Quantitative Survey Items Research Articles

Barriers to Implementing Student-Led IEPs

Traditional teacher-led individualized education programs (IEPs) typically provide limited opportunities for students receiving special education services to meaningfully participate in the process. Even with a significant body of literature supporting the benefits of student-led IEPs, many school-based personnel maintain the traditional teacher-led model. As such, this study explored barriers to student-led IEPs, including an analysis of the differences in perceptions between school personnel who currently report facilitating student-led IEPs and those who report not facilitating student-led IEPs. In total, 275 participants completed quantitative survey items, with 155 of these same participants providing responses to a qualitative open-ended question. Results suggest common barriers to student-led IEPs include factors related to (a) students, (b) systemic issues, and (c) other IEP team members. In addition, those who do not have students who lead IEPs were more likely to identify the following specific factors as barriers: student ability, teacher self-efficacy, personal interest, and the age of the student. Discussions about implications for practice and future research are included.

Latino Parents' Reactions to and Engagement With a Facebook Group-Based COVID-19 Vaccine Promotion Intervention: Mixed Methods Pilot Study.

Misinformation in Spanish on social media platforms has contributed to COVID-19 vaccine hesitancy among Latino parents. Brigada Digital de Salud was established to disseminate credible, science-based information about COVID-19 in Spanish on social media. This study aims to assess participants' reactions to and engagement with Brigada Digital content that sought to increase COVID-19 vaccine uptake among US Latino parents and their children. We conducted a 5-week intervention in a private, moderator-led Facebook (Meta Platforms, Inc) group with Spanish-speaking Latino parents of children aged ≤18 years (N=55). The intervention participants received 3 to 4 daily Brigada Digital posts and were encouraged to discuss the covered topics through comments and polls. To assess participants' exposure, reactions, and engagement, we used participants' responses to a web-based survey administered at 2 time points (baseline and after 5 weeks) and Facebook analytics to calculate the average number of participant views, reactions, and comments. Descriptive statistics were assessed for quantitative survey items, qualitative responses were thematically analyzed, and quotes were selected to illustrate the themes. Overall, 101 posts were published. Most participants reported visiting the group 1 to 3 times (22/55, 40%) or 4 to 6 (18/55, 33%) times per week and viewing 1 to 2 (23/55, 42%) or 3 to 4 (16/55, 29%) posts per day. Facebook analytics validated this exposure, with 36 views per participant on average. The participants reacted positively to the intervention. Most participants found the content informative and trustworthy (49/55, 89%), easy to understand, and presented in an interesting manner. The participants thought that the moderators were well informed (51/55, 93%) and helpful (50/55, 91%) and praised them for being empathic and responsive. The participants viewed the group environment as welcoming and group members as friendly (45/55, 82%) and supportive (19/55, 35%). The 3 most useful topics for participants were the safety and efficacy of adult COVID-19 vaccines (29/55, 53%), understanding child risk levels (29/55, 53%), and the science behind COVID-19 (24/55, 44%). The preferred formats were educational posts that could be read (38/55, 69%) and videos, including expert (28/55, 51%) and instructional (26/55, 47%) interviews. Regarding engagement, most participants self-reported reacting to posts 1 to 2 (16/55, 29%) or 3 to 4 (15/55, 27%) times per week and commenting on posts 1 to 2 (16/55, 29%) or <1 (20/55, 36%) time per week. This engagement level was validated by analytics, with 10.6 reactions and 3 comments per participant, on average, during the 5 weeks. Participants recommended more opportunities for engagement, such as interacting with the moderators in real time. With adequate intervention exposure and engagement and overall positive participant reactions, the findings highlight the promise of this digital approach for COVID-19 vaccine-related health promotion.

