Remote Focus Research Articles

Use of Remote Focus Groups to Improve Inclusive Design Practice

This study examines the use of remote focus groups to obtain wheeled mobility device user’s ideas regarding Shared Autonomous Vehicles (SAVs). Given the global increase in the aging population and disabled people, inclusive design is essential for accessible transportation. Using remote focus groups, this research collected statements from nine wheeled mobility device users about their design preferences, needs, and challenges with SAVs. Participants attended four virtual sessions featured with presentations and videos of SAVs. Discussions were video recorded in Zoom, with transcripts reviewed for accuracy. Data analysis included cleaning, coding, and assessing interrater reliability using the ICC. The findings not reported here highlighted the diverse needs and preferences of participants, emphasizing the importance of collecting information from this group early in the design process. This study shows well-planned remote focus groups can be an effective tool to gather human factors system design information from user populations that face transportation barriers.

Model based optimization for refractive index mismatched light sheet imaging

Selective plane illumination microscopy (SPIM) is an optical sectioning imaging approach based on orthogonal light pathways for excitation and detection. The excitation pathway has an inverse relation between the optical sectioning strength and the effective field of view (FOV). Multiple approaches exist to extend the effective FOV, and here we focus on remote focusing to axially scan the light sheet, synchronized with a CMOS camera’s rolling shutter. A typical axially scanned SPIM configuration for imaging large samples utilizes a tunable optic for remote focusing, paired with air objectives focused into higher refractive index media. To quantitatively explore the effect of remote focus choices and sample space refractive index mismatch on light sheet intensity distributions, we developed an open-source computational approach for integrating ray tracing and field propagation. We validate our model’s performance against experimental light sheet profiles for various SPIM configurations. Our findings indicate that optimizing the position of the sample chamber relative to the excitation optics can enhance image quality by balancing aberrations induced by refractive index mismatch. We validate this prediction using a home-built, large sample axially scanned SPIM configuration and calibration samples. Our open-source, extensible modeling software can easily extend to explore optimal imaging configurations in diverse light sheet imaging settings.

From crisis to capacity: Lessons learned from youth e-mentoring during the COVID-19 pandemic

The COVID-19 pandemic and associated need for social isolation left in-person youth mentoring programs scrambling to keep mentees and mentors connected, and many programs turned to e-mentoring. To better understand the transition period and to inform e-mentoring practice in a post-COVID world, this study explored the experience of mentoring programs shifting to e-mentoring during the first year of the pandemic. Seven remote focus group discussions were conducted with twenty-three staff members from twenty U.S. youth mentoring organizations that used the iCouldBe e-mentoring platform during Spring/summer 2020 or Fall/Winter 2020–2021. Thematic content analysis was used to uncover insights from the data. E-mentoring was successful overall for keeping mentees and mentors in touch, especially for matches with a strong connection before the pandemic. Zoom and text messaging were the most used virtual communication methods. Programs faced many challenges but also experienced unexpected positives, including a strong interest in future e-mentoring implementation. Participants recommended that programs interested in e-mentoring start small and with intention; they also requested a central website with e-mentoring support and ways to connect with other programs and mentors. Although the literature on e-mentoring remains limited, this study contributes a picture of e-mentoring success even during a global crisis.

Stakeholders’ Perspective on the Key Features of Printed Educational Resources to Improve the Quality of Clinical Communication

Social and healthcare professionals often feel ill equipped to effectively engage in difficult conversations with patients, and poor proficiency negatively affects the quality of patient care. Printed educational resources (PERs) that provide guidance on sustaining complex clinical communication may be a source of support if thoughtfully designed. This study aimed to describe the key features of PERs in order to improve the quality of clinical communication according to the perspective of meaningful stakeholders. This was a descriptive secondary analysis of data collected by three remote focus group discussions that involved 15 stakeholders in the context of developing an educational booklet to support professionals in complex communication scenarios. Focus groups were audio-recorded and transcribed verbatim, and an inductive thematic analysis was performed. Three key features of PERs that aim toward quality improvement in clinical communication were identified: (1) having the potential to provide benefits in clinical practice; (2) facilitating, encouraging, and enticing reading; and (3) meeting the need of professionals to improve or update their knowledge. These findings suggest that PERs relevant to professionals’ clinical priorities and learning needs may make their efforts to apply learning in practice more likely and consequently result in improved healthcare quality.

