Pile Sorting Research Articles

Iowa Implementation for Sustainability Framework

BackgroundAn application-oriented implementation framework designed for clinicians and based on the Diffusion of Innovations theory included 81 implementation strategies with suggested timing for use within four implementation phases. The purpose of this research was to evaluate and strengthen the framework for clinician use and propose its usefulness in implementation research.MethodsA multi-step, iterative approach guided framework revisions. Individuals requesting the use of the framework over the previous 7 years were sent an electronic questionnaire. Evaluation captured framework usability, generalizability, accuracy, and implementation phases for each strategy. Next, nurse leaders who use the framework pile sorted strategies for cultural domain analysis. Last, a panel of five EBP/implementation experts used these data and built consensus to strengthen the framework.ResultsParticipants (n = 127/1578; 8% response) were predominately nurses (94%), highly educated (94% Master’s or higher), and from across healthcare (52% hospital/system, 31% academia, and 7% community) in the USA (84%). Most (96%) reported at least some experience using the framework and 88% would use the framework again. A 4-point scale (1 = not/disagree to 4 = very/agree) was used. The framework was deemed useful (92%, rating 3–4), easy to use (72%), intuitive (67%), generalizable (100%), flexible and adaptive (100%), with accurate phases (96%), and accurate targets (100%). Participants (n = 51) identified implementation strategy timing within four phases (Cochran’s Q); 54 of 81 strategies (66.7%, p < 0.05) were significantly linked to a specific phase; of these, 30 (55.6%) matched the original framework. Next, nurse leaders (n = 23) completed a pile sorting activity. Anthropac software was used to analyze the data and visualize it as a domain map and hierarchical clusters with 10 domains. Lastly, experts used these data and implementation science to refine and specify each of the 75 strategies, identifying phase, domain, actors, and function. Strategy usability, timing, and groupings were used to refine the framework.ConclusionThe Iowa Implementation for Sustainability Framework offers a typology to guide implementation for evidence-based healthcare. This study specifies 75 implementation strategies within four phases and 10 domains and begins to validate the framework. Standard use of strategy names is foundational to compare and understand when implementation strategies are effective, in what dose, for which topics, by whom, and in what context.

Perception of Leprosy Patients towards the Disease in a Tertiary Care Hospital of High Prevalent District in West Bengal, India: A Qualitative Study.

Background:Leprosy is a disease having tremendous social implications due to ostracization. Despite continuous efforts made so far to eliminate leprosy, stigma/misbeliefs/adverse attitude toward leprosy still prevails among common people. Community perceptions and attitudes towards leprosy patients are critical and unique indicator of how society stereotypes leprosy.Aims:The qualitative study was conducted to explore the perceptions of leprosy patients towards leprosy.Materials and Methods:Two focused group discussions (FGDs) with 19 newly-diagnosed leprosy patients who can speak vernacular were conducted with help of a predetermined FGD-guide between April and June 2019 in the dermatology out-patient department of the tertiary-care center. Both FGD sessions were recorded, transcribed, and translated into English. These verbatims were thematically analyzed and emerging themes were identified with illustrative quotations. Free list and pile sort data obtained were analyzed by Visual Anthropac version 1.0 software for Smith's salience value Cognitive mapping with two-dimensional scaling and hierarchical cluster analysis.Results:Small size of wound, not giving importance, failure to realize, bad luck and scared of being isolated etc., were the most common reported perceptions. Overall, five themes emerged after pile sorting, namely ignorance about the disease, stigma and economic burden, positive perception after diagnosis, treatment-related suggestions, and myths and frequently asked questions.Conclusion:The study concludes that more IEC campaigns are required to abolish the stigma; and ASHA workers/front-line workers can play a pivotal role. The program (NLEP) can also utilize the role of satisfied cured-patient as peer-educator to improve the attitude of society towards this disease.

Are we expecting too much for too long from the vaccinators? A qualitative study on perceived challenges of COVID-19 vaccinators of district Shahdol, India.

