Secondary Analysis Of Qualitative Data Research Articles

Discovering a “sense of community”: patient experiences of connection in intentionally remote eating disorder care

BackgroundWhile some findings indicate high levels of patient satisfaction with remote eating disorder treatment, others reflect feelings of disconnection due to unique telehealth treatment challenges. The COVID-19 pandemic presented circumstances that likely impacted the findings established thus far. As such, the present study sought to understand patient experiences of connection in an intentionally remote eating disorder treatment program, specifically in a context outside of pandemic transition.MethodsA secondary analysis of de-identified qualitative data previously obtained for quality improvement purposes via a client satisfaction survey was conducted. Adult patient responses (N = 38) were analyzed via reflexive thematic analysis within a critical realist framework.ResultsFour themes were generated from the data: (1) Embracing one’s humanity paves the way for connection, (2) Discovering a “sense of community” in remote care, (3) “They made me feel I was worth recovering”: connection as a vehicle for healing, and (4) Aligning expectations and reality: reconceptualizing the journey to connection in remote eating disorder care.ConclusionsOverall, findings suggest that it is possible for patients to form strong, impactful connections in remote treatment. Importantly, patient perspectives indicated that there were shifts in how these connections were experienced as a result of the remote care environment (e.g., how support could be provided and by whom). Considerations unique to remote care (e.g., offering training to improve clients’ comfort with technology) may be important to fostering connection, thereby contributing to improved patient experiences and treatment outcomes.

Barriers and Facilitators in Accessing Education in Mainstream Schools for Children with Disabilities in Bangladesh: A Qualitative Secondary Data Analysis

ABSTRACT Promoting access to mainstream schools for children with disabilities has been highlighted in national and international legislative and policy initiatives. However, children with disabilities’ access to mainstream school remains an important challenge, particularly in low and middle-income countries, such as Bangladesh. We explored barriers and facilitators in accessing education for children with disabilities through a secondary analysis of qualitative data. Results indicate that children with disabilities experience challenges in their endeavour to access education, including stigma, discrimination, inaccessible built environment, and teachers’ negative attitudes towards children with disabilities. However, support from different sources, specifically parents’ strong motivation towards their child’s education and peer support, are great facilitators for children with disabilities in accessing education. We conclude with recommendations for support for parents to advocate for the rights of their children with disabilities in mainstream schools. We also recommend that government should invest resources to make mainstream schools disability friendly. In particular, accessible classrooms and washrooms are essential to enable in-class participation of children with disabilities. Further, investment is needed for teachers’ training on teaching disabled children in mainstream schools. A collaborative approach between policymakers, teachers, professionals, and parents is imperative to achieve inclusive education.

Challenges and Threats of Cybercrime in Indonesia: A Review of Legal and Information Technology Aspects Related to Ransomware Attacks on Indonesia’s National Data Center

This article discusses the challenges and threats to cybercrime in Indonesia, focusing on two main aspects—law and information technology. Through an in-depth analysis of the applicable laws and regulations and the development of information technology, this study aims to identify the weaknesses and challenges faced in combating cybercrime in Indonesia. Additionally, this article presents several recommendations for improving the effectiveness of cybercrime threats. This research methodology is based on studies and analyses related to the potential threats and challenges of cybercrime from the aspects of legal and information technology, as described in several modern publications. This study used a qualitative approach and secondary data analysis. Recommendations that can be drawn from this study include the need to improve infrastructure and human resources in the security field and increase investment in training and human resources for law enforcement agencies. This can consist of more intensive training programs in information technology crime, data risk recovery management, coordination and cooperation between the public and private sectors, and adaptation and development of real-time threat-monitoring technology using artificial intelligence.

A Qualitative Examination of Clinician Anxiety about Suicide Prevention and Its Impact on Clinical Practice.

