Perceptions Of Healthcare Providers Research Articles

Barriers to pregnancy prevention for adolescents in rural Haiti: perceptions of healthcare providers.

Little is known about healthcare providers' (HCPs) contraceptive views for adolescents in Haiti, who experience high rates of unintended pregnancy. We sought to describe HCPs' perspectives on barriers and facilitators to contraceptive care delivery in rural Haiti. We conducted a cross-sectional survey and qualitative interviews with HCPs in two rural communities in Haiti from 08/2021-03/2022. We assessed demographics, clinical practice behaviors and explored contraception perspectives according to Theory of Planned Behavior constructs: attitudes, subjective norms, and perceived behavioral control (e.g., people's perceptions of their ability to perform a given behavior, barriers and facilitators of a behavior).15-17 We used descriptive statistics to report proportions and responses to Likert scale and multiple-choice questions. Guided by content analysis, we analyzed interview transcripts through thematic inductive coding and team debriefing. Among 58 respondents, 90% (n = 52) were female and 53% (n = 31) were nurses. Most reported always (n = 16, 28%) or very often (n = 21, 36%) obtaining a sexual history for adolescents. A majority agreed/strongly agreed that clinicians should discuss pregnancy prevention (n = 45, 78%), high-risk sexual behaviors (n = 40, 69%), and should prescribe contraception (n = 41, 71%) to adolescents. The most frequently cited provider-level barriers (i.e., significant or somewhat of a barrier) included insufficient contraception knowledge (n = 44, 77%) and time (n = 37, 64%). HCPs were concerned about barriers at the patient-level (e.g. adolescents' fear of parental notification [n = 37, 64%], adolescents will give inaccurate information about sexual behaviors [n = 25, 43%]) and system-level (e.g. resistance to providing care from administration [n = 33, 57%]). In interviews (n = 17), HCPs generally supported contraception care for adolescents. Many HCPs echoed our quantitative findings on concerns about privacy and confidentiality. HCPs reported concerns about lack of contraception education leading to misconceptions, and community and parental judgement. HCPs expressed interest in further contraception training and resources and noted the importance of providing youth-friendly contraceptive care. While HCPs support contraceptive care, we identified actionable barriers to improve care for adolescents in rural Haiti. Future efforts should include increasing HCP knowledge and training, community and parent coalition building to increase contraception support and offering youth-friendly contraceptive care to offset risk for related adverse health outcomes in adolescents in rural Haiti.

Knowledge, attitudes and practices of critical care unit personnel regarding pediatric palliative care: a cross-sectional study

BackgroundFew studies have evaluated the perceptions of healthcare providers in China regarding pediatric palliative care, particularly in critical care units (PICUs), where many children receive palliative care. To evaluate the knowledge, attitudes and practices of PICU personnel in China regarding pediatric palliative care.MethodsThis cross-sectional study was conducted in five cities in China (Shanghai, Suzhou, Chongqing, Chengdu and Yunnan) between November 2022 and December 2022.ResultsThe analysis included 204 participants (122 females), with 158 nurses and 46 physicians. The average knowledge, attitude and practice scores were 9.75 ± 2.90 points (possible range, 0–13 points), 38.30 ± 3.80 points (possible range, 12–60 points) and 35.48 ± 5.72 points (possible range, 9–45 points), respectively. Knowledge score was higher for physicians than for nurses (P < 0.001) and for personnel with previous training in pediatric palliative care (P = 0.005). According to structural equation modelling knowledge had a direct positive effect on attitude (β = 0.69 [0.28–1.10], p = 0.001), and indirect on practice (β = 0.82 [0.36–1.28], p < 0.001); attitude had significant effect on practice as well (β = 1.18 [0.81–1.56], p < 0.001).ConclusionsThere is room for improvement in the knowledge, attitudes and practices of PICU personnel in China regarding pediatric palliative care. The findings of this study may facilitate the design and implementation of targeted education/training programs to better inform physicians and nurses in China about pediatric palliative care.

