Qualitative Focus Group Study Research Articles

Exploring Patient–Clinician Trust During Pregnancy Care

OBJECTIVE: To explore patient experiences and perspectives regarding trust in clinicians during pregnancy care among Latine patients, focusing on those with Spanish as their preferred language. METHODS: We conducted a qualitative focus group study to explore trust in pregnancy care clinicians. Eligible participants self-identified as Hispanic/Latine, reported Spanish or English as their preferred language, were pregnant or had given birth in the previous year, and were at least 18 years old. Participants completed a brief demographic survey. We report descriptive statistics for survey responses. A semistructured discussion guide was developed from a literature review and feedback from a patient advisory panel. We report emerging themes using a modified grounded theory approach with an analysis of focus group transcripts. We mapped themes to the five dimensions of trust according to the Building Trust Initiative—communication, caring, comfort, cost, and competency—and barriers to trust. RESULTS: We conducted eight focus groups (five in Spanish, three in English) through Zoom between July and September 2023. Cost was not discussed in any of the focus groups. Rather, there was an emerging theme around acompañamiento (accompaniment is a distinct form of companionship in which there is shared power during a shared journey), particularly in the Spanish focus groups. Barriers to building trust exist at the interpersonal and health system levels, including miscommunication, lack of continuity, and brevity of appointments. CONCLUSION: This study explores how trust is conceptualized in pregnancy care according to the perspectives of Latine patients. We found that acompañamiento is a unique and crucial dimension of trust among Spanish-speaking patients.

Exploring Trust in Pregnancy Care Clinicians Among Latine Patients in Spanish and English: A Qualitative Study [ID 2683628

INTRODUCTION: Trust between patients and clinicians is critical for better experiences and outcomes, yet there is no consensus on how trust is defined and measured in pregnancy care. We aimed to explore how patients define trust in clinicians; facilitators and barriers to building trust; and how trust may be eroded and rebuilt over time. METHODS: A bilingual, multicultural team led this qualitative focus group study. The semistructured discussion guide included definitions of trust based on a literature review, how trust is built, when trust is lost, external factors that influence the patient–clinician relationship, previous pregnancy experiences, and sources of trustworthy information during pregnancy. The discussions were audiorecorded and transcribed in the language in which they were held. We performed thematic content analysis on transcripts using both deductive and inductive approaches in each language. Codes were organized and synthesized according to emerging themes. The IRB approved this study. RESULTS: We held eight focus groups of Hispanic/Latine pregnant and postpartum patients; five were held in Spanish and three in English with a total of 35 participants. We identified five constructs of trust: communication, comfort, caring, competency, and accompaniment (“acompañamiento”). Facilitators of trust were warm interpersonal dynamics, continuity with clinician and care team, rapid direct communication with clinician, and language concordance. Barriers of trust were inadequate or inaccurate information, rotating clinicians, cold interpersonal dynamics, and language discordance. There were few differences between Spanish and English groups. CONCLUSION: Patient perspectives about building trust with clinicians are critical for improving the quality of patient–clinician relationships, especially when language barriers exist.

Signs, Sources, Coping Strategies, and Suggested Interventions for Burnout Among Preclerkship Students at a U.S. Medical School: A Qualitative Focus Group Study.

Research suggests that burnout can begin early in medical school, yet burnout among preclerkship students remains underexplored. This study aimed to characterize burnout signs, sources, coping strategies, and potential interventions among preclerkship students at one U.S. medical school. The authors conducted a qualitative study of preclerkship students at Mayo Clinic Alix School of Medicine (MCASOM) during June 2019. Participants completed 2 Maslach Burnout Inventory (MBI) items (measuring frequency of emotional exhaustion and depersonalization) and 2 free-text questions on burnout before participating in 1 of 3 semistructured focus groups. Focus group questions were derived from a literature review on medical student burnout with input from the MCASOM Student Life and Wellness Committee. Group discussions were recorded, transcribed, coded inductively, and analyzed iteratively (along with free-text comments) using a general inductive approach from a constructivist perspective. Eighteen of 111 eligible students (16%) participated, with 5/18 (28%) reporting weekly emotional exhaustion and/or depersonalization on MBI items. Analysis of focus group transcripts showed that most students had experienced burnout symptoms during their first or second year, corresponding with school-related stressors and manifesting in cognitive-emotional, physical, and verbal-behavioral ways. Students identified systemic, institutional, and individual burnout drivers and discussed how these drivers interacted (e.g., high standards of excellence at the system level interacted with anxiety and maladaptive thinking at the individual level, creating pressure to always do more). Students used various coping strategies (e.g., self-care, peer support, reframing, and compartmentalization) but emphasized limitations of these strategies and recommended interventions directed toward systemic and institutional burnout drivers. This study offers insights into burnout signs and sources among preclerkship medical students that can inform future large-scale studies. Results suggest that burnout emerges from dynamic interactions among systemic, institutional, and individual factors and may benefit from multipronged interventions.