Clinician distress about working with patients at risk for suicide is well documented in the literature, yet little work has examined its pervasiveness across clinical settings. We conducted a secondary analysis of qualitative data gathered from 26 clinicians in primary care and outpatient mental health clinics serving both adult and child clients on their perception of evidence-based practice use for suicide screening, assessment, and brief intervention. Qualitative data were coded for any mentions of clinician anxiety or emotional response, and brief quantitative measures were collected to characterize our sample. When discussing broader barriers to implementation, 85% of participants spontaneously mentioned anxiety or heightened emotional responses related to delivering suicide prevention practices to those at risk for suicide. Common themes included low self-efficacy in suicide prevention skills, distress related to escalating care, efforts to alleviate such distress, and difficulty related to tolerating the uncertainty inherent in suicide prevention work. Similarly, while standardized anxiety ratings for participants were consistent with those of non-clinical norming samples, clinicians reported mild to moderate anxiety when screening for suicide risk (M = 3.64, SD = 2.19, Range = 0-8) and engaging in safety planning (M = 4.1, SD = 2.88, Range = 1-7) on post-interview surveys. In contrast, survey responses reflected generally high self-efficacy in their ability to screen for suicide risk (M = 7.66, SD = 1.29, Range = 5.25-10) and engage in safety planning (M = 8.25, SD = 0.87, Range = 7-9.5). Findings highlight pervasiveness of clinician distress when implementing suicide prevention practices and can inform future suicide prevention implementation efforts.

Intersection between person-centred practice and Montessori for dementia and ageing in residential aged care.

Internationally, person-centred care (PCC) is embedded in the language of regulations and mandated to be practised in residential aged care (RAC). Despite this, PCC has not been fully adopted in RAC in Australia and internationally, and concerns about the quality of care persist. Over the past 2 decades, Montessori for dementia and ageing has been introduced in RAC to support and inform a cultural change towards PCC. This study aimed to examine the intersection between the goals and approaches of Montessori and PCC in RAC. This qualitative descriptive study reports on a secondary analysis of qualitative data from focus groups (FGs) and interviews with residents, family-members, staff, and volunteers from eight RAC homes in Victoria, Australia. Sixteen FGs and 36 interviews were conducted. A qualitative deductive approach using researcher-developed Montessori for dementia and ageing framework for data analysis was applied. Findings provide support for the intersection between PCC and Montessori with participants' descriptions of PCC aligning with many of the goals and approaches of Montessori. Participants most commonly described Montessori approaches of engagement in daily tasks with purposeful roles and promoting cognitive abilities through multi-sensory stimulation. Least frequently-described approaches included focusing on residents' strengths/abilities, maintaining function, using familiar objects, and guided repetition. Findings have important implications for practice to use Montessori as a vehicle that supports and upskills the workforce to deliver care that is person-centred. Future research must examine the resources required to support the implementation and sustainability of Montessori as a vehicle for PCC.

New Modes of Practice: A Framework Analysis of School Nurses' Accounts of Working With Children and Young People During COVID-19.

To identify new and accelerated modes of practice used by school nurses during the COVID pandemic. To create a quick reference infographic bringing together experiential evidence on the range and considerations regarding different modes of practice for use by the school nursing community of practice. A descriptive qualitative secondary data analysis of open-ended questions in a survey, and focus groups with school nurses. The pragmatic aim was to focus on changes in school nurse modes of practice to ensure continued engagement with children and young people, and school nurses' experience of the benefits and challenges of these modes of practice. Data were collected from 98 school nurse participants across a United Kingdom-wide survey (n78) in April to May 2022, and focus groups (n20) in June to July 2022, within the School Nursing in the Time of COVID project. Data from the seven open-ended questions in the survey and four questions from the focus group were analysed using the framework approach. Modes of practice fell into two categories: individual assessment and support (video-calling platforms, telephone contact, virtual messaging, walk-and-talks and home visits) and group support (wellbeing approaches, social media). Considerations for these modes rooted in school nurses' experience are described. Interpretations were used to create the summarising evidence-based infographic as a quick reference resource for school nurses. There was no 'one size fits all' approach. The modes used by school nurses were adopted or developed out of necessity or resource availability and in response to the specific needs of individuals or groups. The developed infographic provides a quick reference guide to deliver the expressed need for knowledge exchange within the school nursing community by participants in the original studies and can be used to inform current school nurse practice. The developed evidence-based infographic has stand-alone value. It has the potential to raise awareness of the range of different strategies that can be used to facilitate and/or enhance engagement with children and young people, equip school nurses with knowledge to foster innovative and responsive practice and aid critical reflection in a complex post-pandemic landscape. The infographic is a unique resource and is a first step in knowledge exchange based on experiential learning. The resource will be used as the foundation for future work to develop a co-created training resource for school nurse students (undertaking the Specialist Community Public Health Nurses course) and/or continuing professional development resource for established school nurses. This study has been conducted and reported in accordance with COREQ guidelines for qualitative research. A consultation group was closely involved with the planning, conduct and analysis of the original studies. This group consisted of representatives from professional organisations SAPHNA (School and Public Health Nurses Association) and the CPHVA (Community Practitioners' and Health Visitors' Association), a school nurse and a member of the public. SAPHNA have continued in their consultative role for this study and has provided content and usability feedback regarding the infographic. Early findings have been presented to the SN community of practice, and feedback invited, through presentation separately at the CPHVA and SAPHNA annual conference.

