Qualitative Work Research Articles

Assessing the psychosocial impact of stammering on work.

Stammering (stuttering) is a speech condition with high heterogeneity, affecting approximately 1% of adults. Research shows it can limit career progression, impact job performance and quality of life. To assess the psychosocial impact of stammering among healthcare workers and to develop a new workplace support intervention. A cross-sectional questionnaire of healthcare workers who stammer with qualitative work and a survey of occupational health (OH) usual care to assess the need for a workplace intervention. Data from 470 staff questionnaires and 32 OH clinicians were analysed. Eighty-four per cent rated their stammering severity as mild-to-moderate, with the majority reporting adverse impact on job performance and career progression. Most experienced a high degree of anxiety and embarrassment at work, with avoidance behaviours commonplace. Four per cent of respondents sought OH advice for work difficulties. Qualitative data highlighted practical challenges staff experience in the workplace. Sixty-five per cent supported the proposal for a new workplace intervention. We found workplace stress and anxiety were the most common reasons for OH referrals, and we found wide variation in the scope of OH assessments and work adjustments recommended. Most OH respondents reported insufficient clinical knowledge of speech disorders and their impact on work. Stammering can have a negative impact of workers' job performance and job satisfaction. This can precipitate feelings of stress and anxiety, and can affect self-identity at work. We found wide variation in the provision of OH usual care. The results informed the development of a new workplace intervention.

Crowdsourcing historical photographs: autonomy and control at the Copenhagen City Archives

This study of crowdsourcing practices at Kbhbilleder.dk at the Copenhagen City Archives provides a rich description of how motivation and work relations are situated in a wider infrastructure of different tools and social settings. Approximately, 94% of the work is here done by 7 of the 2,433 participants. The article contributes insights into how these super-taggers carry out their work, describing and placing images on a map, through an extensive discursive effort that takes place outside the institution’s more limited interface in private discussion forums with over 60 000 participants. The more exploratory qualitative work that is going on in different discussion groups does not fit within the archive’s technical framework. Instead, alternative archives are growing within privately owned networks, where participants’ own collections merge with images from public archives. Rather than focusing on the nature of participants’ motivation, the article suggests a relational perspective on participation that is useful for analyzing a systems’ support for participation. Pointing out how people’s motivation in citizen science correspond with relational and intra-relational aspects enables an approach to system design that potentially supports or counteracts these aspects.

Practice-based evidence: Perspectives of effective characteristics of Australian group-based physical activity programs for postpartum women.

Many postpartum women often do not achieve recommendations of at least 150minutes moderate-to-vigorous physical activity (MVPA) each week. Previous qualitative work has focused on postpartum women's barriers and challenges to being active, with recent research starting to explore the characteristics of PA programs and women who are active during the postpartum period. Yet, little research has focused on the characteristics of key stakeholders and community organisations that support women to sustain their PA engagement during the postpartum period. This research generates practice-based evidence to provide essential insights for effective implementation, strategies and actions of community group-based PA programs that recruit and retain postpartum women to ensure future interventions are scalable and sustainable. Ten participants (90% female), ranging in age from 34 to 40years, were recruited from nine community organisations/businesses. The ten participants engaged in semi-structured interviews for an average length of 31minutes. Inductive thematic analysis revealed four overarching themes (i) effective practitioners have a history of, and passion for women's health and PA; (ii) low-cost, connected approaches attract postpartum women into community group-based PA programs; (iii) inclusive, flexible, varied, and holistic approaches sustain postpartum women's participation; and (iv) utilise connections to overcome barriers to community group-based PA programs. These four themes were informed by twelve sub-themes relating to the background of stakeholders and practitioners and the approaches that they use to attract and sustain postpartum women in community group-based PA programs. Practice-based findings should inform future practices and the development of future real-world group-based PA interventions for postpartum women. SO WHAT?: Specifically, interventions will need to be designed and implemented by practitioners who have a history of, and passion for women's health and PA, be low-cost, connected approaches, that are inclusive, flexible, varied, and holistic that prioritise physical, emotional, and social wellbeing.