Exploring Knowledge, Attitudes and Perceptions of Young Women, Community Members and Health Care Providers on Legal Abortion in Lusaka District, Zambia

Background: In 1972, Zambia made abortion lawful on a broad basis. However, safe abortion services are still limited, and the necessary standards and requirements for executing an abortion remain stringent. Due to a lack of knowledge and understanding of abortion law, many women and girls continue to seek unsafe abortion methods outside of health facilities. Healthcare providers play a key role in the provision of safe abortion care to eligible girls and women, but little is known about how they handle it. The aim of this study was to Assess and Explore the Knowledge, attitudes, and perceptions of adolescent girls and young women, and healthcare providers on abortion in the Lusaka district. Data was collected from Chawama, Chilenje, Chipata Kanyama, and Matero Level 1 Hospitals in Lusaka District. Method: To answer the research topic, the study used Exploratory mixed approaches. Statistical Package for Social Science, Versioni20.0 (SPSS) was used. The matic analysis was used to examine qualitative data by extracting themes from the responses. To see if there were any differences or correlations between the variables' knowledge, perceptions, and attitudes, cross-tabulations were used. This was demonstrated using Chi-square tests, which were all done at a 95ipercenticonfidenceiinterval with ai 0.05 significance level as the crucial level. For reporting, the SPSS frequencies were exported to Microsoft Word. Results: The study indicated that the knowledge levels on abortion among participants were high (93.25%). However, some participants on the other hand did not have sufficient information regarding the legality of abortion in Zambia. The theme analysis of reasons why they do not favor abortion revealed that one of them is religious, believing that abortion is comparable to murder. The findings also reveal that a person's religious affiliation influences their decision-making and thought process regarding abortion. Conclusion: The findings of this study suggest.......

Managing "socially admitted" patients in hospital: a qualitative study of health care providers' perceptions.

Emergency departments are a last resort for some socially vulnerable patients without an acute medical illness (colloquially known as "socially admitted" patients), resulting in their occupation of hospital beds typically designated for patients requiring acute medical care. In this study, we aimed to explore the perceptions of health care providers regarding patients admitted as "social admissions." This qualitative study was informed by grounded theory and involved semistructured interviews at a Nova Scotia tertiary care centre. From October 2022 to July 2023, we interviewed eligible participants, including any health care clinician or administrator who worked directly with "socially admitted" patients. Virtual or in-person individual interviews were audio-recorded and transcribed, then independently and iteratively coded. We mapped themes on the 5 domains of the Quintuple Aim conceptual framework. We interviewed 20 nurses, physicians, administrators, and social workers. Most identified as female (n = 11) and White (n = 13), and were in their mid to late career (n = 13). We categorized 9 themes into 5 domains: patient experience (patient description, provision of care); care team well-being (moral distress, hierarchy of care); health equity (stigma and missed opportunities, prejudices); cost of care (wait-lists and scarcity of alternatives); and population health (factors leading to vulnerability, system changes). Participants described experiences caring for "socially admitted" patients, perceptions and assumptions underlying "social" presentations, system barriers to care delivery, and suggestions of potential solutions. Health care providers viewed "socially admitted" patients as needing enhanced care but identified individual, institutional, and system challenges that impeded its realization. Examining perceptions of the people who care for "socially admitted" patients offers insights to guide clinicians and policy-makers in caring for socially vulnerable patients.

Healthcare Provider Perceptions of the Use of Medical Interpretation in Primary Care.

Sixty-three percent of Latinos/as/x in Alabama, speak English "not well" or "not at all." Effective provider-patient communication is the foundation of successful clinical interactions. Medical interpretation is important to the healthcare provision for patients with limited English proficiency (LEP). We examined Alabama providers' perceptions of working with medical interpreters to identify strategies to improve healthcare provision for LEP patients. We conducted nine semistructured qualitative interviews with primary healthcare providers in western Alabama. We used NVivo to conduct thematic coding and content analysis. Of the nine providers, one self-identified as Latina and the others identified as White. Four participants worked in community clinics and five worked at university-based clinics. Four themes emerged: preference for in-person interpreters over technology-based interpretation; providers' perceptions and expectations of the roles of professional interpreters; challenges in the communication process; and use of family members or other ad hoc interpreters. To meet the needs of Latino/a/x communities, clinical settings should invest in adequate staffing of in-person interpreters, infrastructure and workflow improvements, and the hiring and training of polylingual providers. Capacity-building opportunities to establish team building between interpreters and providers could be useful tools in improving healthcare provision for LEP patients.