Perspectives of Professionalism, Self-Awareness, Leadership, and Innovation and Entrepreneurship From Experiential Education Preceptors

ObjectiveThe objectives of this study were to (1) quantify the perceived importance of and comfort with the Accreditation Council for Pharmacy Education Standard 4 (ACPE-S4) key elements, (2) describe how preceptors promote and assess key elements, and (3) describe preceptor perceptions of student key element skill demonstration. MethodsThis study used a cross-sectional electronic survey to assess experiential education preceptors’ perceptions of ACPE-S4 key elements. The survey consisted of 2 item categories, with 5 and 15 items included to collect information on preceptor demographics and ACPE-S4 key elements, respectively. Surveys were distributed to 451 introductory and advanced rotation preceptors. Frequencies and means were reported for quantitative survey items, open-ended survey responses were analyzed using a general interpretivist approach. ResultsIn total, 242 surveys were completed for a response rate of 54%. Most respondents identified as female (54.5%) and precepted community pharmacy rotations (28.5%). ACPE-S4 key elements, in order of most to least important, were professionalism, self-awareness, leadership, and innovation and entrepreneurship. Respondents varied in their conceptualization of key elements, with multiple activities used for skill demonstration and assessments. Qualitative analysis identified 2 themes: “Variation in preceptor fluency with S4 key elements” and “Communication as a means to demonstrate and evaluate ACPE-S4 key element skills.” ConclusionVariation among preceptors in conceptualization, learning activities, and comfort in assessment for ACPE-S4 key elements highlights the need for support and resources to assist preceptors in developing activities and assessments for skills reflective of ACPE-S4 key elements. Preceptors commonly relied on vulnerable communication with students to assess key element skills, identifying a potential target for assessment and preceptor development. Pharmacy programs, in addition to the Academy, could benefit from using assessments already offered by preceptors. Finally, explicit evaluation criteria may help to guide skill acquisition and facilitate consistent assessment of key element skills.

Development of a tool for palliative care needs assessment and intervention: mixed methods research at a Swiss tertiary oncology clinic

Palliative care interventions improve quality-of-life for advanced cancer patients and their caregivers. The frequency and quality of service provision could be improved by a clinical tool that helps oncology professionals to assess unmet needs for palliative care interventions and to structure the interventions delivered. This paper aims to answer the following research question: what do oncology professionals and cancer patients view as important elements in a clinical tool for assessing unmet palliative care needs? Based on the feedback from professionals and patients, we developed and refined an intervention-focused clinical tool for use in cancer care. This study used a prospective convergent mixed methods design and was carried out at a single tertiary hospital in Switzerland. Healthcare professionals participated in focus groups (n=29) and a Delphi survey (n=73). Patients receiving palliative care were interviewed (n=17). Purposive sampling was used to achieve maximal variation in participant response. Inductive content analysis and descriptive statistics were used to analyze focus group discussions, open-ended survey questions and interview data. Descriptive statistics were used for analyzing quantitative survey items and interviewee characteristics. Focus groups and Delphi surveys showed that seven key palliative care interventions were important to oncology professionals. They also valued a tool that could be used by doctors, nurses, or other professionals. Participants did not agree about the best timepoint for assessment. Two versions of a pilot clinical tool were tested in patient interviews. Interviews highlighted the divergent patient needs that must be accommodated in clinical practice. Patients provided confirmation that a clinical tool would be helpful to them. This paper reports on research carried out to understand what elements are most important in a tool that helps oncology professionals to identify patients' unmet needs and provide tailored palliative care interventions. This study demonstrated that professionals and patients alike are interested in a clinical tool. Responses from oncology healthcare professionals helped to identify relevant palliative care interventions, and patients provided constructive input used in designing a tool for use in clinical interactions.

Perspectives on Social Justice among Hospice and Palliative Care Social Workers: Voices from the Field

Hospice and palliative care are burgeoning fields of social work practice. Within the social work profession, the pursuit of social justice is a defining ethical value. While some research exists on social justice within palliative and hospice care, no studies have examined its meaning within the context of this highly specialized field. To date, there is an absence of empirical research examining the meaning of social justice within a sample of hospice and palliative social workers. This study attempts to fill this gap. We used qualitative and quantitative survey items to ask hospice and palliative care social workers about the meaning of social justice within their unique practice setting, as well as to identify prominent social injustices and opportunities for action. Using responses from 51 seasoned practitioners, we found that social workers generally defined social justice as equitable access to three core areas—basic needs, high quality care, and education (for both patients, families, and providers)—regardless of a person’s group membership (e.g., race, class, sexual orientation). Participants also made recommendations for improving social justice in clinical practice through advocacy and other initiatives.