Discrimination and Sleep Impairment in American Indians and Alaska Natives.

Sleep impairment may be a key pathway through which discrimination undermines health. Links between discrimination and sleep in American Indians and Alaska Natives (AI/AN) have not been established. Further, it is unclear if such links might depend on the timing of discrimination or if socioeconomic status (SES) might buffer the impact of discrimination. To investigate associations between interpersonal discrimination and sleep impairment in urban AI/AN, for both lifetime and recent discrimination, and controlling for other life stressors. Education and income, indices of SES, were tested as potential moderators. A community sample of urban AI/AN (N = 303, 18-78 years old, 63% female) completed self-report measures of sleep impairment, lifetime and recent discrimination, depressive symptoms, perceived stress, other life stressors (childhood adversity and past year major events), and socio-demographic characteristics. Lifetime discrimination was associated with impaired sleep in AI/AN after adjustment for socio-demographic characteristics, recent depressive symptoms, perceived stress, and other life stressors. Past-week discrimination was associated with sleep in unadjusted but not adjusted models. Education, but not income, was found to buffer the effects of both lifetime and past-week discrimination on sleep in adjusted models. Lifetime discrimination uniquely accounts for sleep impairment and may be especially harmful in those with less education. These findings suggest targeting interventions to those most in need. Limitations include the cross-sectional nature of the data. Longitudinal and qualitative work is needed to understand how education may buffer the effects of discrimination on sleep and perhaps other health problems in AI/AN.

Preliminary findings on the experiences of care for parents who suffered perinatal bereavement during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic poses an unprecedented risk to the global population. Maternity care in the UK was subject to many iterations of guidance on how best to reconfigure services to keep women, their families and babies, and healthcare professionals safe. Parents who experience a pregnancy loss or perinatal death require particular care and support. PUDDLES is an international collaboration investigating the experiences of recently bereaved parents who suffered a late miscarriage, stillbirth, or neonatal death during the global COVID-19 pandemic, in seven countries. In this study, we aim to present early findings from qualitative work undertaken with recently bereaved parents in the United Kingdom about how access to healthcare and support services was negotiated during the pandemic.MethodsIn-depth semi-structured interviews were undertaken with parents (N = 24) who had suffered a late miscarriage (n = 5; all mothers), stillbirth (n = 16; 13 mothers, 1 father, 1 joint interview involving both parents), or neonatal death (n = 3; all mothers). Data were analysed using a template analysis with the aim of investigating bereaved parents’ access to services, care, and networks of support, during the pandemic after their bereavement.ResultsAll parents had experience of utilising reconfigured maternity and/or neonatal, and bereavement care services during the pandemic. The themes utilised in the template analysis were: 1) The Shock & Confusion Associated with Necessary Restrictions to Daily Life; 2) Fragmented Care and Far Away Families; 3) Keeping Safe by Staying Away; and 4) Impersonal Care and Support Through a Screen. Results suggest access to maternity, neonatal, and bereavement care services were all significantly reduced, and parents’ experiences were notably affected by service reconfigurations.ConclusionsOur findings, whilst preliminary, are important to document now, to help inform care and service provision as the pandemic continues and to provide learning for ongoing and future health system shocks. We draw conclusions on how to enable development of safe and appropriate services during this pandemic and any future health crises, to best support parents who experience a pregnancy loss or whose babies die.

Recruitment and retention of culturally diverse older adults into aging research: Investigation planning to explore intergenerational influence

