Primary Qualitative Research Research Articles

Knowledge, attitudes and practices of the healthcare staff and students about disposal of unwanted medications: a systematic review

Abstract Introduction Improper disposal of medications poses a significant environmental risk on the ecosystems and human beings1. When medicines are discarded by flushing them down the toilet or throwing them in the household trash, their active components may leak into the water supply2. Aim This systematic review seeks to compile studies that examine healthcare professionals' and students' knowledge, attitudes, and practices (KAP) regarding medication disposal. It also aims to explore recommendations and barriers related to appropriate medication disposal. Methods A systematic review was conducted by adhering to guidelines outlined in Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 and the Joanna Briggs Institute. The primary outcome is to measure the levels of the healthcare staff and students' knowledge, as well as their attitudes, and practices about disposal of unwanted medications. Authors included qualitative, quantitative, and mixed-method primary research studies. Participants included pharmacists, doctors, nurses, and both undergraduate and postgraduate medical, pharmacy, and nursing students due to their significant involvement with medication and its disposal in healthcare settings. Data extraction was conducted by four of the researchers independently. The study details were categorised into three main domains i.e., knowledge, attitude, and practice using the KAP model. Other relevant information was also extracted, thematically, such as challenges and recommendations. Ethical approval was not required as this systematic review used previously published data. Results 37 studies from 18 countries (21 from Asia, 7 from the US, 5 from Africa, and 2 each from the EU and South America) met the inclusion criteria. 86.5% (n=32) investigated participants' knowledge of medication disposal. Although there is a good level of awareness about the environmental impacts, there are significant gaps in knowledge regarding correct disposal methods, available services, guidelines, and training. 30 studies explored participants' attitudes toward medication disposal. The results indicate a generally positive attitude towards the need for environmentally safe disposal practices. 35 studies evaluated participants' practices in relation to medication disposal. Although there was generally a positive attitude and some understanding of appropriate disposal methods, majority of the participants do not follow the practice guidelines, especially outside healthcare settings. This inconsistency may be due to numerous factors such as inadequate practical training, limited resources, or unclear guidelines. Discussion/ Conclusion Overall, it was found that while healthcare staff and students have fair knowledge and positive attitudes toward medicine disposal, their actual practices are lacking. One significant challenge identified is the limited awareness about proper disposal methods coupled with a lack of established services or guidelines in many regions. Even in cases where take-back programs are available, they often face issues with accessibility. To tackle these challenges, it is suggested by the studies that governmental bodies should establish and enforce clear policies on medication disposal while also expanding educational initiatives to increase understanding among healthcare professionals and students about appropriate disposal methods. Furthermore, improving access to take-back programs is crucial for ensuring safe medication disposal and minimising potential environmental and health hazards.

Systematic development of a complex intervention: a theory and evidence-based physiotherapist led group intervention to increase physical activity and reduce sedentary behaviour following bariatric surgery (PARIS)

ObjectivesTo describe the systematic development of a physiotherapist led group behaviour change intervention targeting physical activity and sedentary behaviour in individuals who have undergone bariatric surgery. Study designIntervention development including evidence synthesis, qualitative research and mapping of intervention components, using the 2008 MRC framework for complex interventions. MethodsWe conducted a systematic review to identify the evidence for promising interventions and components to increase physical activity and reduce sedentary behaviour following bariatric surgery. We also conducted primary qualitative research exploring these behaviours with three key stakeholder groups: patients, clinicians and commissioners. We selected two contemporary behaviour change frameworks to inform intervention development and developed a conceptual matrix in which intervention objectives were defined to inform selection of appropriate behaviour change techniques, proposed mechanisms of action(s), and mode of delivery. We also developed two intervention handbooks for participants and facilitators to support delivery and receipt of the intervention. ResultsWe have developed a behaviour change intervention targeting physical activity and sedentary behaviour in patients following bariatric surgery. Eight intervention objectives were defined and mapped to the Behaviour Change Wheel and Theoretical Domains Framework. We identified what the intervention must be able to do (intervention functions), behaviour change techniques that could be used to achieve this, the proposed mechanism of action, and mode of delivery. This intervention will be subject to a feasibility study, with the intervention delivered online over a six-week period to participants who have had bariatric surgery within the previous five years. Contribution of the Paper•This paper clearly explains the process involved in developing a theory and evidence-based physiotherapy-led complex behaviour change intervention.•The full specification of the intervention including proposed mechanism of effect has been provided, which should facilitate faithful intervention delivery and allow it to be comprehensively evaluated in a planned feasibility study.•This paper aims to enable physiotherapists to develop their own complex interventions, targeting behaviours that are relevant to their patients in their own areas of clinical practice.