Assessment of the Knowledge, Attitude, and Perception of Healthcare Providers Regarding Halal Pharmaceuticals

Background The intersection of religious beliefs and medical practices significantly impacts medication usage and patient adherence to treatment regimens. Emerging within this discourse is the concept of halal pharmaceuticals, emphasizing the alignment of therapeutic drugs with religious beliefs. Despite its importance, there is limited awareness among healthcare providers (HCPs) regarding their ingredients, standards, and manufacturing processes, particularly in the Middle East region. Thus, this study aimed to investigate the knowledge, attitudes, and perceptions (KAP) of HCPs concerning Halal pharmaceuticals, which are crucial for addressing the growing concerns among patients and consumers. Methods A cross-sectional survey involved diverse HCPs (physicians, pharmacists, and nurses) in Jordan. The survey encompassed demographic data, knowledge about Halal pharmaceuticals, attitudes, and perceptions. Descriptive statistics and inferential analyses were performed to examine the associations between demographic variables and KAP scores. Results A total of 381 HCPs participated in the study. While HCPs generally had a high level of knowledge, gaps existed, particularly concerning pharmaceutical composition and Halal alternatives. Attitudes and perceptions were mostly positive or neutral, though variations occurred among professions. Pharmacists exhibited significantly higher knowledge scores compared to physicians and nurses. Information sources included academic institutions, peers, religious and educational books, and online resources. Factors, such as age, marital status, religion, education type, insurance type, working place, and years of experience significantly influenced the KAP scores of participants. Conclusion Tailored educational interventions are critical for addressing knowledge gaps, fostering positive attitudes, and ensuring culturally sensitive healthcare related to Halal pharmaceuticals. Leveraging diverse information sources and tailoring education based on demographics can enhance understanding. Improved knowledge, attitudes, and perceptions enable HCPs to meet the needs of diverse patient populations and provide safe, Halal-compliant medications. Additionally, further research into the perspectives and willingness of patients to pay for Halal pharmaceuticals is essential to ensuring equitable access to pharmaceutical care services.

Exploring Healthcare Providers' and Women's Perspectives of Labor Companionship during Childbirth: An Interpretative Phenomenological Analysis Study.

A labor companion of choice during childbirth is crucial for improving women's birth experience and confidence to give birth. Labor companions provide various benefits, including enhanced communication, emotional support, non-pharmacological pain relief, and better healthcare. However, little is known about the supportive actions of labor companions with respect to women's needs during labor and birth, as well as healthcare providers' perceptions of labor companions. Therefore, this study was conducted to explore the perceptions of healthcare providers and women regarding labor companions. The study utilized an interpretative phenomenology research design. Data collection involved conducting semi-structured interviews with 14 participants. The sample consisted of mothers, physicians, and nurses, ensuring a diverse range of perspectives. An interpretative phenomenological analysis was conducted for data analysis. Five themes were identified: (a) impact of companionship, (b) benefits for healthcare providers, (c) companion roles, (d) loneliness and alienation of mothers, and (e) challenges of implementation. The findings indicated that the presence of a companion reduces the need for unnecessary medical interventions and eases the workload of healthcare providers. Without a companion, mothers often feel lonely and disconnected during the birthing process. The presence of companions is often hindered by space limitations in delivery rooms, the absence of clear policies, and lack of childbirth education programs for companions. Clear policies, education programs, and adequate space are essential for implementing and promoting labor companionship during childbirth.

