives. This highlights the need for early identification of at-risk individuals, and the importance of early CKD diagnosis and management with guideline-directed therapies to either prevent further deterioration of CKD or slow its progression, thus reducing symptom burden and improving quality of life.

Exploring Student Perspectives and Experiences of Online Opportunities for Virtual Care Skills Development: Sequential Explanatory Mixed Methods Study.

Caring profession students require skills and competencies to proficiently use information technologies for providing high-quality and effective care. However, there is a gap in exploring the perceptions and experiences of students in developing virtual care skills within online environments. This study aims to better understand caring professional students' online learning experiences with developing virtual care skills and competencies. A sequential explanatory mixed methods approach, integrating both a cross-sectional survey and individual interviews, was used to better understand caring professional students' online learning experiences with developing virtual care skills and competencies. A total of 93 survey and 9 interview participants were drawn from various faculties, including students from education, nursing, medicine, and allied health. These participants identified the barriers, facilitators, principles, and skills related to learning about and delivering virtual care, including teaching methods and educational technologies. This study contributes to the growing body of educational research on virtual care skills by offering student insights and suggestions for improved teaching and learning strategies in caring professions' programs.