There is a paucity of knowledge regarding challenges faced by the coronavirus disease 2019 (COVID-19) vaccinators in resource constraint settings like district Shahdol, Central India. Hence, the present study was planned to explore the perceived challenges of vaccinators regarding COVID-19 vaccination. In October 2021, district health authorities conducted a one-day workshop with the auxiliary nurse midwives, staff nurses, and lady health visitors who work as vaccinators. It had three distinct but mutually connected phases. In the first phase, a free listing exercise was performed to list out their perceived challenges that are prominent and representative of their cultural domain. In the second phase, the pile-sorting exercise with the challenges mentioned in the above step was performed to produce similar data in the form of a matrix, based on a perceived similarity between them by multi-dimensional scaling analysis. In the final phase, the transcripts generated during the discussion on the free listing and pile sorting exercises was used for the thematic analysis to find plausible explanations for the findings. A total of 15 vaccinators took part in the workshop. In the free listing exercise, a total of 14 items were identified as perceived challenges for COVID-19 vaccinators. The three items with the highest Smith's S value were overtime duty, no holidays, and lack of monetary incentive. The analysis of pile-sorting suggested that participants clustered their 14 perceived challenges into five groups; 1) beneficiaries related, 2) vaccination schedule related, 3) lack of facilities at vaccination site, 4) lack of monetary incentive, and 5) issues related to digital data handling. Thematic analysis suggested that their main challenges were overtime duty, no monetary incentive, and lack of toilet, food, and transport facility at the session site. Vaccinators perceive overtime duty and lack of holidays as their top two challenges and expect monetary incentives for this. The study recommends better basic amenities like toilet facility, sustained and effective community engagement, a monetary incentive, and a better ecosystem for digital data handling for the vaccinators.

Perception Among the Sufferers of Recalcitrant Dermatophytosis Regarding its Causation, Prevention, Care-Seeking Behaviour and their Personal Hygiene: A Qualitative Research.

Background:Recalcitrant dermatophytosis has become a menace in recent times. The perception of the hosts or patients regarding the disease gives a real-life picture of the deep-rooted host-factors and the way to overcome the socio-economic and cultural milieu that becomes a hindrance in preventing the relapse and recurrence of this infection.Aims:This qualitative study was conducted to assess the perception regarding the patients’ understanding of causation and prevention of dermatophytosis, role of personal hygiene, and healthcare seeking behavior, and consequently, exploring the socio-economic and cultural milieu that contributes to the menace of recalcitrant dermatophytosis.Materials and Methods:Two focus group discussions (FGDs) consisting 12 patients with recalcitrant dermatophytosis, who speak the vernacular, were conducted with the help of a predetermined FGD-guide. Both FGD sessions were recorded, transcribed, and translated into English. These verbatims were thematically analyzed and emerging themes were identified with illustrative quotations. Free listing and pile sorted data obtained were analyzed by Visual Anthropac version 1.0 software for Smith's salience value, cognitive mapping with two-dimensional scaling and hierarchical cluster analysis.Results:Washing of clothes with soap antiseptics and drying the clothes under the sun prevents diseases, whereas, not changing undergarments for prolonged periods of time, bathing in ponds using mustard oil spreads the disease, furthermore, staying in wet clothes, working for more than five hours under sun, playing outdoors, household jobs cause tinea, etc. were the most common reported perceptions. Overall, five themes emerged after pile sorting the data, namely, ignorance about the disease, understanding of the predisposing factors of the disease, prevention, role of personal and traditional belief, and care-seeking behavior.Conclusions:There is a dire need to address the myths or traditional beliefs, which are not supported by scientific evidence. Expense of the treatment of dermatophytosis calls for price control of the commonly prescribed antifungals. Poor socio-economic conditions and professional responsibilities hinder people from implementing the preventive measures in spite of their knowledge.

Awareness and preparedness of first responders regarding chemical, biological, radiological, nuclear and explosive (CBRNE) disaster management of a tertiary medical institute in South India: A mixed methods study.