Understanding suboptimal insulin use in type 1 and 2 diabetes: a cross-sectional survey of healthcare providers who treat people with diabetes

BackgroundThe purpose of this study was to understand the healthcare provider (HCP) perspective on the extent of suboptimal insulin dosing in people with diabetes (PwD), as well as specific challenges and solutions to insulin management.MethodsAn online survey of general practitioners and specialists (N = 640) who treat PwD in Germany, Spain, the United Kingdom, and the United States was conducted. Responses regarding HCP background and their patients, HCP perceptions of suboptimal insulin use, and challenges associated with optimal insulin use were collected. Categorical summary statistics were presented.ResultsOverall, for type 1 diabetes (T1D) and type 2 diabetes (T2D), most physicians indicated < 30% of PwD missed or skipped a bolus insulin dose in the last 30 days (T1D: 83.0%; T2D: 74.1%). The top 3 reasons (other than skipping a meal) HCPs believed caused the PwD to miss or skip insulin doses included they “forgot,” (bolus: 75.0%; basal: 67.5%) “were too busy/distracted,” (bolus: 58.8%; basal: 48.3%), and “were out of their normal routine” (bolus: 57.8%; basal: 48.6%). HCPs reported similar reasons that they believed caused PwD to mistime insulin doses. Digital technology and improved HCP-PwD communication were potential solutions identified by HCPs to optimize insulin dosing in PwD.ConclusionsOther studies have shown that PwD frequently experience suboptimal insulin dosing. Conversely, results from this study showed that HCPs believe suboptimal insulin dosing among PwD is limited in frequency. While no direct comparisons were made in this study, this apparent discrepancy could lead to difficulties in HCPs giving PwD the best advice on optimal insulin management. Approaches such as improving the objectivity of dose measurements for both PwD and HCPs may improve associated communications and help reduce suboptimal insulin dosing, thus enhancing treatment outcomes.

Navigating challenges: a socioecological analysis of sexual and reproductive health barriers among Eritrean refugee women in Ethiopia, using a key informant approach

ObjectivesThe study aimed to explore the experiences and perceptions of healthcare providers (HCPs) regarding the sexual and reproductive health (SRH) challenges of Eritrean refugee women in Ethiopia.DesignA qualitative exploratory design...

Department of Veterans Affairs Healthcare Provider Perceptions of Confidence Following a Wheelchair/Adaptive Tai Chi Chuan Training

The changing needs of our nation’s military veterans call for a change in the healthcare system delivery models providing their primary sources of care. The VA Healthcare System has incorporated a whole health movement emphasizing individualized approaches to healthcare by encouraging complementary and integrative programs. Wheelchair/Adaptive Tai Chi Chuan (W/A/TCC) is such program offering a transformative opportunity to programmatically enhance veteran healthcare services by enhancing the training of VA healthcare providers. This article explores the impacts of a 7-posture W/A TCC instructional training program for healthcare providers that has been facilitated throughout the VA healthcare system since 2016. The purpose is to better understand the impact this training has on healthcare providers, including Recreational Therapists (RTs). A mixed-methods design exploring participant perspectives showed increased confidence levels following training in several key areas and no statistically significant differences between RTs compared to all other healthcare providers. Meaningful impacts described by participants are explored. Overall discussion focuses on this specific training program’s unique applicability for directly influencing VA healthcare providers and the veterans being served. Overall results offer support for wheelchair/adaptive tai chi chuan training as one strategy that can be utilized to increase the success of holistic veteran healthcare.

Perceived Benefits and Disadvantages Associated with the Use of the Electronic Consultation Register by Health Providers in the Health District of Toma, Burkina Faso.

Most countries in sub-Saharan Africa need to catch up in integrating information and communication technologies (ICT) into their health systems. This is mainly because of the need for more infrastructure that allows for reasonable use of the technologies. To support the actions of the Ministry of Health of Burkina Faso, a Non-governmental Organization (NGO) has implemented the integrated electronic diagnostic approach (IeDA) Project. The project includes the deployment of an electronic consultation register (ECR). This article aims to explore the perceptions of healthcare providers on the benefits and disadvantages of using the ECR. We conducted a qualitative, descriptive study through individual semi-structured interviews with healthcare providers. Data were collected in the Toma health district in December 2021. In addition, a thematic analysis was performed using NVivo software. Thirty-five healthcare workers were interviewed (19 nurses, 7 midwives, 6 mobile community health and hygiene workers, and 3 birth attendants). Two main themes emerged from our analyses, which are the advantages and disadvantages perceived by ECR users. Our data suggest that using the ECR had many benefits ranging from improving healthcare providers' knowledge and performance in terms of patients' care, assisting and helping in patient diagnosis and treatment and improving patient satisfaction. However, the participants also shared their negative perceptions about the ECR, mentioning that it increased their workload. They also reported lengthened consultation time and work duplication as the tool was still in its trial phase and was used along with the paper consultation register. The ECR is an effective tool for diagnosis and management, which has several advantages and reasonably satisfies patients. However, disadvantages, including increased workload and lack of fluidity and stability of the system, must be considered to ensure better usability.