AbstractBackgroundAfrican American [AA], Latino/Hispanic [LH], and Caribbean [CN]) older adults remain underrepresented in aging clinical research, leading to a knowledge gap regarding best treatments for these populations. Studies have found that culturally diverse older adults often consult family members when making healthcare treatment decisions. However, family members’ involvement when recruiting AA, LH and CN populations into health research studies is relatively unexplored as a potential recruitment strategy. The overall purpose of this research is to understand how intergenerational influence (IGI) – defined as the influence of one generation on another in terms of the transfer of skills, attitudes, preferences, values, and behaviors – can be leveraged to recruit and retain culturally diverse older adults into aging research.MethodsSpecific aims are to 1) explore IGI among 360 AA, CN and LH adults 2) test messages in key markets and 3) enroll 3,000 AA, CN and LH adults > 65 into a statewide health registry. To start, we established the infrastructure to conduct this research: organize a tri‐institutional team developing materials to conduct mixed methods (focus group guides; surveys) to answer specific aim 1; establish a statewide governing council; recruit a qualitative team; and obtain approval from the lead Institution’s Ethics Review Board.ResultOur tri‐institutional team comprises researchers from various disciplines who created focus group guides, survey materials, and online tools for use with focus group participants (Specific Aim 1). We have also established the Florida Statewide Governance Aging (FL‐SAGE) Council consisting of 25‐members throughout Florida, who will inform all aspects of this research. We have also recruited 12 facilitators who have conducted qualitative work with our populations of focus, AA, CN and LH older adults. Another aspect of this tri‐institutional collaboration is the ability to achieve ethics approval from one institution, allowing for more concise monitoring.ConclusionWe hope to demonstrate that our IGI model can be leveraged as an additional strategy to recruit and retain culturally diverse older adults into aging research. Before that, we recognize the significance of establishing a sound infrastructure to conduct this work. We hope our findings will assist other researchers working with diverse populations.

An invitation to analytic abduction

This paper provides an invitation to analytic abduction, an emerging approach to qualitative research. Like deduction and induction, abduction is a mode of inquiry. In a general sense, abduction forwards explanations for novel or surprising observations. In a more practical sense, abduction aims to combine the strengths of both inductive and deductive inquiry by reasoning from concrete data (similar to induction), but using this data to extend, refine, or refute existing theories or propositions (similar to deduction). In this paper, we provide an overview of how and why abduction was developed for qualitative research before demonstrating how to apply analytic abduction to real-world data. Our examples connect data to longstanding and well-researched theories in psychology to highlight the utility of abduction for psychological researchers. We argue that analytic abduction is an ideal resource for qualitative psychologists, as the approach emphasizes qualitative data while leveraging such data to shape theory. This focus on theory provides ample opportunities to use qualitative work to inform concepts central to psychological science, including those that are primarily tied to experimental design, quantitative methods, and deductive reasoning.

Attitudes May Be Hard to Change: Canadian Organ Donors Consider Face and Hand Donation.

Objective:Despite the success of composite tissue allograft (CTA) such as face and hand transplant at improving recipients’ quality of life, organ donors’ hesitation needs to be better understood. The aim of the study was to assess Canadian organ donors’ willingness to donate their face and hands, and the efficacy of an educational intervention.Methods:Canadians registered for organ donation were invited to complete an online survey about CTA. An interactive vignette was introduced part way through to clarify transplant-related concepts, with repeat of questions post-vignette exposure to assess attitudes pliability.Results:A total of 942 participants completed the survey. Fifty-two percent of donors were willing to donate their face after passing, whereas 80% were willing to donate their hands. Reasons to refuse CTA donation included the risk of upsetting their family, having someone look like them, and wanting their body to remain intact. Donors’ willingness to donate their face (38%, P < 0.001) and hands (79%, P = 0.67) decreased following vignette exposure. Comparative analysis of our interventional vignette with a similar study where donors’ donation readiness increased after an educational intervention revealed that our vignette lacked a strong enough emotional component to positively impact donors’ attitude to CTA, and may have exposed participants to alternatives to transplant they were not previously aware of.Conclusions:Canadian organ donors surveyed were willing to donate their face and hands following death, a willingness reduced after watching our informative vignette. Further qualitative work is required to better understand the educational needs and areas to address to increase donors’ acceptance of CTA.