Developing a text-message library for tobacco prevention among adolescents: A qualitative study.

Communicating the risks associated with nicotine and tobacco use to adolescents can be challenging, especially with the current tobacco market's attempt to capture the attention of youths. Text message interventions have emerged to address the need to improve tobacco risk communication. This article informs the design of a message library for tobacco risk communication that is based on the transtheoretical model and addresses the risk of multiple tobacco products. We draw findings from this study from two phases. Phase 1 involved six remote focus group discussions (n = 25) and an in-depth interview, and Phase 2 involved online ideation sessions (n = 11) that led to the current version of the messages. We conducted the study within a larger project for the design and testing of a tobacco prevention program. With thematic analysis and the affinity mapping technique, two research team members identified repeated topics and relevant quotes to organize them into themes and subthemes. In Phase 1, thematic analysis revealed four major themes: 1) Adolescents' gap in tobacco knowledge, 2) Social influence and popularity, 3) Attitude toward marketing, and 4) Text message framing preferences. During Phase 2, participants generated 1-to-7 iterations of the original messages. Votings and discussions resulted in a library of 306 messages under 7 sections, categorized based on the processes of change from the transtheoretical model. The current study presents key insights crucial for developing and evaluating a library of tobacco prevention text messages that is scientifically valid and successfully resonates with today's adolescents. Our future plan is to go beyond this initial message development and vet the message library by adolescents and expert reviewers in tobacco risk communication. Future research may consider developing messages that are tailored based on gender, ethnicity, and other factors that are predictive of tobacco use.

Health Is Power, and Health Is Wealth: Understanding the Motivators and Barriers of African American/Black Male Immigrants With Gastrointestinal Conditions.

The digestive health of African American/Black male immigrants in the United States has not been previously studied. Much of what is known about gastrointestinal (GI) concerns in this population is based on studies conducted on the overall Black American population. The purpose of this narrative study was to understand how African American/Black male immigrants with GI concerns navigated their GI condition. Fifteen African American/Black male immigrants from various cities in the United States participated in two remote focus groups to discover what motivates them to take control of their illness. Narrative analysis was used to analyze the qualitative data. Most men, 47% (n = 7), did not have health insurance, and 67% (n = 10) reported their income was less than US$52,000. The themes identified were: (1) lack of knowledge of GI, (2) denial of initial diagnosis, (3) self-discipline, (4) positive provider interactions, (5) health as a priority, and (6) advice to other African American/Black male immigrants experiencing GI. A strengths-based approach is necessary for describing the health-seeking behaviors among African American/Black male immigrants.

Community Teens' COVID-19 Experience: Implications for Engagement Moving Forward.

Data collected from pediatric primary care settings during the pandemic suggest an increase in internalizing symptoms and disparities in care based upon minoritized identity status(es). To inform care moving forward, the current study characterized the pandemic and related technology usage experiences of teenaged pediatric patients from communities with high hardship indexes. As part of a larger mixed-methods study, 17 teens (Mean age = 15.99 ± .99) and 10 caregivers independently voiced experiences related to the pandemic during remote focus group and interview sessions. Thematic analyses were used to assess qualitative data; descriptive analyses were used to characterize qualitative data. Despite no direct queries about the pandemic, 41% of teens and 40% of caregivers described their lived experiences during the pandemic. Two subthemes emerged within the primary theme of COVID-19: (1) Wellness/Mental Health and (2) Smartphone Use and Utility. Although distress and negative effects were voiced, questionnaire data indicated normative psychosocial functioning for both teen self-report and caregiver proxy report. Informed by the voiced experiences of teens and their caregivers from communities with high hardship indexes, methods for better assessing and managing internalizing symptoms in teen patients are presented. A multi-modal and multi-informant approach that leverages technology to garner information about teens' experiences and deliver care may help improve the well-being of teens in communities systemically burdened with disparities.

Steps to implementation: Understanding barriers and enablers for implementing Arts on Prescription at Home for people impacted by dementia.