The Experiences and Perceptions of First Contact Practitioners in Primary Care-A Qualitative Systematic Review.

First Contact Practitioners (FCP) have developed as a more advanced physiotherapy clinical role delivering specialist MSK services in GP practice settings. They aim to support GPs in effectively managing increasing patient workloads. As FCPs are now a more established NHS role, it is important to understand how these clinicians perceive their roles to guide and support future service development. To review the current evidence regarding the experience of FCPs in the UK. To understand how FCPs perceive their role. To gain an insight into FCP practice which can inform future primary research studies. A systematic review of FCP primary qualitative research studies. Multiple database and grey literature search with screening following PRISMA guidelines. Qualitative critical appraisal and analysis used tools and frameworks from the Joanna Briggs Institute. The review reports on 11 included studies which informed the creation of six key concepts impacting upon FCP role experience and perceptions. These were complexity, competency and role development, role understanding, job satisfaction, wellbeing and burnout and service delivery. FCP clinicians feel broadly positive about their roles, although they report a clear risk of burnout and associated negative impact on their wellbeing. Job satisfaction is linked to adequate training and developing the competencies required to manage patients in an environment of clinical uncertainty. Having access to regular clinical mentorship is a key requirement and FCPs must adapt to the specific demands of work in a GP practice environment.

The effectiveness and acceptability of physical activity interventions amongst older adults with lower socioeconomic status: a mixed methods systematic review.

Older adults with lower socioeconomic status are less likely to be physically active than those with higher socioeconomic status. To inform future intervention development, this review explored: [i] how effective are physical activity interventions at increasing levels of physical activity amongst older adults with lower socioeconomic status?; [ii] what factors are associated with the acceptability of physical activity interventions amongst older adults with lower socioeconomic status?; [iii] what are the implications for developing physical activity interventions for older adults with lower socioeconomic status? This mixed methods systematic review followed PRISMA guidelines. MEDLINE, CENTRAL, Embase, Scopus, Web of Science, PsycINFO, CINAHL, ASSIA and Sports Medicine and Education Index were searched up to May 2023, to identify quantitative, qualitative and mixed methods primary research studies measuring the effectiveness of and/or experiences of physical activity interventions for older adults (aged ≥ 65 years) with lower socioeconomic status. No limits on country were applied. Included studies were assessed for methodological quality using the Mixed Methods Appraisal Tool. Results were synthesised using a results-based convergent synthesis approach with narrative synthesis of quantitative findings and thematic synthesis of qualitative findings. Thirty studies were included. Mixed effects were found for the effectiveness of physical activity interventions, with positive effects for increases in utilitarian walking (i.e. for transport) but not for leisure, mixed effects for objectively measured physical activity and no effects for self-reported total physical activity or muscle strengthening and flexibility activities. Engaging in physical activity interventions was perceived as offering many benefits, social familiarity was important to intervention acceptability and interventions were seen as more acceptable when they were compatible with the lifestyles of older adults with lower socioeconomic status. Future development of physical activity interventions for older adults with lower socioeconomic status should foster social connections, emphasise health benefits of physical activity, hold interventions in locations that are accessible and familiar to older adults with lower socioeconomic status, minimise costs to participants, employ individuals who share participant characteristics to lead interventions, and combine physical activity with other activities older adults with lower socioeconomic status already do to make more efficient use of time. PROSPERO CRD42023417312; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=417312 .