In case of a CBRNE catastrophe, junior doctors (first responders) will be the first to respond to the CBRNE disaster, so they should be fully equipped with the knowledge and skills of managing CBRNE casualties and preventing the endangerment of lives. To assess the awareness and preparedness of first responders in medical institutions regarding CBRNE casualties' management and to explore the perceptions of first responders towards CBRNE disaster management. The present study was a mixed methods study which was conducted during the months of January to March 2020 among 153 study participants. Focus group discussions (FGDs) were conducted along with free listing and pile sorting till data saturation. Data entry was done in an Excel sheet and data analysis was be done using SPSS software v. 21. Out of the 153 participants only 37 participants (24.1%) had ever heard about the term "CBRNE" (chemical, biological, radiological and nuclear disasters) or "hazmat" (hazardous material). At the end of FGDs, participants could answer affirmatively that they had heard the term "decontamination" of CBRNE casualties. Very few participants could ambiguously explain the meaning of the term "decontamination" in the context of CBRNE casualty. There is an imperative need for enhancing not only knowledge and awareness, but also proper training for first responders to utilizing simulation sessions. This is particularly important as health care professionals are the first line of defence when it comes to identifying and treating patients that have come into contact with CBRNE hazards.

English

BACKGROUND COVID- 19 pandemic hit the entire world and every institution was forced to close down. Medical education process comprises of theoretical classes, lab classes, practical classes as well as clinical classes. Medical institutes like other institutions were forced to start online teaching with fully knowing its limitation. Keeping in mind the recent new normal scenario, this study has been conducted in a medical college of West Bengal among medical faculties. We wanted to explore the barriers and facilitators for adoption of online teaching learning method among medical faculties in a medical college. METHODS This qualitative study was conducted among 24 medical educators of all disciplines of MBBS curriculum from 21st August, 2020, to 30th September, 2020. Data was collected by convenience sampling method. The subjects were interviewed with open ended questionnaire and data was analysed using Anthropac software. Free listing, pile sorting and thematic analysis was done. RESULTS Almost equal proportion of male (58.3%) and female (41.7%) faculties participated in this study. Lack of direct interaction, poor infrastructure, systematic error, problem in adapting teaching learning process were the main barriers while minimal contamination of COVID-19, uninterrupted teaching learning process were the facilitators of this process. CONCLUSIONS The coronavirus pandemic has raised huge difficulties for advanced education located around the world. A specific test has been the dire and surprising demand for already up close and personal college courses to be instructed on the web. On the web; instructing and learning suggest a specific academic substance information, principally identified with planning and arranging for better learning encounters and establishing unmistakable learning conditions, with the assistance of advanced innovations. Decoding and understanding these positives and negatives will help education system in creating strategies for more efficient delivery of the lessons, ensuring an uninterrupted learning journey for the students. KEY WORDS Qualitative Study, Free Listing, Pile Sorting, Thematic Analysis

Combining Stakeholder- and Social Network- Analysis to Improve Regional Nature Conservation: A Case Study from Osnabr\xfcck, Germany

Many nature conservation projects fail primarily not because of a lack of knowledge about upcoming threats or viable conservation concepts but rather because of the inability to transfer knowledge into the creation of effective measures. Therefore, an increase in information exchange and collaboration between theory- and practice-oriented conservation actors, as well as between conservation actors, land user groups, and authorities may enhance the effectiveness of conservation goals. By considering the interactions between conservation stakeholders as social networks, social network analysis (SNA) can help identify structural optimization potential in these networks. The present study combines SNA and stakeholder analysis (SA) to assess the interactions between 34 conservation stakeholders in the major city and district of Osnabrück in northwestern Germany and offers insights into cost/benefit optimizations of these stakeholder interactions. Data were acquired using a pile sort technique and guideline-based expert interviews. The SA, based on knowledge mapping and SWOT (strength, weaknesses, opportunities, and threats) analysis, identified individual stakeholder’s complementary properties, indicating which among them would most benefit from mutual information exchange and collaboration. The SNA revealed discrepancies in information exchange and collaboration between theory- and practice-focused stakeholders. Conflicts were found predominantly between conservation associations, authorities and land user groups. Ecological research, funding, land-use conflicts, and distribution of conservation knowledge were identified as fields with high potential for increased information exchange and collaboration. Interviews also showed that the stakeholders themselves see many opportunities for increased networking in the region. The results are discussed in relation to the existing literature on nature conservation networks and used to recommend optimization measures for the studied network. Finally, the conclusion reflects upon the developed approach’s implications and possibilities for conservation stakeholders and planners in general.