Arts on Prescription at Home (AoP@Home) involves a professional artist visiting a person with dementia and their informal carer(s) in their own home to engage them in participatory art making. While there is evidence for the use of these programs, more work is needed to facilitate effective implementation. This study explored contextual barriers and enablers to implementation of AoP@Home within a real-world community aged care service. Two remote focus groups were conducted at a community aged care provider in Sydney, Australia. Key stakeholders (n = 14) were recruited, representing: people with dementia, informal (family) carers, AoP artists, service referrers and community service managers. Focus group transcripts were analysed using qualitative content analysis and mapped onto the Consolidated Framework for Implementation Research (CFIR). Outcomes were reviewed against the Expert Recommendations for Implementing Change (ERIC) strategy compilation to inform development of a tailored implementation strategy. Four overarching themes described the range of barriers and enablers to AoP@Home implementation: (1) "I don't know enough about it" (awareness and engagement within the sector), (2) artists delivering programs, (3) awareness and engagement of people impacted by dementia, (4) practicalities of implementation. All five domains of the CFIR were represented across the four themes. The ERIC compilation provided a list of practical strategies for implementation of AoP@Home. The implementation of psychosocial interventions for people living with dementia within a community aged care service is complex and multifactorial. So what?: Organisations planning implementation should consider conducting their own pre-implementation analysis to identify context-specific strategies.

Transforming musculoskeletal anatomy learning with haptic surface painting.

Anatomical body painting has traditionally been utilized to support learner engagement and understanding of surface anatomy. Learners apply two-dimensional representations of surface markings directly on to the skin, based on the identification of key landmarks. Esthetically satisfying representations of musculature and viscera can also be created. However, established body painting approaches do not typically address three-dimensional spatial anatomical concepts. Haptic Surface Painting (HSP) is a novel activity, distinct from traditional body painting, and aims to develop learner spatial awareness. The HSP process is underpinned by previous work describing how a Haptico-visual observation and drawing method can support spatial, holistic, and collaborative anatomy learning. In HSP, superficial and underlying musculoskeletal and vascular structures are located haptically by palpation. Transparent colors are then immediately applied to the skin using purposive and cross-contour drawing techniques to produce corresponding visual representations of learner observation and cognition. Undergraduate students at a United Kingdom medical school (n=7) participated in remote HSP workshops and focus groups. A phenomenological study of learner perspectives identified four themes from semantic qualitative analysis of transcripts: Three-dimensional haptico-visual exploration relating to learner spatial awareness of their own anatomy; cognitive freedom and accessibility provided by a flexible and empowering learning process; altered perspectives of anatomical detail, relationships, and clinical relevance; and delivery and context, relating to curricular integration, session format, and educator guidance. This work expands the pedagogic repertoire of anatomical body painting and has implications for anatomy educators seeking to integrate innovative, engaging, and effective learning approaches for transforming student learning.

Focus group in the development of concepts for a Nursing model: experience report.

To communicate the experience of developing concepts for the construction of a care model through focus groups. An experience report on the development of concepts through remote focus groups with members of a research group from a public university in southern Brazil. Focus groups were developed in which homogeneity and heterogeneity criteria were observed among participants. In addition to the concepts of the nursing metaparadigm, the concepts of care and family-centered care were developed, relevant to the nursing care model in question. Despite the challenges of conducting remote focus groups, they were suitable for the collective construction of concepts for a nursing care model, allowing the interaction of participants from different locations.

PERCEPTIONS OF THE PEOPLE RECRUITED ABOUT THE STRATEGIC ACTION “O BRASIL CONTA COMIGO” (BRAZIL COUNTS ON ME)

Objective: to analyze the perceptions of academics and supervisors about the strategic action “O Brasil Conta Comigo”(Brazil counts on me). Method: cross-sectional study conducted in Mato Grosso do Sul - Brazil, from December 2020 to March 2021, in two stages: 1) Exploratory (quantitative), via analysis of reports of the 33 supervisors and 90 academics convened, application of an online questionnaire; 2) In-depth (qualitative), using the remote focus group technique, with convenience sampling. Descriptive and content analysis was performed. Results: the reasons for joining and remaining with the action (scholarship, internship hours, and social responsibility), the pedagogical aspects (training, evaluation, and support from educational institutions, and management), and the contributions of the action (assistance and professional training) were identified. Conclusion: the general perceptions of the recruits are positive. Pedagogical aspects related to the evaluation of academics and support from higher education institutions should be reviewed, for more assertive actions in times of health crisis.