Racial and sociodemographic distribution of colorectal cancer screening in Canada: A cross-sectional study.

To assess the racial and sociodemographic distribution of colorectal cancer (CRC) screening uptake in Canada, identify disparities, and evaluate the potential predictors and barriers to CRC screening. Data from the 2017 cycle of the Canadian Community Health Survey (CCHS) were analyzed, focusing on individuals aged 50-74years. CRC screening participation rates were evaluated at both national and provincial levels and across various sociodemographic characteristics. Multivariable logistic regression models were employed to identify predictors and barriers to CRC screening. Of the 56,950 respondents to the 2017 CCHS, 41.7% (n = 23,727) were between 50 and 74years of age. The overall CRC screening participation rate was 59.8%, with provinces like Alberta and Manitoba achieving rates of 65.7% and 66.5%, respectively. Significant disparities were observed across socioeconomic, geographical, and racial or ethnic groups. Notably, older adults [AOR 2.41, 95% CI 2.06‒2.83], higher income earners [AOR 1.99, 95% CI 1.77‒2.24], and non-smokers [AOR 1.76, 95% CI 1.55‒2.0] had higher odds of screening, while immigrants and minority ethnic groups, especially South-East Asians [AOR 0.48, 95% CI 0.29‒0.78] and South Asians [AOR 0.65, 95% CI 0.44‒0.95], had lower odds of being up to date with CRC screening. A significant portion of unscreened individuals cited their healthcare provider's perception of the test as unnecessary. While there is promising progress in CRC screening participation rates across Canada, significant disparities persist. Addressing these disparities is crucial for public health. Efforts should focus on enhancing public awareness, facilitating accessibility, and ensuring cultural appropriateness of CRC screening initiatives.

What do people with inflammatory bowel disease want to know about diet? The dietary information needs of people with inflammatory bowel disease and perceptions of healthcare providers.

Inflammatory bowel disease (IBD) is an incurable illness of the gastrointestinal tract. Its relapsing-remitting nature negatively impacts physical health and quality of life. Food and eating are key concerns for people with this illness. To provide holistic person-centred care, healthcare providers (HCPs) need to meet patients' dietary information needs. However, there is a paucity of literature describing these in any meaningful detail. The present study aimed to explore the perceived dietary information needs of individuals with IBD, the perceptions of HCPs and enablers and barriers to communication. Online and face-to-face semi-structured interviews with 13 HCPs and 29 people with IBD were conducted. The framework method aided thematic analysis of de-identified interview recordings. The cyclical nature of IBD contextualised the five themes. Both individuals with IBD and HCPs articulated similar ideas viewed from different perspectives: (1) living with IBD is exasperating and unique to the individual; (2) individuals with IBD desire dietary information; (3) diet manipulation is used to exert control on a disease with unpredictable nature; (4) people with IBD and HCPs have different views on the role of diet; and (5) doctors are perceived as gatekeepers to accessing dietetics care. A lack of dietary guidance at diagnosis negatively impacts the patient's journey with food and eating. The present study supports a paradigm shift towards holistic person-centred care for consistent access to dietetics services to meet the needs of people with IBD.