The impact of technology on Brazilian social work: potentials and challenges in ethical and socio-educational intervention

The integration of technology into Brazilian social work has presented both potentials and challenges. Social workers, historically engaged in socio-educational interventions from various perspectives, have experienced changes in their working conditions and tools due to technological innovations, especially following the COVID-19 pandemic. The analysis presented reveals that while technology provides greater access to information and connections, it can also be used to amplify neoliberal influences, prioritising low-cost intervention methods at the expense of service quality and distancing professionals from the population they serve. Social work must adopt a critical and proactive approach, guided by its ethical-political project, to identify the challenges and possibilities of this process. Ignoring technological advances can lead to a detachment from social reality or submission to institutional and neoliberal demands. Methodologically, a systematic literature review and qualitative analysis of secondary data were employed, guided by contemporary critical perspectives within social work.

Patient lived experiences of functioning and disability following lumbar discectomy: a secondary analysis of qualitative data

BackgroundKnowledge of patient lived experiences of functioning and disability is limited. This study aims to address the gap in the literature by exploring patient lived experiences of functioning and disability following lumbar discectomy.MethodA secondary analysis, reported in line with the Standards for Reporting Qualitative Research, was conducted of qualitative data exploring patient journeys following lumbar discectomy surgery (DiscJourn). Adult patients (≥ 16 years) undergoing elective or emergency primary lumbar discectomy were recruited from one National Health Service secondary care centre in the UK. Semi-structured interviews were conducted at 1–3 weeks and 1-year post surgery. Participants who completed both semi-structured interviews were eligible for the secondary analysis. Transcripts from the semi-structured interviews were analysed using interpretative phenomenological analysis (IPA). IPA involved two independent reviewers identifying themes for individual data sets followed by an iterative process involving the wider research team to identify overarching themes that represented the whole date set. Subthemes generated from the IPA were mapped against the International Classification of Functioning, Disability and Health (ICF) framework at the level of chapters, in order to ascertain the ICF’s utility in capturing experiences of functioning and disability. Strategies to enhance trustworthiness of data analysis included blind coding, peer examination and debrief, declaration of pre-conceived beliefs and active reflexivity throughout the study.ResultsNine participants met the eligibility criteria and their interview transcripts were analysed. Patient lived experiences of functioning and disability were captured by three overarching themes: Immediate impact following surgery, Multiple roads to recovery over 1 year, and Functioning influenced by personal loci of control. Each theme consisted of three subthemes which were subsequently mapped onto the ICF. Three subthemes mapped to the ICF’s body component, 1 to activity and participation and 3 to environment. Two subthemes themes did not map onto the ICF.ConclusionFindings provide valuable insights into patient experiences of functioning and disability following lumbar discectomy. Convergence in experiences of functioning and disability were identified immediately following surgery. Divergence in such experiences were identified with regards to the roads to recovery over 1 year and the individuals’ locus of control. Findings build on the body of literature exploring patients functioning and disability following discectomy and make recommendations for future research and clinical practice.