Exploring the Relationship between Demographic Isolation and Professional Experiences of Black and Latinx Teachers

Educational leaders throughout the United States have repeatedly emphasized the importance of increasing the number of Black and Latinx teachers in American schools. Prior qualitative work suggests that Black and Latinx teachers who are demographically isolated in their schools often report negative experiences. Drawing on theories of proportional representation in organizations, we use Tennessee statewide survey and administrative data to examine whether self-reported professional experiences of Black and Latinx teachers are different when they are demographically isolated. We estimate models using two measures of demographic isolation: a continuous measure and a theoretically generated ordinal measure. We find that, for Black teachers, the percentage of Black teachers in the school is positively associated with teachers’ perceived satisfaction and support and with the frequency of collaboration. There is also some evidence of threshold effects of demographic isolation for Black teachers, as Black teachers in schools in which at least 60% of fellow teachers are Black report significantly higher satisfaction and support than other Black teachers. Our models do not find any associations between isolation and professional experience for Latinx teachers, but a small sample size and lack of variation in demographic isolation among Latinx teachers makes it difficult to estimate these associations. Our findings suggest that both ordinal and continuous measures of demographic isolation may be useful when examining relationships between demographic isolation and workplace experiences. Because we study factors linked to turnover in prior research, these analyses can contribute to the broader discussion about the retention of Black and Latinx teachers.

Theoretical Foundations to the Impact of Dog-Related Activities on Human Hedonic Well-Being, Life Satisfaction and Eudaimonic Well-Being.

Cross-sectional comparisons of well-being between dog owners and non-owners commonly generate inconsistent results. Focusing on the uniqueness of the relationship might help address this issue and provide a stronger foundation for dog-related psychotherapeutic interventions. This study aims to evaluate the impact of dog-related activities (e.g., exercising the dog) on owner hedonic well-being, life satisfaction and eudaimonic well-being. It was also hypothesised that psychological closeness to the dog would affect these well-being outcomes. For this study, 1030 dog owners aged over 18 years old answered an online questionnaire about the impact of 15 groups of dog-related activities on their well-being. Ordinal regressions were used to estimate the mean response (and its uncertainty) for each outcome, while conditioning for psychological closeness to the dog and controlling for several key covariates. Tactile interactions and dog playing were significantly more beneficial than other activities for hedonic well-being, and dog training and dog presence for eudaimonic well-being. In contrast, dog health issues and behavioural problems were linked to decrements in these well-being outcomes. Higher psychological closeness to the dog predicted greater improvement in well-being in positive dog-related activities. Our quantitative study validates the general findings of previous qualitative work and lays the groundwork for future longitudinal studies.

Towards Understanding Post-Socialist Migrants’ Access to Physical Activity in the Nordic Region: A Critical Realist Integrative Review

Experiences of, and access and barriers to, physical activity (PA) differ between individuals. This becomes perpetuated in a migration context. Although there is super-diversity between migrant groups, health research rarely accounts for this cultural diversity. More concerningly, the matter of context is rarely scrutinized or juxtaposed with the specifics of certain ethnic groups. This integrative review assessed the evidence on post-socialist migrants’ PA levels, constraints, and enablers for PA in the Nordic region. The results show that post-socialist female migrants have an especially high risk of being physically inactive. The qualitative work elucidates socio-cultural factors that impose specific constraints on females when attempting to engage in PA. Furthermore, in scrutinizing the context, Nordic nature (Friluftsliv) is a viable way for migrants to access PA with additional health benefits (e.g., mental). However, the Nordic environment also poses specific PA challenges, such as harsh winters. This can be understood by considering post-socialist migrants’ prior use of, and attitude to, nature. The review highlights the importance of understanding specifics about both migrant groups and contexts through a critical-realist lens in the pursuit of providing PA opportunities. Future PA programs need to understand the contextual, sociohistorical, and cultural settings in which they and migrants are embedded.