Do adults listen? A qualitative analysis of the narratives of LGBTQI adolescents in Madrid

This article explores the experiences of LGBTQI adolescents related to the listening they receive, based on a qualitative focus group study conducted between 2022 and 2023 in Madrid, Spain. After the transcription of the conversations, a thematic analysis was carried out following the systematic procedure designed by Nowell et al. (2017), in order to extract the meanings that the adolescents gave to their experiences. The main thematic axes around which the group discussions revolved were the existence of homophobic ideologies and adultists societies, the experience of not feeling listened to, the safe spaces in which they do feel listened to, the reaffirmation of their identity and satisfaction with their own bodies. Attention was also paid to the processes of subjectivation and agency in relation to listening. The conclusions highlight the importance of role models, the requirement that listening be supported by an intention to learn and recognize others, as well as the urgent need to create safe listening spaces for LGBTQI adolescents.

CLINICIANS' PERCEPTIONS OF MANUAL HANDLING POLICIES IN STROKE REHABILITATION: A QUALITATIVE FOCUS GROUP STUDY.

The professional literature guides manual handling in numerous health care settings. The effects of these guidelines on stroke rehabilitation and the clinical communication of health care professionals are unknown. This paper aims to investigate the perspectives of nurses and physiotherapists on handling guidelines in their professions to identify conflicts in opinions to provide optimum care to people with stroke. A qualitative focus group study. Three focus groups were conducted. The participants were physiotherapists or nurses with 1 year of stroke care experience. The data were thematically analysed. Nineteen participants (12 physiotherapists and 7 nurses) were interviewed. The data analysis revealed 3 themes. First, "The application of handling in stroke rehabilitation" includes clinical reasoning and real-world handling practices. The second theme, "Physical Effects on Therapists," examines the long-term effects of manual handling on therapists, including work-related musculoskeletal disorders. The final theme, "Conflicts among health care professionals," investigates stroke rehabilitation equipment conflicts between nurses and physiotherapists. The study concludes that stroke transfer guidelines in the specialised literature may impact health care professionals' perspectives. Conflicts among health care professionals can impair teamwork. Thus, health care professionals should work together as stroke rehabilitation teams to develop unified transfer guidelines that aid rehabilitation and avoid work-related musculoskeletal disorders.

Perceptions on Specialist Palliative Care Involvement During and After Cardiopulmonary Resuscitation: A Qualitative Study

IMPORTANCE: Cardiopulmonary resuscitation (CPR) is an exceptional physical situation and may lead to significant psychological, spiritual, and social distress in patients and their next of kin. Furthermore, clinicians might experience distress related to a CPR event. Specialist palliative care (sPC) integration could address these aspects but is not part of routine care. OBJECTIVES: This study aimed to explore perspectives on sPC integration during and after CPR. A needs assessment for sPC, possible triggers indicating need, and implementation strategies were addressed. DESIGN, SETTING, AND PARTICIPANTS: A multiprofessional qualitative semistructured focus group study was conducted in a German urban academic teaching hospital. Participants were clinicians (nursing staff, residents, and consultants) working in the emergency department and ICUs (internal medicine and surgical). ANALYSIS: The focus groups were recorded and subsequently transcribed. Data material was analyzed using the content-structuring content analysis according to Kuckartz. RESULTS: Seven focus groups with 18 participants in total were conducted online from July to November 2022. Six main categories (two to five subcategories) were identified: understanding (of palliative care and death), general CPR conditions (e.g., team, debriefing, and strains), prognosis (e.g., preexisting situation, use of extracorporeal support), next of kin (e.g., communication, presence during CPR), treatment plan (patient will and decision-making), and implementation of sPC (e.g., timing, trigger factors). CONCLUSIONS: Perceptions about the need for sPC to support during and after CPR depend on roles, areas of practice, and individual understanding of sPC. Although some participants perceive CPR itself as a trigger for sPC, others define, for example, pre-CPR-existing multimorbidity or complex family dynamics as possible triggers. Suggestions for implementation are multifaceted, especially communication by sPC is emphasized. Specific challenges of extracorporeal CPR need to be explored further. Overall, the focus groups show that the topic is considered relevant, and studies on outcomes are warranted.