Is progress being made on Canada’s palliative care framework and action plan? A survey of stakeholder perspectives

BackgroundThe legalization of Medical Assistance in Dying in Canada in 2016 provided new impetus for improving palliative care. This commitment to improvement included the development of a National Palliative Care Framework and Action Plan. The purpose of this study was to understand the progress made in palliative care since 2016 from the perspective of persons working and volunteering in palliative care and compare geographic differences.MethodsA digital survey was developed from goals identified in Canada’s Palliative Care Framework and Action Plan and administered online using Qualtrics. Participants were recruited through national palliative care organizations. The survey included both quantitative survey items designed to evaluate improvements across 5 domains and 29 items and included open-ended questions about impacts, innovations, and ongoing challenges. Descriptive statistics were generated for survey domains, items, and demographic variables. Geographic differences were compared using Independent-Samples Kruskal–Wallis test. Qualitative data was analyzed inductively into themes.ResultsOne hundred fifty surveys met inclusion criteria and were analysed. Overall, the most improvement was reported in palliative care education and the least improvement was reported in support for family caregivers. Items on which respondents reported the most improvement included healthcare provider education in palliative care, advance care planning, and use of technology. Items on which respondents reported the least improvement were respite for family caregivers, access to bereavement services, and in-home support for family caregivers. Notably, rural participants reported more statistically significant improvements in the domains of education, access, and research and data collection than their urban counterparts. However, rural participants reported less improvement in places to die when home is not preferable. The COVID-19 pandemic was a significant contributor to these perceived improvements and ongoing challenges.ConclusionCanada’s Framework and Action Plan sets out a roadmap for improving palliative care in Canada. Participants in this survey noted significant improvements in key areas, a notable accomplishment amidst the effects of the COVID-19 pandemic. Some improvements were a result of greater use of distance technology. Further leveraging these improvements will make an important contribution to solving some of the rural and remote palliative care issues that have arisen from Canada’s unique geography.

Recovery 101: A Community Psychoeducation Program on Mental Health Recovery and Peer Support Services Created by an Academic Psychiatrist and Delivered by Peers.

Despite the ongoing growing interest and established benefits of mental health recovery and peer support services, little is known about the effects of mental health recovery and peer support services specifically in community education programs. Seeking to further expand this scope, this article details the development, implementation, and evaluation of a recovery and peer services community psychoeducation program created by an academic psychiatrist and delivered by trained mental health peers. A community psychoeducation intervention on recovery and peer services was provided in 2 different series: 5-session and 1-session series. Participants in the intervention were recruited from 2 local nonprofit recovery-oriented organizations and a public mental health service agency. Surveys were administered before and after each presentation session and analyzed both quantitatively and qualitatively. Quantitative survey items covering knowledge, awareness, interest, and likelihood of involvement in peer services for recovery all showed statistically significant gains from before to after the sessions. The qualitative data provided information about the participants' interests in the program in terms of knowledge of recovery, self-improvement, advocacy, resources, support, and nonspecific positive comments. An essential contribution of the program was to introduce participants to recovery and peer services. It also provided them with foundational knowledge that placed participants in a position to begin to practice the concepts of recovery. According to the participants' comments in the surveys, the program imbued a sense of hope and motivation; support and fellowship; and, importantly, role modeling and wisdom from the presenters.

Patient and provider prediabetes knowledge, attitudes, and behavior in a large urban family medicine practice.