Female power portrayals in advertising

Although stereotypical female portrayals are still common in advertisements, in recent years it appears there has been a move toward portraying women in powerful positions in ads. This research investigates the recent trend in advertising that portrays women in positions of power and offers a typology of female power dimensions in ads. Building on previous literature on social power, feminine power, and current trends in advertising, a typology for female power is proposed and verified using two studies. In the first study, data from a pile sort of current print ads is collected and analyzed by cluster analysis and multidimensional scaling. In the second study, semi-structured interviews are employed to verify the proposed typology. Results verified that receivers perceive female power in advertisements in the following power dimensions: sexual power, expert power, family power, and empowerment (including athletic power).

Applying user-centered design in the development of nudges for a pragmatic trial to reduce no-shows among veterans

ObjectiveTo incorporate user-centered design processes into the refinement of nudges designed to reduce no-shows among healthcare appointments for military veterans in the Veterans Health Administration (VA). MethodsWe developed candidate nudges as brief messages based on four broad concepts in behavioral science. We then conducted iterative waves of multi-stage interviews (N = 27) that included a pile sorting task, a “think-aloud” review of each message, and prototype letter reviews. Rapid consensus analysis of each wave’s feedback iteratively refined message language. ResultsVeterans rejected several theoretically plausible messages focusing on avoiding the burden of rescheduling missed appointments or the monetary cost of no-shows. Participants suggested framing calling to cancel an appointment as helping other veterans and emphasized a new motivational theme: expressing personal concern for the veteran. ConclusionUse of iterative UCD methods allowed for early identification of both messages inappropriate for veterans and new veteran-generated nudges around non-judgmental validation that could be incorporated in the design of our pragmatic trial. Practice implicationsRapid team-based qualitative analysis, iterative material design, and space in the study design to incorporate entirely new insights from participants into study materials are all approaches that can improve communications of what matters most to a specific population.

‘Student centered approach’ in implementing community based active case finding for tuberculosis in rural, Puducherry – A qualitative evaluation

BackgroundAs a part of Competency Based Medical Education (CBME) the competencies related to Communication skills, survey technique, can be improvised by exposing the students in community based Active Case Finding for Tuberculosis which helps in sustaining the activity. MethodsCommunity based house-to-house survey using “Student centered approach” was carried out to identify Presumptive TB cases as per the program definition among fourteen villages covered by Thirubhuvanai, Primary Health Centre. The team comprised of trained MBBS student, medical interns supervised by Post graduates, Medical social workers posted at the Department of Community Medicine, of a medical college, Puducherry. After training Mobile based application (Epicollect5) was used for survey. Feedback from students were obtained to explore their experience from ACF. Free listing and pile sorting was done among interns to explore their experience on Epicollect using Visual Anthropic software. ResultsThe major learning of the medical students from ACF activities were communication skills, rapport building with the community people, Screening for TB and their problem. Free listing identified 14 salient variables depending on the cut-off value of 0.083 (Smith's Salience Score) and subjected to pile sorting. Cognitive map identified their experiences into three categories namely knowledge on TB screening, uses of Epicollect and paper-based questionnaire. Totally 19,134 households were screened, among them 77 presumptive TB cases were identified, three positive pulmonary TB cases were detected and linked to TB care pathway. Conclusion“Student centered approach” proved to be effective strategy in ACF for TB from student's reflection. This rigorous ACF outreach activity shares dual benefits individual and community level benefit and also programme level benefits. Implementing this approach of involving MBBS students in ACF activity was successful and it is feasible to continue every year propounded by National TB Elimination Program (NTEP) guidelines.