A - 29 Support for Use of Cognitive Rehabilitation Strategies to Enhance Accessibility of Medications for Opioid Use Disorder Treatment: a Qualitative Secondary Data Analysis

Abstract Objective Despite cognitive rehabilitation paradigms gaining support as adjunctive interventions to opioid use disorder treatments, limited research details strategies that medical providers who prescribe medications for opioid use disorder (MOUD) employ to attend to patient cognitive limitations. We conducted a secondary data analysis to explore this gap in the literature. Method The parent study included individual interviews with 23 MOUD treatment providers from New Mexico and Washington state, and the interview guide centered barriers and facilitators to equitable implementation. A deductive thematic analysis was utilized to identify sources, solutions, and strategies that MOUD providers identified for patients experiencing cognitive impairments. Results Regarding sources of cognitive dysfunction, history of stroke, overdose, severe mental illness, and traumatic brain injury were emphasized. Low health literacy was also identified as a justification to modify approach. Strategies providers utilized fell under five subthemes: visual aids; communication (e.g., repetition; open questions); engaging caregivers; leveraging peer support; and increasing visit frequency. Though less common, some providers emphasized only focusing on substance use and safety. Conclusions There have been calls to better attend to cognitive functioning as a potential moderator of MOUD treatment outcomes; however, existing personalized care guidelines do not address this adequately. The present study revealed variability in clinical decision-making that may exacerbate health inequities among individuals seeking MOUD treatment –a population disproportionately impacted by social determinants of health (e.g., housing; access to healthcare; quality of education). Greater focus on equitable MOUD implementation is needed to explore methods of personalizing care for individuals seeking MOUD treatment presenting with cognitive dysfunction.

Differences in the Use and Perception of Telehealth Across Four Mental Health Professions: Insights From a Secondary Analysis of Qualitative Data.

There is growing evidence that the uptake and use of telehealth is influenced by the distinct specialty area or type of healthcare service provided, with mental health services presenting particular challenges. However, little is known about how telehealth use differs between different mental health professions, and no qualitative research has explored variations in telehealth use and perspectives at the profession level within Australian mental health services. To address this gap, we analyzed transcripts from 19 semi-structured interviews conducted with mental healthcare professionals in a local health district within New South Wales, Australia. A secondary analysis of the data revealed the distinct ways in which different mental health professions perceive and engage with telehealth depending on their specific role and approach to practice. Application of a systems theory lens highlighted the challenges each profession faces at different levels of telehealth engagement, and the macro-systemic power dynamics and hierarchies that shape profession-specific differences in telehealth use.

Experiences of social isolation and loneliness in chronic kidney disease: a secondary qualitative analysis.

Many patients with chronic kidney disease (CKD) experience loneliness and social isolation, which are associated with a higher risk of mortality, morbidity, and poor mental health. We aimed to describe the perspectives of patients with CKD and their caregivers on loneliness and social isolation, to inform strategies to increase social participation. A secondary analysis of qualitative data from the Standardized Outcomes in Nephrology (SONG) initiative dataset (36 focus groups, three Delphi surveys and seven consensus workshops) was conducted. We extracted and thematically analyzed data from patients with CKD, including those receiving hemodialysis or peritoneal dialysis and those with a kidney transplant, as well as their caregivers, on the perspectives and experiences of loneliness and social isolation. Collectively the studies included 1261 patients and caregivers from 25 countries. Six themes were identified: restricted by the burdens of disease and treatment (withdrawing from social activities due to fatigue, consumed by the dialysis regimen, tethered to treatment, travel restrictions); external vulnerability (infection risk, anxiety of dining out); diminishing societal role (grieving loss of opportunities, social consequences of inability to work); fending for oneself in healthcare (no one to relate to, lost in uncertainty, unmet psychosocial needs); undermining self-esteem (unable to engage in activities which previously defined self, shame and self-consciousness about appearance, hindering confidence for intimate relationships); and feeling ostracized (disconnected by family and friends, fear of stigma and being misunderstood, guilt of burdening others). For patients with CKD and their caregivers, social participation is substantially impaired by the burden of CKD and its treatment, and fear of risks to health such as infection. This undermines patient and caregiver mental health, particularly self-esteem and sense of belonging. Additional interventions are needed to improve social connections among people with CKD and their caregivers.

Applying Communication Science to Substance Use Prevention Messaging.