Context: One-third of American adults have prediabetes. However, only 11% are aware of their condition, and they often do not receive prediabetes education or management. Prior studies have indicated knowledge gaps among primary care providers and patients on prediabetes management. Objective: To understand family medicine providers' and patients' attitudes, knowledge, and behaviors regarding prediabetes and its management to inform a prediabetes management intervention. Study Design: Cross-sectional surveys. Setting: A large academic family medicine practice in downtown Philadelphia with 30,000 patients making 80,000 visits annually. Population studied: Family medicine providers (attending physicians, nurse practitioners, residents) and adult patients seen within the last year, with HbA1c in the last 6 months between 5.7-6.4% (excluding pregnant, diabetes diagnosis). Instruments: Provider survey asking demographics, knowledge, attitudes, management, DPP awareness, barriers to prediabetes treatment, and open-ended question on how the practice could improve prediabetes management. Patient survey asking demographics, awareness of diagnosis and risk, knowledge, attitudes, experiences with DPP, prediabetes experiences with PCP, and same open-ended question as provider survey. Provider survey distributed via email; patient survey via Epic MyChart patient portal. Outcome Measures: Descriptive statistics for all quantitative survey items; thematic analysis of open-ended responses. Results: Fifty-four providers and 148 patients completed the surveys (57% and 16.5% response rates, respectively). Nearly all providers (96%) felt that prediabetes screening and management is important but most (74%) prescribe metformin to ≤ 25% of eligible patients. Over half (56%) were unaware of DPP, and 52% of those aware of DPP did not know how to refer a patient. Over half (59%) of patients reported having been told they have prediabetes and 84% thought diet and lifestyle changes were effective treatment, but 65% were unaware of medication options and only 5% had been referred to DPP. In open-ended responses, providers requested more nutrition counseling and an improved DPP referral process; patients also requested nutrition counseling and classes. Conclusions: Providers and patients saw prediabetes as important but reported knowledge and management gaps, particularly for metformin and DPP, and requested additional practice resources.

The feasibility and acceptability of a classroom-based physical activity program for children attending specialist schools: a mixed-methods pilot study

BackgroundChildren with disabilities often engage in less than the recommended amount of daily physical activity (PA). Classroom-based PA breaks are a favourable method of promoting PA for children. However, evaluations of these programs in specialist schools are scarce, with even less research into their feasibility and acceptability. This may hinder effective implementation and program scalability. This pilot study investigated the feasibility and acceptability of implementing a classroom-based PA break program in Australian specialist school classrooms, using the Australian Joy of Moving (AJoM) program.MethodsForty primary/junior classes and their teachers across five specialist schools implemented the AJoM program for eight weeks as the intervention group within a pilot cluster randomised controlled trial. A mixed-methods design investigated classroom teachers’ (N = 22; 6 males, 16 females) perspectives of the feasibility and acceptability of the program after implementation through semi-structured telephone interviews (n = 7 teachers), qualitative survey responses (n = 18 teachers) and quantitative survey items (n = 19 teachers). Qualitative data were analysed using predominantly deductive thematic analysis. Quantitative data were analysed using descriptive statistics.ResultsClassroom-based PA breaks may be feasible for getting children with disabilities more active at school. However, considerable variation exists in teachers’ perception of the AJoM experience. While several teachers indicate that the program content could be pertinent for their class, common divergences in perceptions of feasibility and acceptability appear to relate to the age and developmental level or needs of the students in the class.ConclusionsThis study provides preliminary evidence for the feasibility and acceptability of implementing classroom-based PA breaks in specialist schools. However, results demonstrate the importance of (1) allowing a high level of flexibility in the design and implementation of programs to meet the varying needs of class groups and (2) providing a large variety of resources to cater to the heterogeneity of the children.Trial registrationThis trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619000193178) on 11 February 2019.