Food Classifications by Brazilian Amazon Mothers: Interactions With Eating Practices

ObjectiveTo assess how mothers classify foods and how their eating practices interact with these classifications, with special attention to meanings and uses given to ultra-processed foods. DesignQualitative research with in-depth interviews and pile sorts. SettingUrban Brazilian Amazon. ParticipantsA sample of 34 mothers were selected through theoretical sampling. AnalysisContent analysis for in-depth interviews and multidimensional scaling and cluster analysis for pile sorts. Phenomenon of InterestFood classification. ResultsClassifications were based on context (ie, a time or a situation in which the food is eaten) and foods’ healthiness. Five food groupings based on mothers’ classifications were defined: (1) main meal foods, (2) fruits and fruit juices, (3) convenient foods, (4) leisure foods, and (5) canned sardines. Ultra-processed foods were classified differently from non-ultra-processed foods and considered unhealthy, consumed on special occasions or when there was no time or desire to cook. Conclusions and ImplicationsResults highlight the potential of incorporating context-based categories and personal experiences to guide nutrition interventions and the potential of pile sorts to tailor messages to target populations.

Quantitative and qualitative evaluation of perception of medical faculty toward competency-based medical education for undergraduate curriculum

INTRODUCTION: Competency-based medical education (CBME) is an outcome-based education system. There is a big shift in roles and responsibilities of teachers, students, and teaching methods. This study was planned to evaluate the faculty perceptions and concepts toward the CBME and its implementation. METHODOLOGY: This is a mixed-method study with elements of qualitative (free listing and pile sorting) and quantitative (three-point Likert scale) assessment of faculty perceptions on CBME designed through Google Forms, and the responses obtained were analyzed. Three hundred faculties were recruited for a quantitative study, out of which 125 responded. For qualitative analysis, the preclinical faculties (n = 20) were recruited. Percentages for the responses were calculated. Free-listing and pile-sorting exercise data were analyzed in Visual Anthropac 1.0 software. RESULTS: The responses from participants showed encouraging analysis. A total of 128 faculty members responded that a response rate was 43%. Thirty-eight responses were obtained through interview pertaining to the concepts (qualitative study) of CBME. From the free-listed items or responses, the items were selected based on salience or ranking or investigator's judgment for pile sorting to understand clustering of responses. CONCLUSION: Majority of the faculties had a positive perception about the implementation of CBME. Coordination between the Preclinical, paraclinical and clinical departments and proper lesson plan were the factors facilitating effective implementation. Inadequate faculty training and unanticipated holidays were the challenges for the implementation of CBME. Proper faculty training is the utmost important aspect in the effective implementation.

Perception, Readiness and Preferred Training Methods on Bioethics as Emerging Medical Professionals-An Explorative study from Tamil Nadu

Context: Indian medical graduate is envisioned to possess adequate knowledge on bioethics as reiterated in the code of ethics, a regulatory document for professional conduct, etiquette and ethics of doctors by Medical Council of India (MCI). Aims: To describe the awareness on medical bioethics among trainee interns and junior residents and elicit characteristics for effective training methodologies on bioethics attertiary medical teaching hospitals across Tamil Nadu. Settings and designs:Mixed methodology usingcross-sectional survey in combination with pile sorting, free listing exercises followed by in-depth interviews to generate rich qualitative inputs. Methods and material: Google Forms survey was designedand link was disseminated using social affinity groups and snowballing techniques through social media. Statistical analysis used: Data was analyzed using MS Excel for quantitative survey and Visual Anthropac4.98.1/X softwarefor pile sorting and free listing exercises and manual content analysis for interviews. Results:Among 135 respondents for online survey from across 25 medical colleges in Tamil Nadu, 57.5%were females, 42.2%had training on bioethics and 54.4%during internship period.Experts conducted training for only 34% of participants. Cluster analysis identified communication skills, personality traits, and medico-legal interface as the major areas of focus for bioethics training and majority favoured a combination of curriculum-based and self-directed learning through online modules, and immersive-blended portals like TEDX styled talks with expertsas innovative methodologies for training on bioethics. Conclusions:Novel and participatory training methodologies are favoured in imparting training to enhance bioethics preparedness among emerging medical professionals.