Abstract 10619: Determination of Cost Drivers and Variation Associated with Isolated Aortic Valve Replacement Surgery: Evaluating the Impact of Interval Feedback and Barriers and Facilitators of Cost Awareness among Cardiac Surgeons and Health Care Providers

Introduction: Marked variation among surgeons and relevant health care providers (HCPs) in aortic valve replacement (AVR) costs was demonstrated. Despite presentation of these data to HCPs, cost variation persists. We sought input from cardiac HCPsregarding intraoperative cost awareness, decision making and potential motivators towards greater cost consideration. Objectives: Three fold purpose: I) Determine the primary intraoperative cost drivers of performing an isolated AVR in a single-center Canadian hospital, II) Evaluate the impact of communicating cost and driver variability on decision making, and III) Identify the barriers and facilitators of incorporating cost considerations in isolated AVRs among HCPs. Methods: From May 2017-May 2019, data was collected on AVR cost drivers (n=216). There were three phases of data feedback to HCPs. Separate focus groups were held (Phase III) for cardiac HCPs including surgeons, anesthesiologists, perfusionists , residents, and OR nurses (n=27). Semi-structured interviews were used to elicit provider perspectives. Transcribed audio data was analyzed through the use of thematic analysis to develop a core set of common and comprehensive themes. Results: Data collection demonstrated marked inter-surgeon variation around the surgical costs of procedures. After feedback to HCPs, variation persisted and the median cost for AVRs increased. Five themes were identified from HCP groups: cost awareness, intraoperative decision making, influence surrounding intraoperative cost decision making, provider-based motivation for implementing intraoperative cost decision making, and cost drivers for an AVR. Conclusions: No difference in cost or variation before and after data feedback to HCPs was insufficient to impact surgeon’s behaviour in case costing, which motivated the qualitative work in the form of focus groups. HCPs demonstrated low cost awareness regarding cost drivers of AVRs. They expressed interest in engaging in cost decision making that was informed by cost containment. Measures such as listing the price of cost drivers in the OR and providing cost feedback could potentially encourage engagement in cost decision making for AVRs.

Access to CAR-T Cell Therapy in Underrepresented Populations: A Multicenter Cohort Study of Pediatric and Young Adult ALL Patients

Introduction: Social determinants of health such as race, ethnicity, and socioeconomic status (SES) are associated with inferior outcomes in patients with B-cell acute lymphoblastic leukemia (B-ALL). Latinx patients have worse event-free survival and are at increased risk of relapse when compared to non-Latinx peers; given that low SES is also an independent predictor of relapse, some of this disparity is likely the result of structural racism. Chimeric antigen receptor T-cell therapy (CAR-T) is a promising approach to improve survival for patients with relapsed/refractory (r/r) B-ALL. However, given the limited number of cellular therapy centers, these therapies may not be equally accessible to patients of low SES or patients from historically disadvantaged populations. The sociodemographic characteristics of pediatric and young adult patients referred for CAR-T have not been well-described. We aimed to evaluate how sociodemographic characteristics of patients referred for CAR-T from outside institutions (referred CAR-T) differed from r/r patients referred for CAR-T at their home institution (local CAR-T), r/r patients not referred for CAR-T at their home institution (other relapse), and patients without r/r disease (without relapse). We hypothesized that there would be a higher proportion of non-Latinx White patients and patients with higher SES among referred CAR-T patients.Methods: We conducted a multicenter, retrospective cohort study of children and young adults with B-ALL treated at five large pediatric hospitals between 2012-2018. Patients diagnosed with B-ALL between age 0 and 29 were included. Clinical and demographic data (including race/ethnicity, insurance, and primary language) were collected from the electronic health record and analyzed using descriptive statistics. For patients residing within the United States, ArcGIS NSES Index software was used to assign SES score by census tract (0-100, with 50 as the national average).Results: Our cohort included 1374 patients with B-ALL, of which 372 (27%) had r/r disease (Table 1). Among 372 r/r patients, 142 were referred CAR-T patients and 230 were treated for r/r leukemia at their home institution (35% local CAR-T and 65% other relapse). Median distance traveled to CAR-T therapy was 824 miles among referred patients and 20.5 miles among local CAR-T patients. The majority of patients (76% of the overall cohort and 79% of those receiving CAR-T) were either White or Latinx.A higher proportion of local CAR-T patients were Latinx compared to referred CAR-T patients (56% vs. 29%; p<0.01). Conversely, fewer local CAR-T patients were non-Latinx White compared to referred CAR-T patients (28% vs. 47%; p<0.01). A higher proportion of local CAR-T patients had public insurance compared to referred CAR-T patients (65% vs. 31%; p<0.001). A higher proportion of local CAR-T patients identified Spanish as their primary language compared to referred CAR-T patients (24% vs. 6%; p<0.001). Mean SES scores were similar across all groups.Conclusions: In a large multicenter cohort of B-ALL pediatric and young adult patients, the demographics of referred CAR-T patients were notably different than local CAR-T patients. Latinx patients are at increased risk of relapse, making access to CAR-T all the more essential; however, we found less than one-third of patients referred from outside institutions for CAR-T cell therapy were Latinx, while a majority of patients receiving CAR-T cell therapy locally were Latinx. This association suggests that barriers to access such as distance and need for travel may differentially impact Latinx patients due to structural racism. Spanish-speaking patients and patients with public insurance were also underrepresented in referrals from outside institutions. However, these observational differences may be in part due to regional variations in the demographics of the population. Preliminary analysis by site is underway and indicates that center level demographic variation may be driving some of the observed differences. Very few Black and Asian patients received CAR-T within our cohort making any assessments of patterns of care difficult. Future work will involve additional analysis to identify non-clinical factors that may influence referral and enrollment rates on CAR-T clinical trials as well as qualitative work to understand these factors from the patient and provider perspectives. [Display omitted] DisclosuresWalters: AllCells, Inc: Consultancy; BioLabs, Inc: Consultancy; Vertex pharmaceuticals: Consultancy; Ensoma, Inc.: Consultancy. Ramsey: Vertex Pharmaceuticals: Consultancy; Cystetics Medicines: Consultancy.