Daughter Adjustment to Life Following the Death of Their Mother: Scoping Review

The objective of this scoping review was to assess and summarize existing literature on daughter adjustment to life following the death of their mother. The review examined factors that hinder and/or help daughter adjustment to mother loss, guided by the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis. Included sources were published quantitative and qualitative primary research studies, and dissertations/theses. Sources referenced mother loss by death due to any cause, mother-bereaved daughters of any age and identification (e.g., biological, adopted, foster, step), and factors that hinder and/or help daughter adjustment to mother loss. MEDLINE Complete, APA PsycInfo, CINAHL, Embase, SCOPUS, and Web of Science were searched with no restrictions on language or date of publication. From 2774 sources retrieved, 30 were included for final review and data charting. A template thematic analysis was conducted on charted qualitative data. Findings indicate that many factors involved in daughter adjustment to mother loss are not categorically unhelpful or helpful; their utility is context-dependent. Safe, continued connections with mothers, growth mindsets and spiritual or religious beliefs are internal resources that may facilitate adjustment. External support from maternal figures and surviving parents, may have an especially salient influence, both positive and negative, on daughter adjustment, coping and development. Particularly helpful for mother-bereaved daughters may be activities that promote mindfulness, healthy self-expression, distraction, connection with others, and a sense of mastery or self-esteem. Research focused on identifying mother-bereaved daughter needs is required to inform social perceptions of mother loss, bereavement education, support, and policy.

An exploration of the emotional response among nurses in Bermuda, during the Covid-19 pandemic.

This paper utilizes an ontological approach to conduct a qualitative literature review in order to investigate the emotional impact of the Covid-19 pandemic on nurses internationally. After identifying common themes in the literature review, primary research is conducted to investigate the emotional impact of the Covid-19 pandemic on nurses working in Bermuda´s only acute healthcare facility. The literature review used the FRAMEWORK approach (Richie and Spencer, 1994, as cited in Hackett et al. (2018) to select a total of 16 papers for review, each of them qualitative primary research, aside from one paper reviewing international literature. Within the second part of this paper, investigating the experience of nurses in Bermuda, a grounded theory approach was utilised to collect primary data. Convenience sampling was used to recruit subjects to participate in one-on-one semi-structured interviews. Data saturation was achieved after 9 interviews. The FRAMEWORK method was utilised to analyse the interview transcripts, and identify, organise and collate themes. The literature review highlights that nurses have strong emotional responses to caring for patients during the Covid-19 pandemic. Specific responses include: higher stress levels at work due to higher, more challenging workload, and a reliance on clinical leaders to assuage this stress. Stigma experienced outside of work lead to feelings of anxiety and isolation. Despite this, there was a common theme that nurses felt a satisfaction within their role to ´play their part´ in the pandemic. The primary research conducted in Bermuda demonstrates that there was an initial fear of Covid-19, receding as the pandemic developed. Much anxiety was due to a perceived lack of knowledge about the disease, lack of a coherent strategy, and inadequate equipment to protect staff, and properly care for patients. An increased level of cooperation amongst staff, and mutual support amongst nurses was noted, as was social stigma leading to feelings of isolation and anxiety. Social interactions and holistic activities were identified as primary resources to alleviate stress and uncertainty. Nurses in Bermuda elicited many of the same emotional responses as their international colleagues, as a result of caring for patients during the pandemic. These manifested as a result of higher, more challenging workload, and uncertainty about preparedness plan and quickly changing situations within the working environment. The results from this study can help formulate changes in policy to ensure smoother transitions to pandemic preparedness in the future.