Implementation of virtual pulmonary rehabilitation during the COVID-19 pandemic: Experiences and perceptions of patients and healthcare providers

BackgroundPulmonary rehabilitation (PR) plays an important role in the management of symptomatic patients with chronic respiratory diseases (CRD). While studies have investigated the feasibility and efficacy of virtual PR (VPR), it is important to understand the experiences of patients and healthcare providers (HCPs) during the rapid digital health transformation that occurred in the COVID-19 pandemic. ObjectivesTo explore the experiences and perspectives of patients and HCPs who participated in VPR during the pandemic. MethodsSemi-structured interviews were conducted with CRD patients and HCPs. This study used a qualitative descriptive approach and a team-based inductive thematic analysis. ResultsParticipants included 11 HCPs (7 female; 29–55 years) and 19 CRD patients (11 male; 62–83 years; 15 COPD, 4 COPD/ILD). Three major themes and 10 subthemes were identified: i) the pandemic response: a ‘trial by fire’ (navigating uncertainty, emotional impact of change, shifting practice amid complexity); ii) beyond the emergency: navigating a ‘new normal’ (eligibility and assessment for VPR, virtual exercise, virtual education and resources, clinical supervision and patient safety); and iii) care beyond boundaries: the implications of using technology for PR (benefits and limitations of technology, psychosocial implications, VPR in the future). ConclusionThe pivot to VPR was acknowledged as positive by both patients and HCPs although both groups were mindful of the implementation challenges. These findings provide insight into the experience of HCPs and patients in introducing VPR in response to the pandemic and will inform future implementation of VPR for individuals with CRD.

"Are all referrals necessary?" Experiences and perceptions of maternity healthcare providers on emergency intrapartum referrals in Dar es Salaam, Tanzania.

Intrapartum continuity of care to reduce maternal morbidity and mortality relies heavily on a functional and effective referral system between tiers of care. Capacity building of providers in managing intrapartum referrals is expected to improve the efficiency of the referral system, but this does not always work in practice. This study explored the experiences and perceptions of maternity healthcare providers on emergency intrapartum referrals in Dar es Salaam, Tanzania. An exploratory qualitative study was conducted at Amana Regional Referral Hospital and Muhimbili National Hospital in Dar es Salaam. Maternity healthcare providers were purposively recruited based on cadre, working experience of more than three years in the maternity wards. An in-depth interview guide which involved questions and probes was used to conduct eleven interviews. Data was thematically analyzed. Three major themes emerged, namely: 1) causes of referrals are beyond medical indications; 2) limited maternity healthcare provider capability at referring facilities; and 3) limited communication between referring and receiving facilities. According to maternity healthcare professionals, referrals were seen as a way to minimize blame and a clinical management tool to prevent difficulties. They advocated for more understanding of the skill set among maternity healthcare providers, but some had negative perceptions towards performing their responsibilities. Skills gaps among maternity healthcare providers at referring hospitals influenced referral decision-making and service provision. There was hostility between referring and receiving hospitals. Capacity-strengthening strategies such as ongoing skills training and changes in attitudes toward referrals require improvements. The referring hospital should only consider referrals as a last resort after other case management has been completed.

Perception of health care providers on the quality of oxytocin across six E-MOTIVE Trial sites in Kenya

Background: According to the WHO, in 2020, almost 800 women died daily from preventable causes related to pregnancy and childbirth. An estimated 95% of these deaths were in low- and middle-income countries (LMICs). Postpartum hemorrhage (PPH), excessive bleeding after childbirth, is a leading cause of maternal death globally. Of the estimated 95% of maternal deaths in LMIC, an unacceptable 95% were due to PPH. A significant barrier to women receiving PPH treatment is access to quality PPH medicines, which is the basis for reducing maternal mortality. The E-MOTIVE Trial Kenyan hub conducted an online survey on September after the E-MOTIVE trial findings were released. This survey assessed the perception of health care providers’ (HCPs) of the quality of oxytocin in Augmentation of Labour, Active Management of third Third Stage of Labor (AMSTL), including PPH management. Methods: An online survey was conducted using the Survey Monkey platform in Gatundu level 4 hospital, Makindu subcounty hospital, and Vihiga, Embu, Nyeri, and Kakamega county referral hospitals. The survey targeted HCPs working within the respective maternity units. The results were analyzed in Excel. Results: 56 HCPs across the 6 health facilities participated in the survey. On augmentation of labor, Oxymed Medisel and Oxytocin Umedical were perceived to be more effective, while a score of 100% with Curtocin and Oxyt Kilitch were perceived to be very ineffective. On AMSTL, Oxymed Medisel, Syntocinin Norvatis, and Oxytocin Laborate were perceived to be very effective, whereas Curtocin and Oxyt Kilitch were perceived to be very ineffective. On PPH management, Oxytocin Umedical, Syntocinon Norvatis, and Oxytocin Laborate were perceived to be very effective, whereas Curtocin and Oxyt Kilitch were perceived to be very ineffective. Oxytocin Laborate was available across the health facilities, with other brands lacking in some facilities. Conclusion: Access to and availability of quality PPH medicines are key to effectively managing PPH and reducing maternal mortality.