Teacher preparation and the COVID-19 disruption: Understanding the impact and implications for novice teachers

The COVID-19 pandemic required many school districts and teacher preparation programs to make major changes to student teaching placements. Preservice students who completed student teaching during the academic year 2019- 2020 are now employed as first year teachers, yet the impact these changes had on teachers’ self-efficacy is not clear. First-year teachers (N=162) responded to a survey which included items from the teachers’ sense of self-efficacy scale (TSES) to understand how teacher self-efficacy differed based on disruptions to student teaching placements and current teaching modality (hybrid, virtual, in-person). Participant responses to quantitative survey items were analyzed using a two-way MANOVA, while a qualitative survey item was analyzed using thematic analysis. Results from the two-way MANOVA show a significant interaction at the p<.05 level between current teaching modality and change in student teaching placement on overall teacher self-efficacy (p=.003), student engagement (p=.005), and instructional strategies (p=.001). Thematic analysis resulted in 11 themes sorted into positive, neutral, or negative impact categories with the greatest number of themes in the negative impact category. Overall, the results add to the knowledge base about the importance of student teaching to teacher self-efficacy. Implications for higher education faculty, policymakers, and school leaders are discussed.

What Family Circumstances, During COVID-19, Impact on Parental Mental Health in an Inner City Community in London?

The introduction of lockdown due to a public health emergency in March 2020 marked the beginning of substantial changes to daily life for all families with young children. Here we report the experience of families from London Borough of Tower Hamlets with high rates of poverty and ethnic and linguistic diversity. This inner city community, like communities worldwide, has experienced a reduction or closure in access to education, support services, and in some cases, a change in or loss of income, job, and food security. Using quantitative survey items (N = 992), we examined what differences in family circumstances, for mothers and fathers of young children aged 0–5 living in Tower Hamlets, during March 2020 to November 2020, were associated with their mental health status. We measure parental mental health using symptoms of depression (self-report: Patient Health Questionnaire depression scale: PHQ-8), symptoms of anxiety levels (self-report: General Anxiety Disorder: GAD-7), and perceptions of direct loneliness. We find parental mental health difficulties are associated with low material assets (financial security, food security, and children having access to outside space), familial assets (parents time for themselves and parent status: lone vs. cohabiting), and community assets (receiving support from friends and family outside the household). South Asian parents and fathers across ethnicities were significantly more likely to experience mental health difficulties, once all other predictors were accounted for. These contributing factors should be considered for future pandemics, where restrictions on people's lives are put in place, and speak to the importance of reducing financial insecurity and food insecurity as a means of improving the mental health of parents.

Virtual Recruitment Is Here to Stay: A Survey of ID Fellowship Program Directors and Matched Applicants Regarding Their 2020 Virtual Recruitment Experiences.

BackgroundGraduate Medical Education training programs transitioned to all-virtual recruitment in 2020. Limited data have been published regarding the consequences of this transition. We aimed to understand (1) infectious diseases (ID) fellowship programs’ recruitment efforts and the effect of virtual recruitment on application and interview numbers and (2) the number of programs to which matched applicants applied and interviewed and applicants’ perspectives on virtual recruitment.MethodsIn 2020–2021, we surveyed all US ID fellowship program directors (PDs) and matched applicants. Descriptive data analysis was performed on quantitative survey items. Free-text responses were analyzed through a quantitative content analysis approach.ResultsThe PD response rate was 68/158 (43%); the applicant response rate was at least 23% (85/365). PDs reported a 27% increase in mean number of applications received and a 45% increase in mean number of applicants interviewed compared with the previous year. Applicants especially valued the online program structure information, PD program overview videos, didactic and curriculum content, and fellow testimonials and profiles. Most applicants preferred interviews lasting no more than 40 minutes and interview days lasting no more than 5 hours. Nearly all (60/64, 94%) PDs adequately learned about candidates; most (48/64, 75%) felt unable to showcase their program as well as when in-person. Most PDs (54/64, 84%) and applicants (56/73, 77%) want an option for virtual recruitment.ConclusionsVirtual recruitment enabled programs to accommodate more applicants and highlighted applicants’ preferences for programs’ augmented online presences and time-limited interview days. Most programs and applicants want an option for virtual interviews.

Quality of work life of paramedics practicing community paramedicine in northern Ontario, Canada: a mixed-methods sequential explanatory study.