Cross-cultural comparative analysis of student motivation and autonomy in learning: perspectives from Hong Kong and the United Kingdom

IntroductionThis research project examines student perspectives on independent learning in the United Kingdom and Hong Kong. Independent learning describes learning undertaken by students outside of standard institutional learning environments. Prior research has suggested that motivations to undertake independent learning and the strategies involved may differ across cultural contexts, institutions, and individual learners.MethodsThis research employs primary qualitative research consisting of interviews with 16 students in Business Studies (eight British and eight Chinese). The study takes a social constructionist approach to better establish the ways in which culture may serve as a mediator for motivation to learn independently and the strategies pursued to this end.ResultsThe study’s findings note key differences in the motivations to complete independent learning across either cohort, as well as distinct conceptualizations of what strategies and practices facilitate effective independent learning.DiscussionThis research highlights significant cultural differences in the motivations, strategies, and skills related to independent learning between students in the United Kingdom and Hong Kong. It also notes the potential for socioeconomic factors, institutional structures, and assessment methods, alongside culture, to contribute to these differences.

Public perceptions of inequality in the UK: a summary of key findings from the qualitative research

Abstract Primary qualitative and quantitative research was commissioned to support the strand of the IFS Deaton Review of Inequalities addressing ‘public attitudes to inequalities’, to explore: people’s awareness and concerns about different types of inequality in society; the extent to which they personally support structural explanations for inequality; and what manifestations of inequality are of most and least concern to them. In order to do this, qualitative research was designed to take an exploratory approach, as well as to dig beneath surface opinions to uncover the values and beliefs, often rooted in personal experiences, that underpinned participants’ responses. This article presents findings from 12 online discussion groups with the general public in the UK conducted in April–May 2021.

Patient and public understanding of antimicrobial resistance: a systematic review and meta-ethnography.

To further develop an understanding of laypeople's (adult patients and public) beliefs and attitudes toward antimicrobial resistance (AMR) by developing a conceptual model derived from identifying and synthesizing primary qualitative research. A systematic search of 12 electronic databases, including CINAHL, MEDLINE, PsycINFO, PubMed and Web of Science to identify qualitative primary studies exploring patient and public understanding of AMR published between 2012 and 2022. Included studies were quality appraised and synthesized using Noblit and Hare's meta-ethnographic approach and reported using eMERGe guidance. Thirteen papers reporting 12 qualitative studies were synthesized. Studies reported data from 466 participants aged 18-90 years. Five themes were identified from these original studies: the responsible patient; when words become meaningless; patient-prescriber relationship; past experience drives antibiotic use; and reframing public perception. These themes supported the development of a conceptual model that illustrates the tension between two different assumptions, that is, how can antibiotics be used for the collective good whilst balancing the immediate needs of individual patients. Findings suggest that AMR is a distinct ethical issue and should not be viewed purely as a prescribing problem. The meta-ethnography-generated conceptual model illustrates many factors affecting the public's perception of AMR. These include laypeople's own knowledge, beliefs and attitudes around antibiotic use, the relationship with the healthcare provider and the wider context, including the overwhelming influence of the media and public health campaigns. Future research is needed to explore effective health messaging strategies to increase laypeople's baseline awareness of AMR as a public threat.

Lived experiences of end-of-life care at home in the UK: a scoping review of qualitative research.

Home is the preferred place of care and death for most people with advanced illness. To examine and describe the published qualitative literature on the lived experiences of dying at home, to characterise the participants and their contexts, and to identify key gaps in knowledge, with a view to informing future research. A scoping literature review, undertaken in accordance with the PRISMA-ScR guideline, examined studies focusing on the lived experiences of dying at home in the UK. The online databases CINAHL and MEDLINE were searched with relevant Medical Subject Heading (MeSH) terms and keywords to identify primary qualitative research published between 2010 and 2022, exploring the lived experiences of patients, families, and/or unpaid carers in the UK. In total, 442 articles were screened, 61 of which underwent full-text review; 13 studies were retained in the final set. All studies explored the experience of bereaved family and/or unpaid carers, and one study interviewed a person who was dying. Where specified, the majority of experiences related to deaths from cancer, many with specialist palliative care team involvement. Included studies yielded a breadth of diverse findings, with the most common subject themes relating to the availability and quality of care, and support for families and carers. There is limited published evidence exploring the lived experiences of end-of-life care at home and this constrains the extent to which community services can be evidence informed in their design and delivery. More research is needed to examine the first-hand experiences of people who are dying at home, particularly for those with non-cancer conditions and where specialist services are not involved.