‘It is guiding us to protect ourselves’: a qualitative investigation into why young people engage with a mass-media HIV education campaign

This study explores how and why young people engage with MTV Shuga, a popular mass media campaign in South Africa, to understand what makes effective HIV edutainment. Young MTV Shuga viewers from the Eastern Cape, South Africa and their parents participated in remote individual interviews and focus groups in 2020. Qualitative data were transcribed and analysed using a thematic iterative approach. Young participants engaged with MTV Shuga for relatable, tolerant and complex stories about young people navigating HIV and relationships. These stories, which made viewers aware of sexual health services, inspired young people to reflect on how they might engage with different sexual health scenarios. MTV Shuga initiated conversations among peers, partners and some families about HIV that made them feel supported and equipped to tackle problems in their own lives. Complex, relatable, non-judgemental and youth-centred storylines can make HIV edutainment engaging to youth audiences. This approach allows space for reflection and inspires discussion and debate, turning young people from passive recipients of HIV messaging to active decision-makers. Television-based interventions can disseminate resources and knowledge into communities, however, watching them with parents can expose young people to judgement. HIV edutainment should therefore be available through different mediums so young people can engage in tolerant environments

Recommending Physical Activity to Your Aging Patients? What Clinicians Need to Know to Increase Adherence From the Older Adult Perspective.

A wealth of scientific evidence supports that being physically active may prevent or delay the onset of cognitive impairment and dementia. However, a critical barrier is that while most clinicians recommend physical activity (PA) and older adults recognize its health benefits, most older adults fail to regularly practice PA. Thus, it is necessary to explore and disseminate knowledge on how to help clinicians truly partner with people and help them to change their behavior and become more active. Clinical and scientific efforts are underway to establish dose-specific PA recommendations for cognitive brain health. However, an important knowledge gap is how to develop effective strategies to increase PA adherence in aging. To better understand the perspective of older adults, we undertook a mixed-method study on sixty-five sedentary older adults at risk for cognitive decline. Participants answered a questionnaire battery related to PA engagement, and a subcohort participated in a remote focus group. Our findings revealed four main themes: First, age and aging are determinants in PA practice. Second, maintaining both an active mind and autonomy are priorities, but planned PA is not usually related as part of being “active.” Third, motivational challenges in PA engagement were noted. And fourth, they emphasized a call for tailored recommendations. Therefore, we present a multidimensional model of PA adherence to maximize brain health in older adults and suggest a tool kit and key questions to effectively screen sedentary aging adults and translate current guidelines into the needs of the individual by using behavior change strategies.

Using Creative Approaches and Facilitating Remote Online Focus Groups With Children and Young People: Reflections, Recommendations and Practical Guidance

The importance of engaging and involving children and young people (CYP) in research is widely recognised, especially for educational research exploring CYP’s perceptions and experiences of school processes. Historically, working with CYP to collect qualitative data has involved face-to-face interactions, however the social distancing requirement during the COVID-19 pandemic meant there was a need to move ‘online’ and work ‘remotely’. In this paper we share our experiences of undertaking remote online synchronous focus groups with CYP and discuss how we overcame the challenges associated with conducting qualitative research with CYP ‘from a distance’. We used remote online synchronous focus groups to explore CYP’s perspectives on how education settings can support social, emotional, and mental wellbeing. We reflect on approaches used to uphold rigour and quality, and work ethically and sensitively. We have organised this into five topics reflecting distinct parts of the planning, design and practice: 1) working with CYP as research advisors to shape the design, feasibility and suitability of the methods and approach; 2) developing creative approaches within the online focus groups to increase engagement and inclusion; 3) considering logistical and technical practice; 4) considering ethical practice underpinning online group data collection with CYP; and 5) valuing participation and disseminate findings when working from a distance with participants. We present reflections and guidance for other researchers considering the use of remote online synchronous focus groups with CYP, as a feasible and valuable means for collecting data in both a time- and cost-effective manner.