This article aimed to evaluate pilot community paramedicine (CP) programs in northern Ontario from the perspectives of paramedics to gain program recommendations related to both rural and urban settings. An online questionnaire was created and distributed to 879 paramedics with and without CP experience employed at eight emergency medical services providers in northern Ontario. An explanatory sequential design was used to analyze and synthesize the results from the quantitative survey items and the open-ended responses. Seventy-five (40.5%) respondents participated in a CP program, and the majority of 75 paramedics who indicated they participated in CP (n=41, 54.4%) were from rural areas. CP was generally well received by both paramedics currently practicing CP and those who were not practicing CP. The majority (86.3%) of paramedics stated paramedics should be practicing CP in the future. Paramedics identified developing professional relationships and improving health promotion as positive aspects of CP. Areas for CP program improvement included better organization and scheduling, improved training and a need for better patient tracking software. Engaging and consulting paramedics in the ongoing process of CP development and implementation is important to ensure they feel valued and are part of the change process.

What educational strategies and mechanisms facilitate EBP use? A mixed methods examination of therapist perceptions within a system-driven implementation of multiple EBPs.

Many strategies may be used by external consultants (such as treatment developers and trainers) and internal program leaders to support evidence-based practice (EBP) implementation. The goal of this study was to identify which educational implementation strategies are considered by therapists to be most helpful, through which mechanisms, and whether these strategies are linked to EBP use. Semi-structured interviews were conducted with 60 therapists, and 826 therapists completed surveys regarding their perceptions of educational implementation strategies and reported delivery of EBPs within a system-driven, multiple-EBP implementation effort. Using sequential QUAL → QUAN mixed methods, we first identified qualitative themes. Next, we conducted a multilevel logistic regression to examine how quantitative survey items corresponding with qualitative themes predicted EBP use. Initial qualitative thematic analyses revealed four implementation strategies perceived as essential for EBP delivery: connection to a community of trained therapists, ongoing consultation/supervision, availability of internal supervisors trained in the EBP, and access to EBP materials and resources. Quantitative results showed strategies related to connections with a community of trained therapists (i.e., percentage of other therapists at an agency with EBP training and delivery experience as opposed to those who are only trained in the EBP), ongoing consultation/supervision, and having an internal supervisor trained in the EBP (receiving EBP-specific in-house supervision) were significantly associated with EBP use while receiving EBP boosters was not. The closest quantitative indicator corresponding to access to EBP resources, EBP web-based training, was not associated with EBP use. Therapist reported these strategies supported EBP delivery through exposure to other therapists' cases, guidance/feedback, emotional support, and removing logistic barriers to EBP use. These findings demonstrate how considering therapist perspectives and creating a network of EBP support via supervisors, consultants, and a community of therapists experienced in the EBP may be particularly critical to EBP delivery. Public mental health systems are increasingly implementing multiple evidence-based practices (EBPs). There are many strategies that may be used by external consultants (such as treatment developers and trainers) and internal program leaders to support EBP implementation. The goal of this study was to identify which of these internal and external implementation strategies are considered by therapists to be most helpful and how these strategies are linked with continued use of EBPs. First, qualitative interviews with therapists revealed the following strategies are key for supporting their delivery of EBPs: (1) connections to a community of trained therapists, (2) ongoing consultation/supervision, (3) having an internal supervisor at their program who was trained in the EBP, and (4) access to EBP materials and logistic resources. Next, quantitative analyses of survey data examined whether any of the strategies therapists identified as most helpful predicted the continued delivery of EBPs by therapists after initial training. Results confirmed that strategies involving connections with a community of therapists trained in and experienced with the EBP, ongoing consultation/supervision, and having an internal supervisor trained in the EBP were each significantly associated with EBP use. Therapist reported these strategies supported EBP delivery through exposure to other therapists' cases, guidance/feedback, emotional support, and removing logistic barriers to EBP use. These findings can assist systems and programs in prioritizing implementation strategies to support the sustained delivery of EBPs.