Patient-perceived factors influencing physical activity sensor use in stroke prevention and rehabilitation: A thematic synthesis protocol.

While the putative benefits of "fitness trackers" continue to fuel a booming consumer market, results of device-based clinical interventions remain remarkably mixed. This study will explore factors influencing wearable physical activity (PA) sensor use in the context of stroke prevention and rehabilitation for older adults. The findings of this thematic synthesis will provide insights into factors influencing the use of PA sensors in stroke which may inform more effective device-based interventions. Thematic synthesis as a formal method described by Thomas and Arden can be used within a systematic review to synthesize primary qualitative research. Accordingly, the proposed study will systematically search bibliographic databases for relevant peer-reviewed papers and synthesize coded thematic data within included papers. The quality of papers will be assessed using the JBI Critical Appraisal Checklist for Qualitative Research. Patterns in the text will be coded, preliminary data visualised, and higher-level analytical themes discerned to explain factors influencing the use of PA sensors in older stroke patients. This study does not require ethics approval. Results are expected to be available by June 2024. Data from the thematic synthesis will provide insights into barriers and facilitators influencing the use of wearable PA sensors in stroke and older adults at risk, and implications these factors have for the design of effective device-based interventions. Systematic review registration: PROSPERO registration number: CRD42020211472. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020211472.

Measles Vaccine Coverage and Disease Outbreaks: A Systematic Review of the Early Impact of COVID-19 in Low and Lower-Middle Income Countries.

Objectives: We aimed to evaluate changes to measles-containing vaccine (MCV) provision and subsequent measles disease cases in low- and lower-middle income countries (LICs, LMICs) in relation to the COVID-19 pandemic. Methods: A systematic search was conducted of MEDLINE, OVID EMBASE and PubMed records. Primary quantitative and qualitative research studies published from January 2020 were included if they reported on COVID-19 impact on MCV provision and/or measles outbreak rates within LICs and LMICs. Results: 45 studies were included. The change in MCV1 vaccination coverage in national and international regions ranged -13% to +44.4% from pre-COVID time periods. In local regions, the median MCV1 and overall EPI rate changed by -23.3% and -28.5% respectively. Median MCV2 rate was disproportionally impacted in local areas during COVID-interruption time-periods (-48.2%) with ongoing disruption in early-recovery time-periods (-17.7%). 8.9% of studies reported on vaccination status of confirmed measles cases; from these, 71%-91% had received no MCV dose. Conclusion: MCV vaccination coverage experienced ongoing disruption during the recovery periods after initial COVID-19 disruption. Vaccination in local area datasets notably experienced longer-term disruption compared to nationally reported figures.