A256 NAVIGATING IBD CARE : HEALTHCARE PROVIDERS’ INSIGHTS ON IMPLEMENTATION OF NURSE NAVIGATOR-LED IBD FLARE PATHWAY

Abstract Background Disparities in access to healthcare for persons living with inflammatory bowel disease (IBD) persist. An IBD nurse navigational role promises to improve access to evidence-based specialist care by minimizing inequities in access to care. Little is known about how to implement a provincial nurse navigational role in the Canadian health system. Aims This study aims to explore healthcare providers' perceptions of barriers and facilitators to the implementation of an evidence-based IBD flare pathway through a provincial nurse navigational role. Methods This was a national qualitative study performed in collaboration with the CCC PACE Program, in which two virtual semi-structured group interviews were conducted in 2022. One group interview was with six IBD nurses from three provinces, and the second was with five gastroenterologists from five provinces. Participants were purposefully recruited. The Consolidated Framework for Implementation Research (CFIR) and the Capability, Opportunity, Motivation, and Behaviour (COM-B) frameworks informed the interview script development. Data were transcribed verbatim and subjected to content analysis, with major themes categorized into the COM-B domains. The results of preliminary data analysis are presented. Results While IBD nurses emphasized the critical role of effective communication tools, standardized referral systems, strong administrative support and patient education and engagement as facilitators, they also highlighted challenges like patient resistance, variability of training and the necessity for tailored patient care. Other barriers identified were the medical complexity of managing overlapping conditions, remote vs in-person considerations and the perception and definition of a flare. On the other hand, IBD-focused gastroenterologists emphasized the potential of integrating pathways into electronic medical records and the value of empowering nurse navigators. However, they pointed out concerns regarding the inherent variability in disease presentation, entrenched medical beliefs, comfort levels with nurse-led pathways and the inherent diversity in medical practices. Both groups identified resource constraints as a barrier and an effective triage process as a facilitator. Conclusions This study sheds light on the multifaceted perceptions of healthcare providers concerning the implementation of an evidence-based IBD flare pathway through a provincial nurse navigational role. These insights underline the complexity of implementing a nurse navigational role and the need for targeted interventions and resources to address the identified barriers while leveraging the facilitators. Funding Agencies CCC

Patient and healthcare provider perceptions of acceptability of fingerstick point-of-care hepatitis C testing at Aboriginal Community Controlled Health Services in Australia