143 A Youth-Led Digital Education Intervention to Improve Blood Pressure for Adults Who Present to the Emergency Department with Hypertension

OBJECTIVES/GOALS: To describe a study to develop, test, and collect implementation data on a youth-led hypertension (HTN) education digital intervention that acts as an electronic tool to guide youth through learning and then teaching adults on how to achieve better HTN control. Adults with uncontrolled HTN are recruited from a New Jersey emergency department (ED). METHODS/STUDY POPULATION: Adults with HTN and youth (15-18 years) participate in a remote user-centered design session focus group to provide input in the development of the youth-led HTN education digital intervention. 100 adult ED patients with uncontrolled HTN (blood pressure (BP) ≥130/80 mm Hg) who live with a youth (15-18 years) and the youth themselves are recruited for a randomized control trial (RCT). The adult-youth dyad is randomized to one of two arms, each a 6-week program with youth earning a digital badge: 1) intervention- youth-led HTN education with the adult, or 2) control- youth learn life skills (such as job readiness/resume building). Implementation metrics are collected through a post-intervention survey and qualitative interviews on the digital badge intervention including acceptability, feasibility, and fidelity. RESULTS/ANTICIPATED RESULTS: We completed two youth focus groups (total of 8 participants) and data collection is ongoing. Youth have shown great interest in the intervention prototype and thought their peers would find it acceptable. They suggested additions to nutrition education activities, such as adding a sodium tracker and examples of high sodium foods. For the RCT, the primary study outcome is adult BP change (from baseline to 1 week and 2-months post-intervention), with secondary outcomes of HTN knowledge and youth self-efficacy. We anticipate that intervention arm adults will have a more significant decrease in BP than control arm adults. We also expect that HTN knowledge and youth self-efficacy will be higher for the intervention arm. Implementation data collected will allow for improvements to future renditions of the intervention. DISCUSSION/SIGNIFICANCE: Bringing health education home while simultaneously empowering youth is an innovative technology-driven model for improving BP for patients with uncontrolled HTN who may lack access to care. Outcomes of this project will result in a scalable and easily adoptable model to reach an otherwise difficult to reach adult population.

In Their Own Words: The Challenges Experienced by Certified Nursing Assistants and Administrators During the COVID-19 Pandemic.

This qualitative study aimed to provide an in-depth understanding of the challenges experienced by certified nursing assistants and administrators during the unprecedented COVID-19 crisis. We conducted 6 administrator interviews and 10 remote focus groups with day and evening CNAs at 5 nursing homes (N = 56) in downstate New York. Content analysis was conducted, and emerging themes were identified across sites and roles. Results showed numerous challenges for both CNAs and administrators including many that were personal. These personal challenges included feeling helpless, anxious, or fearful; experience of COVID illness; and balancing high concurrent demands of work and family. There were also many operational challenges such as a lack of COVID testing capacity, information, and consistent guidance and support, staffing and equipment. Understanding these challenges can facilitate goals to promote future safety, skill refinement, and enhanced resilience in the workforce.

Using augmented reality to improve patient outcomes with negative pressure wound therapy.

Augmented reality (AR) is a burgeoning digital technology that is finding more frequent use in health care. The benefits of AR, such as hands-free imaging and remote viewing, make this a tool particularly suited to wound care. To the author's knowledge, no attempts have been made to leverage this technology in a way that might improve patient outcomes. Similarly, few studies on remote wound consultation focus on the inpatient setting. This study demonstrated the use of AR to improve the outcome of patients undergoing negative pressure wound therapy. A case-control study of 27 patients treated in a rural Louisiana hospital was performed. A retrospective control group (n = 15) was identified and compared with similar cases (n = 12) that used AR by the bedside nursing staff and an offsite certified wound care clinician. At univariate analysis, the treatment group was found to have fewer unintended surgical revisions (P =.002), fewer interruptions in therapy time (P =.01), and fewer readmissions related to wound infection (P =.004) compared with the control group. Correlational testing was performed and showed a significant correlation between the number of dressings performed and the number of complications that arose (0.71) as well as between premature dressing removals and number of readmissions related to infection (0.74). The results of this study, although preliminary, show how AR can be used in the acute care setting to positively influence outcomes of patients undergoing wound care. Further testing is necessary to replicate these findings and assess the use of AR with other advanced modalities or for other indications in the acute care setting.