AN EXPLORATION TO CHRISTIANITY TEACHING CONCERNING PENAL MEDIATION OF CRIMINAL PROCEDURE LAW IN INDONESIA

Civil court justice shares the nature of mediation as part of litigation process. However, criminal procedure code does not accommodate penal mediation by litigation and non-litigation process. Therefore, penal mediation is considered as an Alternative Dispute Resolution in criminal law. This article attempts to build conversation between jurisprudence and theology, especially speaking the nature of mediatorship of Christian teaching that could be considered as beneficial donates for future penal mediation in criminal law in Indonesia. This research is qualitative work. Literatures, articles, books and related references will receive attention. In conclusion, penal mediation applies to litigation and non-litigation tract, the state should conduct its implementation, modern law maintains its legacy, Christology serves the initiation, and penal mediation pursues restorative justice.

The experience of qualitative research with young fathers: considerations of gender, class and reflexive practice

Qualitative research into the lives and experiences of young fathers has seen some increased interest in recent years, yet comprehensive understandings of the ‘doing’ of such research remain absent from the literature. The small existing literature positions young men who are fathers as potentially difficult to research, in terms of access and encounters. This article draws on experiences and reflections from two UK-based research projects with young men who are fathers to explore the practice of qualitative work with this particular group of participants. Beyond the choice of methodology, there appear to be several elements pertaining to the practice of researching the lives of young men who are fathers that may require consideration. Through discussion of gender, class, context, authenticity and rapport, the article argues that researching young men is not inherently problematic but is a practice which requires consideration and substantial reflexion in order to produce fruitful research encounters for both parties. This article therefore seeks to add nuance and insight into the experience of researching with young men who are fathers, and in doing so, adds sophistication to our limited understandings of qualitative encounters with this group.