Firefighters and police search dog handlers’ experiences working closely with paramedics in urban search and rescue incidents: a qualitative focus group study from Oslo

BackgroundRescue operations are in Norway defined as situations where patients are difficult to access or that more resources are needed than the health services alone possess and can put in operation (Bull A, Redningshåndboken er endelig her! [Internet]. Hovedredningssentralen. 2018 [cited 2023 May 15]. Available from: https://www.hovedredningssentralen.no/redningshandboken-er-endelig-her/). Rescue operations after large incidents may include civil protection, military forces, non-governmental organizations and other resources, but the initial rescue effort must be performed by the emergency services as time often is of essence. The central area of an accident where special training and personal protection equipment is necessary or mandatory is called the Hot Zone. This study examines Urban Search And Rescue (USAR) firefighters and police officers reported experiences from ambulance personnel’s contribution in the Hot Zone.MethodsWe conducted five focus group interviews with USAR-trained firefighters and police officers. The interviewees were those on duty on the agreed dates. The interviews were taped, transcribed, and analysed using thematic analysis as described by Braun & Clarke.ResultsThree themes were identified; Feeling safe during missions, Building USAR capacity, and Trust-building within USAR-teams. The firefighters and police officers reported their and the patients’ safety are best managed by EMS-personnel, whose presence strongly contributes to their own feeling of safety in a dangerous area. When EMS handles victims and injured emergency workers, firefighters and police officers can focus on their own primary tasks. Indeed, interviewees reported that building a USAR capacity depends on having USAR-trained EMS-personnel in the Hot Zone. The interviewees have clear and consistent opinions on how to establish an interagency USAR capacity effectively. Trust is paramount to the interviewees, and they express a high degree of trust within USAR Oslo.ConclusionsFirefighters and police officers regard USAR-trained EMS-personnel as a natural and integrated part in urban search and rescue teams. EMS-personnel in the dangerous area deliver safety and medical professional assistance to both rescue workers and patients. Informants in this study had clear opinions on how to establish and maintain such a service.

The lived experiences of HIV-positive women in rural Zimbabwe: A qualitative focus group study.

The study explored and described the meaning attached to the lived experiences of women living with human immunodeficiency virus (HIV) in the rural context of Zimbabwe. Stigma and discrimination negatively impact one's ability to perform the expected social roles, the quality of life, and the efforts to prevent the spread of HIV and acquired immunodeficiency syndrome (AIDS) and reduce HIV-related mortality. Thus, the study aims to understand the meaning attached to the lived experiences of HIV-positive women living in rural areas or villages of Matabeleland South province in Zimbabwe. The study used a qualitative, descriptive, and exploratory design. Four focus group discussions were conducted with 24 HIV-positive rural women living in Matabeleland South province, Zimbabwe. An Interpretative Phenomenological Analysis (IPA) was adopted to explore and describe the meaning attached to the lived experiences of women living with HIV. Two interconnected themes were identified in the analysis with their sub-themes. These were: (1) struggle for social belonging, with subthemes - loss of social belonging and reduced access to community-based empowerment opportunities and (2) struggle for maintaining the quality of life with subthemes - lack of need-based community healthcare and food insecurity. Being a woman living with HIV in rural Zimbabwe means a perpetual struggle to maintain one's humanness and quality of life.Contribution:This study's results will support the efforts of the Zimbabwean government to improve the quality of life of HIV-positive women living in rural areas.

General practitioners' experiences of providing lifestyle advice to patients with depression: A qualitative focus group study.