Sludges against Ponzi schemes

Pyramid schemes are adapting to the digitalisation era and mimicking various organisations. The organisers of these schemes quite often appeal to such human qualities as greed and the desire to get rich quickly. Thus, it is becoming increasingly relevant to develop new methods for countering pyramid schemes taking into account modern realities and behavioural characteristics of an individual decisionmaker. The focus of the research is on selecting sludge tools to fight against digital pyramid schemes. Methodologically, the study relies on the concepts of behavioural economics, in particular, of the nudge theory (nudges vs sludges). The methods include brainstorming, focus groups. The evidence comes from primary qualitative research, in-depth interviews with both non-professional investors and experts in the field of financial market held in 2022. The analysis allowed defining the concept of sludge and present the types of sludge tools. The paper provides an original list of sludge tools as well as a set of practical tools to counter pyramid schemes, which, in particular, consists of legal restrictions, monitoring of Ponzi schemes’ activities, financial enlightenment, a legal information system, self-coordination of investors, and an individual approach. The paper concludes that sludge tools differ in terms of the length of impact and the speed of obtaining a result. Short-term sludges generate a fast effect and prevent from investing in pyramid schemes without preliminary preparation of participants; they, for instance, include placing a poster with a warning against Ponzi schemes, ensuring a careful reading of the contract, mandatory familiarisation with the List of entities with detected signs of illegal activities in the financial market created by the Bank of Russia, taking a risk test for assessing the probability of a decreased price or lost asset, ensuring advice of a financial counsellor as an obligatory stage of investment. The findings contribute to the understanding of the need for proactive (preventive) measures’ development aimed at countering fraudulent schemes.

Use of qualitative research in World Health Organisation guidelines: a document analysis

BackgroundGuidelines depend on effect estimates, usually derived from randomised controlled trials, to inform their decisions. Qualitative research evidence may improve decisions made but where in the process and the methods to do this have not been so clearly established. We sought to describe and appraise how qualitative research has been used to inform World Heath Organization guidance since 2020.MethodsWe conducted a document analysis of WHO guidelines from 2020 to 2022. We purposely sampled guidelines on the topics of maternal and newborn health (MANH) and infectious diseases, as most of the qualitative synthesis to date has been conducted on these topics, likely representing the ‘best case’ scenario. We searched the in-built repository feature of the WHO website and used standardised search terms to identify qualitative reporting. Using deductive frameworks, we described how qualitative evidence was used to inform guidelines and appraised the standards of this use.ResultsOf the 29 guidelines, over half used qualitative research to help guide decisions (18/29). A total of 8 of these used qualitative research to inform the guideline scope, all 18 to inform recommendations, and 1 to inform implementation considerations. All guidelines drew on qualitative evidence syntheses (QES), and five further supplemented this with primary qualitative research. Qualitative findings reported in guidelines were typically descriptive, identifying people’s perception of the benefits and harms of interventions or logistical barriers and facilitators to programme success. No guideline provided transparent reporting of how qualitative research was interpreted and weighed used alongside other evidence when informing decisions, and only one guideline reported the inclusion of qualitative methods experts on the panel. Only a few guidelines contextualised their recommendations by indicating which populations and settings qualitative findings could be applied.ConclusionsQualitative research frequently informed WHO guideline decisions particularly in the field of MANH. However, the process often lacked transparency. We identified unmet potential in informing implementation considerations and contextualisation of the recommendations. Use in these areas needs further methods development.

Perlindungan Hukum Peserta Arisan Online Akibat Tindakan Wanprestasi Penyedia “Arisan Online” Berdasarkan Buku III Kitab Undang-Undang Hukum Perdata

The development of communication technology gave birth to various phenomena in society, one of which is the phenomenon of online arisan. Previously, arisan was often found in the midst of Indonesian society and was carried out conventionally by holding meetings between its members. Nowadays, arisan can be found online through various social media with various types and ways of implementation. In arisan, there is an engagement relationship between arisan members and the relevant arisan chairman or owner. In general, arisan is carried out only with an oral agreement between the members and the chairman. Online arisan activities are not free from various problems such as the negligence of the parties in carrying out their obligations. Therefore, this thesis will specifically discuss the case in verdict Number 2/Pdt.G.S/2021/PN Trt regarding protection due to default actions of online arisan providers and the application of Law by Judges in verdict Number: 2/Pdt/G.S/2021/PN Trt against compensation claimed by online arisan participants for default by online arisan providers based on Book III of the Civil Law. This research uses normative juridical research methods by using laws and regulations as primary legal materials and qualitative research types. The research specification is descriptive analytical to obtain a comprehensive description and analysis by describing the laws and regulations. The results of this study show that the form of legal protection given to online arisan participants is repressive legal protection in the form of rules related to online arisan formulated in the Civil Law. Repressive legal protection in the form of compensation. The profit fee agreed by the parties in the agreement was not fulfilled by the judge on the grounds of the principle of justice of the online arisan provider. In this case, the Judge's application of law is inconsistent in his considerations. On the other hand, the Judge's decision is made based on his authority as stipulated in the Judicial Power Act.