English

Various studies claim that war has devastating effects on the psychological well-being of its victims. Such conflicts destroy not only cities and their infrastructure but also the established systems; such as the schooling system. In the wake of such destruction, millions of children are displaced and find themselves apart from their homes and their schools. Their attempts at accommodating themselves with the host communities are not easy, given the immense trauma they experienced. The resulting psychological and social problems make it more difficult for these children to fit in. The disruption to their education is yet another factor that affects their attempts at fitting in. The current paper aims to present a literature review focusing on the issues faced by child victims of war and conflicts. From their most apparent needs to the more subtle ones, this paper aims to evaluate the overall status of Syrian children in Turkey. This paper investigates the abovementioned issues by rewieving the previous literature with the help of the both quantitative and qualitative work from international NGOs and researchers. Although a large number of studies on the topic have been conducted, the majority of them focused on the current and short-term psychosocial effects that children face. However, there is much work to be done to prevent the long-term effects of the same. &nbsp; Key words: Syrian children, psychological well-being, education.

Adaptation of patients diagnosed with human papillomavirus: a grounded theory study

BackgroundHuman papillomavirus is the most common cause of sexually transmitted diseases. Various studies report that positive human papillomavirus diagnosis results in psychosexual issues for the infected and reduces their quality of life. However, the adaptation of the infected has not been addressed yet. The present study aims to identify the process by which individuals infected with human papillomavirus adapt to their disease.MethodThis is a qualitative work of research with a grounded theory design. The setting of the study was the skin clinic of Shahid Faghihi Hospital in Shiraz. The participants consisted of 27 individuals: 18 patients, 3 doctors, 2 counselors, and 4 spouses of patients. The subjects were selected via purposeful and theoretical sampling method until data saturation was reached. Data were collected through face-to-face, in-depth, semi-structured interviews from April 2019 to December 2020. The collected data were analyzed using Corbin and Strauss’s method (2015) and MAXQDA 2018.ResultsThe theory which emerged from the data was “trying to maintain resilience in the absence of psychological security.” Analysis of data showed the main concern of participants in adapting to their diagnosis with human papillomavirus was “life stress”. “Stigma and ignorance” was found to be a contextual condition and “paradox in support” was an intervening condition in the patients’ adaptation. The patients’ action/interaction responses to their main concern in the context in question were “emotional confrontation” and “maintaining resilience.” The outcome was “oscillation between tension and tranquility.”ConclusionThe present study explains the process by which patients with human papillomavirus adapt to their condition. Identification of the concerns of patients with human papillomavirus and the factors which affect their adaptation can help healthcare policy-makers and providers develop effective support plans in order to increase patients’ quality of life. Early interventions, e.g. counseling care providers to modify their behaviors toward alleviating the psychosexual tension of the infected, can facilitate the adaptation of the infected and decrease the consequences of the infection for them.Graphical

Social prescribing, evidence and progress; the view from England

Abstract Social prescribing enables primary care to refer individuals with health and/or social issues to a ‘link worker' whom provides ‘holistic' support to patients and refers them to further agreed non-clinical activities (e.g. walking group) and/or social services (e.g. housing). Social prescribing has the potential to help managing or addressing a wide range of health and social issues, particularly pertinent in a pandemic and post pandemic world, centred around individual choice, and based on maximising the asset offered by the voluntary sector. Yet, evidence and policy development have gone hand in hand, and sometimes in reverse in England. The NHS made a good case and rationale for implementing social prescribing before the concomitant evidence base had rigorously proven its impact. Researchers are now in a position of trying to evidence (and communicate what good evidence might be) whether what has been rolled out works, in what ways, and for whom. In contributing to the development of the evaluation of social prescribing, the main challenge experienced was that what counts as good evidence depends entirely on ‘what is meant' by social prescribing. Social prescribing was found to be a pathway consisting of a set of relationships and set of activities/complex interventions as part of that pathway, therefore asking ‘what works' is not trivial. So, for the patient pathway there is a need for robust, well conducted evidence syntheses from different parts of the pathway, good qualitative work around the experiences of referrers and individuals, secondary data analysis of the health service use, effectiveness work on the activities themselves, all crucially underpinned by strong data monitoring and capture. Working with a very broad range of stakeholders (commissioners, healthcare providers, activity providers, link workers, and individuals with lived experience) goes some way to communicating this complexity and helping base decisions on the most appropriate evidence.