Depression is an increasingly common mental health disorder in the UK, managed predominantly in the community by GPs. Emerging evidence suggests lifestyle medicine is a key component in the management of depression. We aimed to explore GPs' experiences, attitudes, and challenges to providing lifestyle advice to patients with depression. Focus groups were conducted virtually with UK GPs (May-July 2022). A topic guide facilitated the discussion and included questions on experiences, current practices, competence, challenges, and service provision. Data were analysed using template analysis. 'Supporting Effective Conversations'; 'Willing, but Blocked from Establishing Relational Care'; 'Working Towards Patient Empowerment'; and 'Control Over the Prognosis' were all elements of how individualised lifestyle advice was key to the management of depression. Establishing a doctor-patient relationship by building trust and rapport was fundamental to having effective conversations about lifestyle behaviours. Empowering patients to make positive lifestyle changes required tailoring advice using a patient-centred approach. Confidence varied across participants, depending on education, experience, type of patient, and severity of depression. GPs play an important role in managing depression using lifestyle medicine and a patient-centred approach. Organisational and educational changes are necessary to facilitate GPs in providing optimal care to patients with depression.

Emergency medical dispatchers’ experiences of using the Medical Priority Dispatch System telephone triage to identify maternity emergencies: a qualitative focus group study

ObjectivesThe ambulance service plays a pivotal role in the provision of care in out-of-hospital maternity emergencies. Telephone triage of this patient group is complex and must be sensitive to an...

Self-management support (SMS) in primary care practice: a qualitative focus group study of care professionals’ experiences

BackgroundTo support self-management of chronically ill persons, innovative approaches of care practice are being developed. Unfortunately, many self-management supporting interventions struggle to achieve reliable and consistent improvements at various levels (patient, provider and healthcare system level). One possible strategy to facilitate translating theory into practice, is to consider the healthcare professionals’ perspective prior to the development of new interventions. An exploration of their knowledge and opinion about barriers and facilitators is necessary before employing any self-management support (SMS) intervention. Therefore, our study aims to explore care professionals’ perspectives about SMS within the Flemish primary care setting.MethodsThis study used a qualitative study design to examine SMS in primary care setting. Five focus groups were conducted, grouped into three waves. Participants were healthcare professionals in Flanders representing different disciplines and settings. A maximum variation purposive sampling was used to recruit participants. For the data analysis, the framework of thematic networks by Attride-Stirling was applied.ResultsA total of 34 healthcare professionals participated. Three global themes related to SMS were derived from the thematic analysis: (1) Characteristics, (2) Support strategies, (3) Barriers and facilitators. SMS was characterised as a collaboration-based and person-centred approach. A variety of supporting strategies were mentioned by the focus group participants. Most strategies consisted of informing and educating patients. Complementary to individual strategies, collaborative strategies were deemed necessary to support self-management. Regarding barriers and facilitators, different patient-related factors were identified. Additionally, competencies of healthcare providers and external factors seem to hinder the implementation of SMS in practice.ConclusionsThis focus group study highlights the importance of a collaborative, person-centred approach to SMS in the context of chronic diseases. Our findings point to the need for interventions that raise awareness and address barriers associated with SMS. Since generic SMS does not exist, the road to success is a growth process in which support must be adapted to the individual patient.

Physical Therapists' Acceptance of a Wearable, Fabric-Based Sensor System (Motion Tape) for Use in Clinical Practice: Qualitative Focus Group Study.