Gendered plants and plant categorization by gender: classificatory and “storied” knowledge in Trás-os-Montes, Portugal

Background: An anthropomorphizing process arises out of classification systems, whereby analogy is drawn between the social differences of gender and the morphological and biological characteristics used to designate or classify plants. On the other side, it is observed that men and women categorize plants differently on the basis of their practices and knowledge.This paper addresses two assumptions: the consistent cognitive mechanisms of attributing gender to plants in classifications and the local differentiation of knowledge and social variability of categorization of plants based on gender.Methods: The data presented results from research carried out in Portugal in two rural villages, using participant observation, structured ethnobotanical interviews and free pile sorting task (79 interlocutors; among them 11 local experts). A literature review provided some examples from studies conducted in other contexts, which have been used to analyze and discuss our findings.Results: Gender differentiations are present in plants naming and identification. Plants morphologically similar can take different designations or have the same name with gender variations depending on people’s perceptions of female or male features. The survey conducted in these Portuguese case studies shows also a gender variability of knowledge, although knowledge about plants is usually quite shared.Conclusions: The mechanism of plant differentiation using gender attributes seems to be transcultural. However, the plant classification by gender must be explained from a local standpoint and knowledge about plants should be understood as a “storied knowledge”.Key words: plant nomenclature, ethnobotanical classification, gender, storied knowledge

Using Cultural Domain Analysis to Understand Community Perceptions of Infant and Young Child Foods in Sri Lanka

Objectives1) To understand how Sri Lankan caregivers conceptualize young child foods; 2) To explore local food classification systems; 3) To explain why some foods are culturally prescribed (remedies) or proscribed (taboos) for young children MethodsDesign: This ethnographic sub-study was conducted within a four-phase, mixed methods formative research design across rural, estate, and urban sectors of Sri Lanka. Data collection methods and sampling. Data were collected between Oct. 2020 – Feb. 2021 using free lists, pile sorts, and semi-structured interviews in urban (Batticaloa and Colombo), rural (Kilinochchi, Ratnapura, and Matara), and estate (Nuwara Eliya) sectors of Sri Lanka. Free lists (n = 150) and pile sorts (n = 84) were conducted among caregivers of young children. Both community leaders (n = 24) and caregivers (n = 21) were purposively sampled for interviews. Data analysis. Cultural domain analysis was conducted using Anthropac. Textual analysis of interview data followed an inductive approach whereby themes were identified, coded, and extracted for interpretation using Dedoose. Findings across methods were triangulated to enhance credibility. Results1. Among all sectors of Sri Lanka, caregivers identified rice as the most important food for young children diets, highlighting the importance of this staple regardless of sector or ethnicity. Only 2 animal source foods (eggs and fish) were included within the top 15 most salient foods. 2. Local food classification systems highlight a ‘hot’ and ‘cold’ paradigm, reflecting the underlying Ayurvedic medical belief system, influencing dietary choices. 3. Overall, 48 food proscriptions were identified, including ‘egg’ and ‘fish, specifically during child illness. Some locally-available fruits and vegetables were also proscribed, depending on their ‘cold’ nature, level of digestibility, and relation to illness causation. Prescribed foods (n = 47) were also found, most of which were herbal remedies (22 food or spice mixtures) to address child illness. ConclusionsUnderstanding local food definitions, food classification systems, and food rules may aid in shaping policies aiming to include culturally-appropriate strategies to improve feeding practices in Sri Lanka. Funding SourcesUNICEF.