WHY IS THE STUDY PARTNER REQUIREMENT A BARRIER TO RECRUITMENT IN PRECLINICAL ALZHEIMER’S DISEASE TRIALS?

Alzheimer's disease (AD) clinical trials, including preclinical trials that enroll cognitively unimpaired participants with biomarker evidence of AD, require co-enrollment of a participant and a study partner. We previously found that the study partner requirement is among the most important barriers to preclinical trial recruitment and that this barrier may be greater in trials that require biomarker disclosure compared to trials that do not. This study examines why the study partner requirement is a barrier to enrollment in preclinical trials. We are conducting a mixed methods in-person interview study with 200 cognitively unimpaired participants, ages 60 to 85, recruited from the University of California, Irvine Consent-to-Contact Registry. We review example preclinical AD trial consent forms and then ask open-ended and forced choice questions to elucidate attitudes toward participation, including assessment of positive and negative associations with the study partner requirement. We collect participant demographics and responses to the AD Knowledge Scale, Risk for AD Scale, and Research Attitudes Questionnaire. To elucidate the study partner barrier, we will use a proportional odds model regressing the ordinal level of agreement for a statement that the study partner requirement reduces probability of enrollment upon the reported level of agreement for varying statements related to the study partner (Table 1). We will perform content analyses for themes and correlations and summary analyses from quantitative survey items. We will present participant reported availability of a study partner for preclinical AD trials and the frequency of positive and negative associations with the study partner requirement. We will explore potential covariate relationships with study outcomes, including overall willingness to enroll in a preclinical AD trial.

POLST Facilitation in Complex Care Management: A Feasibility Study.

The Physician Orders for Life-Sustaining Treatment (POLST) form is an advance care planning tool designed for seriously ill patients. The discussions needed for high-quality POLST decision-making are time intensive and often do not occur in the outpatient setting. We conducted a single-arm feasibility study of POLST facilitation by nonphysicians using Respecting Choices Last Steps, a standardized, structured approach to facilitation of POLST conversations. Community-dwelling adults aged 65 and older enrolled in a complex care management program in a Midwestern urban hospital. We assessed the feasibility and acceptability by determining the proportion of eligible patients who enrolled and completed the study, by adherence to the Respecting Choices protocol, and by responses to qualitative and quantitative survey items about the intervention. We enrolled 18 (58.1%) of 31 eligible patients, with a mean age of 77.8 years (standard deviation: 6.95); 12 were African American. The POLST facilitation was delivered to all 18; 10 (55.6%) completed POLST forms. Direct observation of intervention delivery using a checklist found 85% of the required elements were performed by facilitators. We completed 6- to 8-week follow-up interviews in 16 of 18 patients (88.9%). We found 87.5% of decision makers agreed or strongly agreed that "Talking about the (POLST) form helped me think about what I really want." The POLST facilitation can be successfully delivered to frail older adults in a complex care management setting, with high fidelity to protocol. Further research is needed to demonstrate the effects of this approach on decision quality and other patient-reported outcomes.

Student representations of dyadic and global teacher-student relationships: Perceived caring, negativity, affinity, and differences across gender and race/ethnicity

This mixed-method study (N = 657) explores high school students’ representations of their relationships with teachers in both dyadic teacher-student pairs and on a “global” level with all teachers at a focal school, as well as differences in these representations by student gender and race/ethnicity. The goals are to provide greater insight into how students represent both types of relationships, blending approaches in teacher-student relationship and school climate research, and to explore the ways in which individual student differences may be associated with trends in students’ representations. Specifically, students’ representations of their dyadic relationships with teachers are explored through content analysis of qualitative student survey data, while a global measure of students’ relationships with teachers across the school are modeled through exploratory and confirmatory factor analysis of quantitative survey items. Both sets of data are then disaggregated by student gender and race/ethnicity. Key findings include the multidimensionality of students’ perceptions of teacher caring, the distinction of negative relationship characteristics, and the potentially unique role that perceived affinity may have in students’ representations, particularly across student sub-groups. Implications include the need for greater attention to and articulation of students’ representations of their relationship in both research and practice.