Low back pain (LBP) is a costly global health condition that affects individuals of all ages and genders. Physical therapy (PT) is a commonly used and effective intervention for the management of LBP and incorporates movement assessment and therapeutic exercise. A newly developed wearable, fabric-based sensor system, Motion Tape, uses novel sensing and data modeling to measure lumbar spine movements unobtrusively and thus offers potential benefits when used in conjunction with PT. However, physical therapists' acceptance of Motion Tape remains unexplored. The primary aim of this research study was to evaluate physical therapists' acceptance of Motion Tape to be used for the management of LBP. The secondary aim was to explore physical therapists' recommendations for future device development. Licensed physical therapists from the American Physical Therapy Association Academy of Leadership Technology Special Interest Group participated in this study. Overall, 2 focus groups (FGs; N=8) were conducted, in which participants were presented with Motion Tape samples and examples of app data output on a poster. Informed by the Technology Acceptance Model, we conducted semistructured FGs and explored the wearability, usefulness, and ease of use of and suggestions for improvements in Motion Tape for PT management of LBP. FG data were transcribed and analyzed using rapid qualitative analysis. Regarding wearability, participants perceived that Motion Tape would be able to adhere for several days, with some variability owing to external factors. Feedback was positive for the low-profile and universal fit, but discomfort owing to wires and potential friction with clothing was of concern. Other concerns included difficulty with self-application and potential skin sensitivity. Regarding usefulness, participants expressed that Motion Tape would enhance the efficiency and specificity of assessments and treatment. Regarding ease of use, participants stated that the app would be easy, but data management and challenges with interpretation were of concern. Physical therapists provided several recommendations for future design improvements including having a wireless system or removable wires, customizable sizes for the tape, and output including range of motion data and summary graphs and adding app features that consider patient input and context. Several themes related to Motion Tape's wearability, usefulness, and ease of use were identified. Overall, physical therapists expressed acceptance of Motion Tape's potential for assessing and monitoring low back posture and movement, both within and outside clinical settings. Participants expressed that Motion Tape would be a valuable tool for the personalized treatment of LBP but highlighted several future improvements needed for Motion Tape to be used in practice.

‘He just looked like he couldn’t learn, whereas he just couldn’t see’: exploring clinician experiences working with people who have co-occurring communication and visual impairment

ABSTRACT Individuals with concurrent visual and communication impairments necessitate specialized, multidisciplinary care, yet the adequacy of orthoptists' and speech pathologists' skills and resources remains underexplored. This research aims to examine these professionals' perspectives and test the acceptability of qualitative methods before a broader study. Qualitative focus group study with thematic analysis. Three, 1.5-hour semi-structured focus groups were conducted with a total of seven clinicians on videoconferencing platform, Zoom. Four orthoptists and three speech pathologists with at least 12 months of relevant clinical experience took part in focus groups. Focus groups were transcribed and analysed using thematic analysis. Four main themes with 12 subthemes were identified. Theme 1, positive impacts of interprofessional care, reflected the value of collaboration, dual knowledge and addressing both disabilities in improving client outcomes. Theme 2 highlighted barriers to effective clinical management, including limited communication between professions, lack of interprofessional knowledge, poor role awareness, orthoptists use of objective measures, and resource barriers. Theme 3 related to participants’ lack of formal and informal training experiences, and theme 4 included enablers to improving clinical competency. All participants agreed with the allocated time for each focus group and believed the questions were appropriate and relevant to the aim of the study. A number of suggestions were made to enable a more successful focus group discussion in the future. This study revealed perceived gaps in interdisciplinary collaboration, skills, and knowledge, including a lack of role awareness and effective management practices for clinicians. Further training, resource development and research is warranted.

Facilitators and barriers of empathetic behaviour in physiotherapy clinical practice: A qualitative focus group study

BackgroundEmpathy is an essential competence of a person-centered approach, and a recognisable ability for providing physiotherapy quality healthcare. Empathetic communication enhances the improvement of patient outcomes and their experience of treatment. ObjectiveThe aim of the study was to present further insights considering facilitators and barriers of an empathetic communication between patients and physiotherapists. MethodsA qualitative focus group study was designed according to COREQ guidance for qualitative studies. Two focus groups were conducted. The first group included six patients and two individuals from non-governmental organizations, whereas three physiotherapists, two academic physiotherapist personnel and two undergraduate physiotherapy students participated in the second group. Both groups were audio recorded, and all data was verbatim transcribed for coding thematic analysis. Results9 themes were revealed regarding empathetic facilitators (qualities of good communication, relationship building, interprofessional collaborative practice, positive environment, love for the healthcare profession and professionalism), while 8 themes were revealed regarding barriers (challenging situations, working conditions, burn out, depreciation of empathetic communication, lack of training, lack of professionalism, lack of personal development and health professionals’ own personal problems). Conclusion(s)The enhancement of empathy can be accomplished in a trustworthy relationship between patient and clinicians where the development of proficient communication skills are prioritized. However, hindering factors associated with health professionals, patients and the health system should be surmounted. Ethical approval number339-ΣΕ8/10-1-2020.

Factors influencing speech pathology practice in dysphagia after stroke: A qualitative focus group study.