Challenges Encountered by Healthcare Providers in COVID-19 Times: An Exploratory Study

Healthcare establishments are unique and complex. The Indian healthcare system comprises of public and private healthcare establishments. Different challenges are encountered by the healthcare professionals in their daily operations. The sudden emergence of COVID-19 posed a new threat to the already burdened healthcare system. The pandemic changed the healthcare paradox with newer workplace and societal challenges faced by the healthcare personnel. The purpose of this study is to identify the antecedents of workplace and societal challenges faced by the healthcare personnel. Our study conducted in Kolkata and other adjoining areas of West Bengal included respondents who volunteered for individual in-depth interviews. The sample size was kept at n = 20 after due technical considerations. Freelisting and pile sorting was done to generate clusters. The qualitative study identified five constructs with 18 items under workplace challenges and three constructs with five items under societal/community challenges. Workplace challenges included resource availability, adequacy and allocation, financial issues, perceived managerial ineffectiveness, inconsistent guidelines and perceived occupational stress, while societal/community challenges included dread disease, social adaptiveness and challenges related to essential services. A salience threshold was established and the multidimensional scaling provided four major clusters: financial support and sustainability, adaptive resilience, infection risk mitigation and healthcare facility preparedness. Suggestive actions for the identified challenges were summed as enhanced production of diagnostic kits through public–private partnership models and industrial production reforms. Enhanced testing facility for COVID-19 will help to identify new cases. Financial stresses need long-term sustainable alternative that will avoid pay cuts and unemployment. Treatment regimen, diagnostic protocols, waste disposal guidelines should be worked upon and leading national agencies be consulted for technical support, research and development.

An Ethnomedical Perspective: Understanding Young Child Illness in Sri Lanka Using Cultural Domain Analysis

ObjectivesTo understand how community perspectives toward young child nutritional illness compare to biomedical perspectives in Sri Lanka. MethodsThis ethnographic sub-study was embedded in a multi-phase, mixed methods formative research design to understand infant and young child feeding practices in urban, rural, and estate sectors of Sri Lanka. Data were collected among caregivers of young children to understand nutritional illness using free lists (n = 150), pile sorts (n = 84), semi-structured interviews with caregivers (n = 21) and community leaders (n = 24). Data were collected in Sinhalese and Tamil languages and translated into English for analysis. Free list and pile sort data were analyzed using cultural domain analysis with Anthropac. Textual data were analyzed thematically using Dedoose. Data sets were combined for methodological triangulation. ResultsDuring interviews, caregivers described a combination of biomedical and traditional medicine approaches for treating common childhood illness, a reflection of the continued importance of traditional medical belief systems. Beliefs grounded in Ayurvedic medicine remain important drivers of health and nutrition-seeking behaviors. Consumption of ‘cold’ foods was frequently cited as an important cause of child illness. Some caregivers did explain that promoted foods such as eggs, leafy green vegetables, fruits, and green grams are appropriate dietary choices for good child health and nutrition. Cultural domain analysis revealed nutrition-related illnesses were less salient than other common young child illnesses such as fever, common cold, and cough. Low weight was the only nutritional illness that appeared in the top 15 most salient illnesses among participants. Despite a 17% average child stunting prevalence across all sectors of Sri Lanka, chronic malnutrition and stunting were not mentioned by nearly all participants, suggesting that a local understanding of this condition may not align with the biomedical importance placed on it by health professionals. Overweight/obesity did not appear to be a concern despite a growing national prevalence. ConclusionsPolicies and programs aimed at improving infant and young child feeding practices in Sri Lanka may benefit from understanding and incorporating community perspectives toward nutrition-related illnesses. Funding SourcesUNICEF

Designing a couple-based relationship strengthening and health enhancing intervention for pregnant women living with HIV and their male partners in Zambia: Interview findings from the target community