Water Users’ Perspectives: Summary of Withdrawal Survey Responses and Commentary

The state of South Carolina is currently in a multiyear process of updating the State Water Plan, and water demand projections are an important component of that work. Predictions of water demand are inherently uncertain, but perhaps they can benefit from input by a diverse and robust sample of water users. A brief survey regarding water use was distributed to 780 permitted and registered water users in the state, including all water suppliers, industries, and irrigators withdrawing more than 3 million gallons in a month or more than 100,000 gallons in a day. There are 316 responses to 10 quantitative survey items that are summarized, presented, and discussed. Results indicate that most respondents plan to maintain their current levels of water use, consider their withdrawal reports to be accurate within 10%, and believe their current water supplies to be critical to their enterprise. A qualitative review of comments noted on survey responses includes a variety of potential drivers of water demand. The results motivate a discussion of recommendations for future research.

Acceptability of Human Papillomavirus Self-Test Devices among Women from High-Risk Populations

Objective: There is growing interest in human papillomavirus (HPV) self-testing as a potential cervical cancer screening strategy, yet little is known about women’s views on different self-test devices. We examined the acceptability of several HPV self-test devices among women from two populations with cervical cancer disparities. Methods: We conducted focus groups with Appalachian and African American women (n=34) in 2014 and 2015. Women provided both quantitative and qualitative feedback on four HPV self-test devices: Rovers® Viba-Brush (Device A [brush]); Evalyn® Brush (Device B [brush]); HerSwab® (Device C [swab]); and Delphi Screener® (Device D [lavage]). Quantitative survey items about the self-test devices used a 5-point Likert scale. Results: Appalachian women were more willing to use Device B at home by themselves (mean=4.3) compared to Devices C (mean=2.9) and D (mean=2.5) (both p<0.05). African American women were also more willing to use Device B at home by themselves (mean=3.7) compared to Devices C (mean=2.7) and D (mean=2.4) (both p<0.05). In general, women tended to rate Devices B and A more positively than Devices C and D on device appearance and usability. Qualitative data identified several potential issues related to device appearance (e.g., color and size), usability (e.g., knowing how far to insert a device), and instructions (e.g., font size). Conclusion: Women’s acceptability differed across the various HPV self-test devices, likely due to preferences regarding device appearance, usability, and the understandability of instructions. Findings will be highly useful for designing future HPV self-test programs and maximizing women’s participation in such programs

Why do people with chronic disease not contact consumer health organisations? A survey of general practice patients

Aim Consumer health organisations (CHOs) are non-profit or voluntary sector organisations that promote and represent the interests of patients and carers affected by particular conditions. The purpose of this study was to examine, among patients with chronic disease, what differentiates those who contact CHOs from those who do not and what stops people from making contact. CHOs can enhance people's capacity to manage chronic disease by providing information, education and psychosocial support, but are under-utilised. Little is known about barriers to access. Data were from a baseline telephone survey conducted as part of a randomised trial of an intervention to improve access to CHOs. Participants constituted a consecutive sample of 276 adults with diagnosed chronic disease recruited via 18 general practitioners in Brisbane, Australia. Quantitative survey items examined participants' use and perceptions of CHOs and a single open-ended question explored barriers to CHO use. Multiple logistic regression and thematic analysis were used. Findings Overall, 39% of participants had ever contacted a CHO for their health and 28% had contacted a CHO specifically focussed on their diagnosed chronic condition. Diabetes, poorer self-reported physical health and greater health system contact were significantly associated with CHO contact. The view that 'my doctor does it all' was prevalent and, together with a belief that their health problems were 'not serious enough', was the primary reason patients did not make contact. Attitudinal and system-related barriers limit use of CHOs by those for whom they are designed. Developing referral pathways to CHOs and promoting awareness about what they offer is needed to improve access.