Experiences of hospital care for people with multiple long-term conditions: a scoping review of qualitative research

BackgroundMultiple long-term conditions—the co-existence of two or more chronic health conditions in an individual—present an increasing challenge to populations and healthcare systems worldwide. This challenge is keenly felt in hospital settings where care is oriented around specialist provision for single conditions. The aim of this scoping review was to identify and summarise published qualitative research on the experiences of hospital care for people living with multiple long-term conditions, their informal caregivers and healthcare professionals.MethodsWe undertook a scoping review, following established guidelines, of primary qualitative research on experiences of hospital care for people living with multiple long-term conditions published in peer-reviewed journals between Jan 2010 and June 2022. We conducted systematic electronic searches of MEDLINE, CINAHL, PsycInfo, Proquest Social Science Premium, Web of Science, Scopus and Embase, supplemented by citation tracking. Studies were selected for inclusion by two reviewers using an independent screening process. Data extraction included study populations, study design, findings and author conclusions. We took a narrative approach to reporting the findings.ResultsOf 8002 titles and abstracts screened, 54 papers reporting findings from 41 studies conducted in 14 countries were identified as eligible for inclusion. The perspectives of people living with multiple long-term conditions (21 studies), informal caregivers (n = 13) and healthcare professionals (n = 27) were represented, with 15 studies reporting experiences of more than one group. Findings included poor service integration and lack of person-centred care, limited confidence of healthcare professionals to treat conditions outside of their specialty, and time pressures leading to hurried care transitions. Few studies explored inequities in experiences of hospital care.ConclusionsQualitative research evidence on the experiences of hospital care for multiple long-term conditions illuminates a tension between the desire to provide and receive person-centred care and time pressures inherent within a target-driven system focussed on increasing specialisation, reduced inpatient provision and accelerated journeys through the care system. A move towards more integrated models of care may enable the needs of people living with multiple long-term conditions to be better met. Future research should address how social circumstances shape experiences of care.

Credit scoring and risk management in islamic banking: the case of Al Etihad Credit Bureau

This current research aims to assess the performance of Al Etihad Credit Bureau (AECB) operating in the United Arab Emirates (U.A.E.) in reducing credit risk in the Islamic banking model. The research aims to clarify the effects of credit scores on credit risk management in Islamic banks and the extent of adopting Islamic banks of these ratings when evaluating the borrowers. The study was done based on a primary qualitative research method where six top managers from AECB and nine managers from UAE’s Islamic banks who are involved with credits within the bank were interviewed using a structured interviews approach. It was found that Islamic banks perceive AECB services and products as useful for credit scoring and risk management as a supplement to their internal subjective rules and guides. AECB applies the same rating across banks and financial institutions in the UAE. The study has implications for Islamic banks, AECB, and financial policymakers in the UAE.

Ethical challenges for Health Technology Assessment (HTA) in the evolving evidence landscape.

Since its inception, Health Technology Assessment (HTA) has typically determined the value of a technology by collecting information derived from randomized clinical trials (RCTs), in line with the principles of evidence-based medicine (EBM). However, data from RCTs did not constitute the sole source of information, as other types of evidence (such as primary qualitative research) have often been utilized. Recent advances in both generating and collecting other types of evidence are broadening the landscape of evidence, adding complexity to the discussion of "robustness of evidence." What are the consequences of these recent developments for the methodology and conduct of HTA, the HTA community, and its ethical commitments? The aim of this article is to explore some ethical challenges that are emerging in the current evolving evidence landscape, particularly changes in evidence generation and collection (e.g., diversification of data sources), and shifting standards of evidence in the field of HTA (e.g., increasing acceptability of evidence that is thought of as lower quality). Our conclusion is that deciding how to best maintain trustworthiness is common to all these issues.