IntroductionInterpersonal support can promote positive outcomes among people living with HIV. In order to develop an acceptable psychoeducational couples-based intervention aimed at strengthening the relationship context and improving HIV outcomes before and after pregnancy, we conducted qualitative interviews with pregnant women living with HIV and their male partners. MethodsWe interviewed a convenience clinic-based sample of pregnant women living with HIV (n = 30) and male partners (n = 18) in Lusaka, Zambia. Interviews included pile sorting relationship topics in order of perceived priority. Interviews also focused on family health concerns. Interviews were audio-recorded, translated, transcribed, and thematically analyzed. Pile sorting data was analyzed using descriptive statistics. ResultsAll female participants were living with HIV; 61% of the male partners interviewed were additionally living with HIV. The most prioritized relationship topic among both genders was communication between couples. Honesty and respect were important relationship topics but prioritized differently based on gender. Female participants considered emotional and instrumental support from male partners critical for their physical and mental health; men did not prioritize support. Intimate partner violence was discussed often by both genders. Family health priorities included good nutrition during pregnancy, preventing infant HIV infection, safe infant feeding, sexual health, and men's alcohol use. ConclusionsA major contribution of this study is a better understanding of the dyad-level factors pregnant women living with HIV and their male partners perceive to be the most important for a healthy, well-functioning relationship. This study additionally identified gaps in antenatal health education and the specific family health issues most prioritized by pregnant women living with HIV and their male partners. The findings of this study will inform the development of an acceptable couples-based intervention with greater likelihood of efficacy in strengthening the relationship context and promoting family health during and after pregnancies that are affected by HIV.

Exploring the Cultural Model of Social Stress Among Andean Women in the Peruvian Highlands

Abstract We conducted research to explore how women in the highlands perceive and identify stress within the cultural context of the Andes. Using cultural domain analysis, consisting of free listing and pile sorting, we demonstrate the shared cultural model of stress among Andean women. The project describes different types of stress that impact women including economic insecurity, lack of access to education, and spousal problems. We demonstrate what this research tells us about how Andean women organize sources of stress. The practical implications of this study involve researchers and practitioners considering social factors present in the lives of Andean highland women. The research can improve discussions about how these issues influence individual social stress levels.

16185 Iowa Implementation for Sustainability Framework: Specification and validation

ABSTRACT IMPACT: Framework is designed to aid selection of implementation strategies to promote adoption and sustainability of EBP to improve health care quality, safety and value. OBJECTIVES/GOALS: An application-oriented implementation framework based on Diffusion of Innovation theory, identified 81 strategies for clinician-use within four implementation phases. The goal of this research was to further specify strategies based on emerging implementation science and establish external validity. METHODS/STUDY POPULATION: An iterative mixed-methods process guided framework revisions. First, individuals (n=1,578) requesting use of the framework over the last seven years were sent an electronic questionnaire. Evaluation captured usability, generalizability, accuracy of phases, and implementation phases for each of 81 strategies. Second, nurses who use the framework pile sorted strategies for multidimensional scaling and hierarchical analysis using Anthropac software. Third, a panel of five EBP/implementation experts used data and a consensus process to add clarity with the naming, and further specify strategies. RESULTS/ANTICIPATED RESULTS: Survey respondents (n = 127, 8% response) were nurses (94%), at least Master’s educated (94%), from health systems (52%) or academia (31%), in the U.S. (84%). The framework, rated on a four-point scale (1 = not/strongly disagree to 4 = very/strongly agree; reported are ratings 3 and 4) was deemed useful (92%), generalizable (100%), and with accurate timing (96%). 51 participants linked strategy timing to a single phase (54 strategies, 66.7%, p&lt;0.05, Cochran’s Q); most strategies (30) matched the original model. Pile sorting (n=23) generated a concept map and hierarchical clusters of groups. Experts used these data and implementation science to specify each strategy and revise the framework. DISCUSSION/SIGNIFICANCE OF FINDINGS: The Iowa Implementation for Sustainability Framework (IISF) offers a typology to guide implementation for healthcare improvements. This study specifies 77 implementation strategies, confirms four phases, identified 10 domains, and begins to establish external validity for the framework.