Dysphagia affects over half of adults after stroke. Dysphagia rehabilitation aims to improve swallowing and reduce negative outcomes for these adults. However, significant variability exists in dysphagia rehabilitation. Research is needed to explore the underlying clinician-specific and workplace factors that contribute to variability in dysphagia rehabilitation after stroke. To explore factors influencing speech pathology practice in dysphagia rehabilitation after stroke. We used a phenomenological approach with an interpretivist perspective. Twenty speech pathologists working in dysphagia rehabilitation participated from different workplace settings around Australia. Five semi-structured focus groups were conducted online. Data were inductively analysed using thematic analysis with a coding reliability method. Four themes were discussed within focus groups: (1) relationship between experienced and less experienced clinicians: 'Following what other people have done', (2) need for collaborative learning: 'A safe space to share and train', (3) variation between settings impacts on continuity of care: 'There's a difference between community and acute', and (4) working effectively with multidisciplinary teams (MDT): 'An MDT which can listen to the voice of speech pathology'. Relationships between senior and junior speech pathologists, within speech pathology and MDT, and across inpatient and community settings influenced speech pathology practice. Flattened hierarchies in speech pathology, collaborative learning in workplaces, mutual respect within teams and connection across inpatient and community settings could improve the quality and consistency of dysphagia rehabilitation after stroke. What is already known on this subject Dysphagia rehabilitation can improve swallowing after a stroke. However, dysphagia rehabilitation is characterised by variability in clinical practice. Clinician-specific and workplace factors influence clinical practice and may contribute to variability in dysphagia rehabilitation. What this study adds Professional relationships influence speech pathologists' clinical practice, including relationships between senior and junior clinicians, between inpatient and community settings and with peers and multidisciplinary teams. Workplace norms and hierarchies, poor continuity of care between settings and competing priorities from other disciplines can hinder dysphagia rehabilitation. However, collaborative learning, positive workplace cultures and respectful transdisciplinary care can improve the quality and consistency of clinical practice. What are the clinical implications of this work? Flattening hierarchies in the workplace can foster a safe learning space. Further, questioning workplace norms and seeking out peer learning within and across settings can build clinical skills and confidence. Developing positive workplace cultures that support continuous development may be key for empowering speech pathologists to provide high-quality and consistent dysphagia rehabilitation.

Opinions and perceptions of patients with cardiovascular disease on adherence: a qualitative study of focus groups

BackgroundCardiovascular diseases are becoming more frequent throughout the world. Adherence to both pharmacological and non-pharmacological treatment, as well as lifestyles, is important for good management and control of the disease. This study aims to explore the opinions and perceptions of patients with ischemic heart disease on the difficulties associated with therapeutic adherence.MethodsAn interpretive phenomenological study was carried out using focus groups and one semi-structured interview. The MAXQDA qualitative data analysis program was used for inductive interpretation of the group discourses and interview. Data were coded, and these were grouped by categories and then consolidated under the main themes identified.ResultsTwo in-person focus groups and one remote semi-structured interview were performed. Twelve participants (6 men and 6 women) from the Hospital de San Juan de Alicante participated, two of them being family companions . The main themes identified were aspects related to the individual, heart disease, drug treatment, and the perception of the health care system.ConclusionsAdhering to recommendations on healthy behaviors and taking prescribed medications for cardiovascular disease was important for most participants. However, they sometimes found polypharmacy difficult to manage, especially when they did not perceive the symptoms of their disease. Participants related the concept of fear to therapeutic adherence, believing that the latter increased with the former. The relationship with health professionals was described as optimal, but, nevertheless, the coordination of the health care system was seen as limited.

Management Practices and Implementation Challenges in District Education Directorates in Ghana

Background: Subnational actors and organizations are crucial mediators of policy implementation due to their proximity to schools. However, in low- and middle-income country contexts, little is known about their management practices and factors that shape the adoption of these practices to improve education delivery. Purpose: We explore the management context of five District Education Directorates in Ghana, and the factors that enable or constrain them to plan and implement policy. Participants: Forty-three interviews and focus groups with regional and district education officials, district political actors, and basic education school headteachers and teachers. Research Design: A qualitative study of semistructured interviews, focus groups, and education policy and planning documents. Analysis: To understand how policy implementation happens within complex, multitiered bureaucracies, our theoretical framework uses four management functions described in Williams et al. (2021) to explore two different paradigms of how to change public bureaucracies: target setting and prioritization; measurement and monitoring; accountability and incentives; and problem-solving. We coded and analyzed our data based on this framework and developed district-wide narrative memos to synthesize the findings. Findings: We identify three areas of (mis)alignment in management practices: across bureaucratic levels and among actors; around clear and consistent priorities for learning; in expected actions and availability of resources. These (mis)alignments can constrain or be leveraged by districts to improve education delivery in Ghana. Implications: We argue for better prioritization of goals toward learning and the efficient allocation of funds for management practices typical of effective organizations.