Общая выживаемость и факторы прогноза у пациентов с метастазами рака почки в головной мозг после нейрохирургического лечения

Treatment of patients with brain metastases is an urgent problem that must be chosen as part of an integrated approach to detection, based on the characteristics of detection, the patient’s condition, and the severity of neurological deficit. The introduction of new techniques used with the use of neurosurgical and drug treatment, the original method of radiation therapy can increase the survival of patients, as well as improve the quality of life. This article presents the results of a retrospective analysis of the overall survival of patients with cerebral metastases of kidney cancer after neurosurgical resection. The aim of the study is to study the overall survival rates in patients with kidney cancer metastases in the brain after neurosurgical treatment. Material and methods. A retrospective analysis of the results of treatment of 114 patients with brain metastases from kidney cancer who received neurosurgical treatment at the National Medical Research Center of Oncology named after N.N. Blokhin. In the overall survival analysis, survival data were found in 102 (89.5%) of 114 patients. Of these, 80 (78.4%) patients died, and 22 (21.5%) patients are still being followed up. The extracranial disease status (ECM) at the time of surgical treatment was known in 82 (71.9%) patients, of which 45 (54.8%) patients underwent ECM, and 37 (45.1%) did not. In 92 (90.1%) patients, total removal of brain metastases (BM) with perifocal and perivascular zones was performed, in the rest of the patients; fragmentary resection of the focus was performed. Results. Overall survival (OS) after neurosurgical treatment 54.4%; 35.6%; 30.8% and 19% at 12, 24, 36, and 60 months, respectively, with a median OS of 13.8 months (95% CI, 10.29 to 18.6). Statistically significant predictors of overall survival were established: Karnofsky index ≥80% (p<0.0001) and absence of extracranial metastases (p=0.0107). The best survival rates were achieved in the group of patients with a history of nephrectomy and targeted or immunotherapy after neurosurgical treatment. Conclusion. Neurosurgical treatment, which is used with microsurgery and intraoperative navigation, allows a rapid reduction in neurological symptoms, good local control in the area of the remote focus with the course of postoperative complications. Neurosurgical intervention includes consideration of overall survival rates and, as part of anticancer drug therapy that increase overall survival rates.

It Was Trial by Fire: Recommendations for Building a Stronger Nursing Home Workforce After COVID-19

The COVID-19 crisis showed the urgent need for a unified, well-supported nursing home workforce. The objective of this qualitative study was to examine the lived experience of certified nursing assistants (CNAs) and administrators during COVID-19 to identify best practices moving forward. Six administrator interviews and 10 remote focus groups with CNAs at 5 nursing homes (N=56) were examined through directed content analysis. Based on priorities identified by CNAs and administrators, the following practices may be most impactful: 1) ongoing and responsive staff training; 2) transparent, direct, and two-way communication channels; 3) prioritizing hiring permanent staff to avoid shortages and reliance on agency staff; 4) building collaborative staff-management relationships; 5) providing flexible job benefits; 6) providing staff-centered emotional support resources; and 7) appraising COVID-19 innovations. Our results suggest that rather than returning to “business as usual,” nursing homes can draw on these lessons to build a more sustainable workforce and industry.

Challenges Reported by Certified Nursing Assistants During COVID-19: A Qualitative Study

Certified nursing assistants (CNAs) who care for vulnerable nursing home residents faced unprecedented circumstances due to the COVID-19 pandemic. While staff and PPE shortages were ubiquitous and widely known, the focus of this qualitative work was to gain a broader understanding of the numerous challenges they faced. We conducted 10 remote focus groups with CNAs at 5 nursing homes (N=56) in downstate New York. Content analysis was conducted, and emerging themes identified. Results showed a myriad of emotional challenges including helplessness, fear and anxiety. Operational challenges focused on lack of COVID testing capacity, information, and consistent guidance and support, in addition to staff and equipment. Individual challenges included personal experience of COVID illness and that of colleagues, and balancing high concurrent demands of work and family. These results are discussed in the context of developing recommendations to promote future safety, skill refinement and enhanced resilience in the workforce moving forward.