BackgroundHepatitis C (HCV) is highly prevalent in First Nations communities globally. Barriers in the uptake of testing and treatment create challenges to realise elimination of HCV in these communities. In efforts to reduce barriers to testing and treatment, the SCALE-C study implemented an HCV test-and-treat intervention integrating point-of-care HCV testing and FibroScan®. SCALE-C was carried out at four Aboriginal Community Controlled Health Services (ACCHS; renowned for providing culturally safe care) in four regional towns in Australia. This qualitative analysis sought to understand healthcare provider and patient perceptions of acceptability of a community-based HCV test-and-treat intervention within ACCHS. MethodsSemi-structured interviews were undertaken with 23 patient participants and 14 healthcare personnel (including Aboriginal Health Workers/Practitioners, nurses, general practitioners, and practice managers) from across the four ACCHS involved in SCALE-C. A coding framework was developed among study authors and informed by Sekhon's Theoretical Framework of Acceptability. ResultsThe SCALE-C intervention enabled opportunities for healthcare providers to listen to patients, and for patients to feel heard (affective attitude). HCV testing was opportunistic and often occurred outside of the allocated SCALE-C clinical hours (burden). For patients, HCV testing within SCALE-C was viewed as a moral responsibility and ensured protection of self and others (ethicality). For personnel, SCALE-C (including following up visits) was regarded as an opportunity to engage with patients especially those with complex health needs which may be unrelated to HCV risk factors (ethicality). Patients and personnel widely regarded the SCALE-C intervention to be effective, and the test-and-treat model was preferable for both patients and personnel. ConclusionThe SCALE-C intervention was broadly perceived to be acceptable among both healthcare providers and patients within ACCHS. Whilst the prioritisation of HCV was viewed as increasing patient engagement, it was also regarded as an opportunity for addressing other healthcare needs within Aboriginal communities. HCV test-and-treat models of care delivered by ACCHS simplify the HCV care pathway and ensure all HCV care is provided in a culturally safe setting (e.g., patients did not need to attend external services such as pathology).

Perceptions of reproductive healthcare providers regarding their involvement in offering expanded carrier screening in fertility clinics: a qualitative study

Research questionWhat are the main arguments of reproductive healthcare providers in favour or against their involvement in offering expanded carrier screening (ECS) for recessive disorders in fertility clinics in the Netherlands? DesignSemi-structured interview study with 20 reproductive healthcare providers between May 2020 and January 2021. Participants included 11 gynaecologists, 7 fertility doctors, one nurse practitioner and one clinical embryologist, recruited in academic medical centres (N=13), peripheral facilities associated with academic centres (N=4), and independent fertility treatment centres (N=3) in the Netherlands. An interview guide was developed, and thematic content analysis was performed using ATLAS.ti software. ResultsArguments of reproductive healthcare providers in favour of their potential involvement in offering ECS included: (1) opportunities offered by the setting; (2) motivation to assist in reproduction and prevent suffering; and (3) to counter unwanted commercialization offers. Arguments against involvement included: (1) lack of knowledge and familiarity with offering ECS; (2) insufficient staff and resources and potential high costs for clinics and/or couples; (3) the emotional impact it might have on couples; (4) perceived complexity of counselling and expected elongation of waiting lists; and (5) expected low impact on reducing the burden of diseases. Participants believed that more evidence and research is needed prior to their involvement on the costs-benefits, implications, and demand. ConclusionWhile agreeing that the field of medically assisted reproduction provides a unique opportunity for offering ECS, reproductive health care workers feel a lack of capability and limited motivation to offer ECS to all or a selection of couples in their fertility clinic.

Glucose management in critically ill adults: A qualitative study from the experiences of health care providers

Aims and objectiveTo explain the components and elements of glucose management in critically ill adult patients from the healthcare providers’ experiences. BackgroundCritically ill adults are highly susceptible to stress-induced hyperglycaemia due to glucose metabolic disorders. Healthcare workers play a key role in the glycaemic management of critically ill patients. However, there is a lack of qualitative studies on the content and elements of glycaemic management and healthcare workers' perceptions about glycaemic management in China. DesignQualitative study that followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. MethodsIndividual semi-structured interviews were conducted from January to April 2022. Fifteen physicians and nurses were recruited from ten hospitals in mainland China. Data were analysed using inductive thematic analysis. ResultsGlucose management in critically ill adult patients from their experiences included two parts: the inner ring (practice behaviours) and the external space (methods and drivers). The practice behaviours of glucose management include five elements, while the methods and drivers of glucose management focus on three elements. The content covered under each element was identified. ConclusionThis study developed a glycaemic management model for critically ill adult patients, clarified its elements based on the perceptions of healthcare providers and elaborated on the methods and drivers covered under each element to provide a reference for physicians and nurses to develop a comprehensive glycaemic management guideline for critically ill adult patients. Relevance to clinical practiceOur study proposed a glucose management practice model for critically ill adult patients, and the elements and components included in this model can provide a reference for physicians and nurses when performing glucose management in critically ill patients.