“Longer than I Would’ve Originally Liked and Originally Thought”: Postsecondary Debt and Marriage Plans for Young Adults Coming of Age in the Great Recession

While student loans play a large role in the financing of higher education, there has been relatively little qualitative work on how young adults understand their debt burdens and the debt’s perceived future impact. We examine this topic utilizing a sample of 105 young people from working-, middle-, and upper middle-class backgrounds who experienced young adulthood during the Great Recession. While most respondents are accepting of debt at the time of postsecondary enrollment, their inability to meet the demands of their debt leads to frustration and anxiety. Further, many respondents are concerned that this debt will impact their ability to support themselves and transition into the role of a marital partner, although this varies across social class backgrounds and debt levels. We argue that this debt, and its corresponding repercussions, are likely to contribute to the continued bifurcation of family life in the United States.

Feasibility and acceptability of a toolkit-based process to implement patient-centered, immediate postpartum long-acting reversible contraception services

National guidelines recommend that maternity systems provide patient-centered access to immediate postpartum long-acting reversible contraception (ie, insertion of an intrauterine device or implant during the delivery hospitalization). Hospitals face significant barriers to offering these services, and efforts to improve peripartum contraception care quality have met with mixed success. Implementation toolkits-packages of resources and strategies to facilitate the implementation of new services-are a promising approach for guiding clinical practice change. This study aimed to develop a theory-informed toolkit, evaluate the feasibility of toolkit-based implementation of immediate postpartum long-acting reversible contraception care in a single site, and refine the toolkit and implementation process for future effectiveness testing. We conducted a single-site feasibility study of the toolkit-based implementation of immediate postpartum contraception services at a large academic medical center in 2017 to 2020. Based on previous qualitative work, we developed a theory-informed implementation toolkit. A stakeholder panel selected toolkit resources to use in a multicomponent implementation intervention at the study site. These resources included tools and strategies designed to optimize implementation conditions (ie, implementation leadership, planning, and evaluation; the financial environment; engagement of key stakeholders; patient needs; compatibility with workflow; and clinician and staff knowledge, skills, and attitudes). The implementation intervention was executed from January 2018 to April 2019. Study outcomes included implementation outcomes (ie, provider perceptions of the implementation process and implementation tools [assessed via online provider survey]) and healthcare quality outcomes (ie, trends in prenatal contraceptive counseling, trends in immediate postpartum long-acting reversible contraceptive utilization [both ascertained by institutional administrative data], and the patient experience of contraceptive care [assessed via serial, cross-sectional, online patient survey items adapted from the National Quality Forum-endorsed, validated Person-Centered Contraceptive Counseling measure]). In the implementation process, among 172 of 401 eligible clinicians (43%) participating in surveys, 70% were "extremely" or "somewhat" satisfied with the implementation process overall. In the prenatal contraceptive counseling, among 4960 individuals undergoing childbirth at the study site in 2019, 1789 (36.1%) had documented prenatal counseling about postpartum contraception. Documented counseling rates increased overall throughout 2019 (Q1, 12.5%; Q4, 51.0%) but varied significantly by clinic site (Q4, range 30%-79%). Immediate postpartum long-acting reversible contraception utilization increased throughout the study period (before implementation, 5.46% of deliveries; during implementation, 8.95%; after implementation, 8.58%). In the patient experience of contraceptive care, patient survey respondents (response rate, 15%-29%) were largely White (344/425 [81%]) and highly educated (309/425 [73%] with at least a 4-year college degree), reflecting the study site population. Scores were poor across settings, with modest improvements in the hospital setting from 2018 to 2020 (prenatal visits, 67%-63%; hospitalization, 45%-58%; outpatient after delivery, 69%-65%). Based on these findings, toolkit refinements included additional resources designed to routinize prenatal contraceptive counseling and support a more patient-centered experience of contraceptive care. A toolkit-based process to implement immediate postpartum long-acting reversible contraceptive services at a single academic center was associated with high acceptability but mixed healthcare quality outcomes. Toolkit resources were added to optimize counseling rates and the patient experience of contraceptive care. Future research should formally test the effectiveness of the refined toolkit in a multisite, prospective trial.