Investigating the relevance of the advanced activities of daily living tool for the screening and diagnosis of mild cognitive impairment and dementia to the Sub-Saharan African migrant population in Belgium: A qualitative focus group study

Introduction: Early diagnosis of dementia is partly based on the evaluation of the basic (b-), instrumental (i-) and advanced (a-) activities of daily living (ADL). Adapting the item content of assessment tools to maintain relevance, understanding, and equivalence of the items and scales across other groups is pertinent. However, there are limited assessment tools developed on or adapted for use on the growing older Sub-Saharan African (SSA) migrant population in Europe. Focusing on the item content, we evaluated the relevance of the advanced activities of daily living (a-ADL) tool to the older SSA migrant population in Belgium. Method: Two focus group discussions were organized with participants from the SSA community in Gent, Belgium. Relevant, irrelevant, unclear, and new items were identified. The data was analyzed through the inductive method while consensus agreements were used to arrive at refined themes. Results: Out of the 49 items on the tool, both groups unanimously agreed that 15 items were relevant and 23 irrelevant. Thirteen new items were identified, whereas 15 items were considered unclear. Conclusion: Participants agreed the tool was relevant but should be adapted. Verification and validation of these results in a larger SSA older migrant population in Belgium is strongly recommended.

Informing adolescent substance misuse prevention: A parent focus group perspective

AbstractSubstance misuse during adolescence is an issue, and engaging parents in prevention efforts has significant positive impacts; yet barriers to engagement exist. The purpose of this qualitative parent focus group study was to understand the perspectives of participants (n = 5) about information and delivery platforms that will promote, engage, and support parents in prevention efforts. Thematic analyses identified five key themes from the semistructured interview: (1) educational support, (2) community support, (3) venues and platforms, (4) influences of other countries, and (5) potential barriers. Implications for clinical mental health and school counselors, and future research are discussed.

Heteronormative biases and distinctive experiences with prostate cancer among men who have sex with men: a qualitative focus group study

BackgroundMen who have sex with men (MSM) face many challenges and biases in healthcare. Within urology there is a need to better understand how prostate cancer impacts MSM given the unique ways in which side effects that accompany treatment may affect this population. The goal of this study is to explore the experience of MSM with prostate cancer to advance the existing literature in this area and inform implementation and delivery of clinical practice and policy guidelines.MethodsFour focus groups were conducted with a semi-structured interview guide. Using a phenomenological qualitative approach consistent with grounded theory [1] and naturalistic inquiry principles we sought to better understand the direct experiences of MSM with prostate cancer. Audio transcriptions were thematically analyzed to identify themes that impact MSM throughout their prostate cancer journey. An iterative, team-wide classification process was used to identify, organize, and group common codes into higher-order categories and themes.ResultsPatient’s choice of provider and their interactions with the healthcare system were strongly impacted by their sexual identities. Participants commented on navigating the heteronormative healthcare environment and the impact of assumptions they encountered. MSM experienced the sexual side effects of prostate cancer treatment in unique ways. Issues with erectile dysfunction and ejaculatory dysfunction had significant impacts on patient’s sexual experience, with some describing being forced to explore new modes of sexual expression. Anejaculation was a theme that was distressing for many participants. The emotional impact of a prostate cancer diagnosis was significant in the men interviewed. Common themes included loss of identity and fear for future relationships.ConclusionsMSM have unique concerns after prostate cancer treatment that differ from men who don’t identify as MSM. It is critical that providers familiarize themselves with the concerns of this patient population regarding prostate cancer treatment. An important step toward reducing heteronormative bias in prostate cancer care is to better understand the goals, identity, and sexual practices of MSM and to provide informed anticipatory guidance.