Government policies on job satisfaction of radiographers in tertiary hospitals, Gauteng.

The National Department of Health has different operational policies to monitor the performance of its employees and to reward them accordingly. These policies could have a direct bearing on job satisfaction and career advancement for radiographers employed by the public sector, as there are previous reports that show that these policies affect the job satisfaction of other healthcare professionals negatively. The aim of the study was to explore the influence of government policies on the job satisfaction of radiographers employed by public tertiary hospitals in the Gauteng province. The study was conducted in two public tertiary hospitals in the Gauteng province. The study used a primary exploratory qualitative research design, with a purposive sampling technique. Data were collected through individual and focus group interviews. The researcher recorded and transcribed the interviews. Thematic analysis was used to analyse the data. Three government policies had a negative impact on job satisfaction for radiographers. These were the Occupational Specific Dispensation (OSD), the Performance Management and Development System (PMDS) and the Employment Equity Act (EEA). The failure to effectively implement these policies also had a negative bearing on career pathing. The implementation and structure of these three government policies have resulted in job dissatisfaction amongst radiographers employed by public tertiary hospitals and reduced the structure of career pathing. The study highlighted three government policies that negatively affect job satisfaction in Gauteng.

How do Researchers Address the Criteria for Quality of Action Research Studies in Healthcare: A Scoping Review

Background: The challenges being experienced by health and care systems across the globe are not being adequately addressed by current research paradigms and approaches. The scientific literature has recommended that in order to understand complex interventions, such as the implementation of integrated care, in complex systems, longitudinal and qualitative research approaches are required. Action research approaches have the potential to be a transformative force in healthcare through its dynamic dual intention of action and research that facilitates organisational change, teamwork and the empowerment of heath care professionals in hospitals and communities thus contributing to improvements in the quality of care. Despite its potential value, there is no clear consensus on what constitutes ‘good’ action research with many empirical investigations appearing to insufficiently engage with quality criteria that has been described in some detail in the literature including four factors from Shani and Pasmore’s complete theory of action research.
 Objectives: The aim of this scoping review was to explore the extant literature on action research studies in healthcare and assess and synthesise how researchers addressed criteria for quality of action research studies in healthcare.
 Eligibility criteria: This scoping review considered qualitative and quantitative primary research utilising action research approaches, published in the English language between the years 2016 and 2021.
 Sources of evidence: The following databases were searched: PubMed, CINAHL and ProQuest. In addition, a manual search of key action research journals was performed.
 Data extraction was conducted using Rayyan software and a bespoke data extraction table was developed to produce a descriptive summary of the results, addressing the objectives and research question. The review used the Arksey, and O’Malley (2005) revised six-step framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR). As recommended, the findings are presented in narrative and tabular form with figures to support the data where appropriate.
 Results: 3263 articles were originally identified. 641 articles were identified as duplicates entries and were removed before screening. A further 2565 articles were excluded as they did not meet the inclusion criteria. A total of 57 articles were included in the review. Most publications were in 2016. Several different action research approaches were used. Most studies had nursing participants and were set in hospitals with most publications in Europe. Only 13 of the 57 articles considered all 4 of the Shani and Pasmore quality factors and none considered the integration of these factors.
 Conclusion: This Scoping review builds upon knowledge generated by previous systematic reviews and contributes to knowledge and practice by providing coherence on how best to approach an action research project and attend to quality. If action research is to fulfil its potential as a transformative power for change within health care, action researchers need to demonstrate the rigor in their work. The authors offer some guidance in this area. Just as AR has dual intention, researchers have a dual obligation, to do good and to do good action research.