Despite a wealth of evidence-based messaging on youth alcohol and drug prevention, there remains a dearth of research on how to construct and deliver these messages effectively. Communication science is useful for increasing the efficacy of these messages in reducing substance use risk among youth. This study explores the perspectives of youth and youth-serving providers to identify theory-informed substance use prevention messages and strategies and how the content and delivery of prevention messages evolved during the COVID-19 pandemic. This is a secondary analysis of qualitative data derived from focus groups with 53 youth ages 13 to 18 years and 18 youth-serving providers conducted in the USA between 2021 and 2022. The results describe theory-informed strategies that are important to consider when constructing effective substance use prevention messaging for youth, including preferences around key communication framework constructs, including sources, content, channels, and context. An element that emerged across the communication constructs was the saliency of "connection" in youth substance use prevention messaging content. Findings point to the need to further explore connection related to having shared experiences and the extent to which these dimensions are critical ingredients to effective substance use prevention.

Fenomena Kesulitan Generasi Z dalam Mendapatkan Pekerjaan Ditinjau Perspektif Teori Kesenjangan Generasi

This study examines the phenomenon of difficulties faced by Generation Z in obtaining a job, using the perspective of generation gap theory. The purpose of this study is to understand the factors that cause this generation to experience challenges in the job market, as well as to analyze how the differences in values, skills, and expectations between Generation Z and previous generations contribute to these difficulties. Through a qualitative approach and secondary data analysis, the study found that a significant generation gap in terms of in-demand skills, career expectations, and adaptation to technological changes plays a major role in this issue. These findings are expected to provide insights for policymakers, companies, and educational institutions to develop more effective strategies in bridging the gap and increasing employment opportunities for Generation Z.

Colour-evasive racial ideologies underpinning the hidden curriculum of a majority-minority occupational therapy school in London, England: an analysis of minoritised undergraduate students’ experiences

ABSTRACT The concept of ethnoracial ‘majority-minority’ was introduced to describe changing population demographics where racial or ethnic groups traditionally in the majority have become a numerical minority. Despite their increase in recent years, very little is known of how hidden curricula manifests in these settings. Hence, this study sought to interrogate the hidden curriculum of race at an Occupational Therapy school with a majority-minority student-educator population in London, England. We conducted a secondary analysis of qualitative data from a larger action research project. The main data source was derived from two group interviews involving 11 racially minoritised student participants, and thematically analysed through a hidden curriculum lens. Trustworthiness of the analysis was enforced through crystallisation. The hidden curriculum of race was identified as embedded within (1) formal learning, (2) the null curriculum, (3) the informal curriculum, and (4) administrative structure and functioning. It is underpinned by pervasive colour-evasive racial ideologies which perpetuate health and workforce inequities. This paper concludes that majority-minority population demographics are insufficient to mitigate the impact of wider societal norms of oppression on hidden curricula. Thus, concerted and collective efforts involving all professional stakeholders are needed to embed intersectional, critical race-conscious approaches throughout formal learning across the academic curriculum.

“GO AND GET IT CHECKED”: EXPLORING THE DECISION TO ATTEND THE EMERGENCY DEPARTMENT FOR LOW BACK PAIN

Purpose and backgroundLow back pain burdens individuals, society and services, including Emergency Departments (ED), straining services and prolonging wait times. Despite reported personal influences on deciding to attend ED, the role of third-party advice remains underexplored. Sparse guidance for clinicians and service-users highlights the need for effective back pain management strategies, to alleviate system pressure and optimise patient outcomes. This study explored how advice influences the decision to attend the ED for back pain.Methods and ResultsFrom a subtle realist stance, the design was a secondary analysis of qualitative data, where 47 patients (26M:21F, aged 23–79 years) with back pain were purposively sampled from four EDs (2 Northern and 2 Southern) in England between August and December 2021. Eight patients had previously visited ED for this episode of back pain. As this was during the pandemic, semi-structured interviews were conducted online, audio-recorded, transcribed verbatim and analysed using a reflective thematic analysis.Three themes were identified as crucial in making the decision to attend ED: The Healthcare professional; Trusted others; and the Individual. Healthcare professionals often dictated decisions, leaving participants feeling powerless. Trusted others provided varying support levels, often acting as allies. Individuals grappled with anxieties around their condition and treatment expectations.ConclusionThis study highlights the need for clinicians to provide clarity and guidance to individuals and their Trusted others, seeking advice regarding escalation to visit the ED with back pain. There was evidence that worrying about pain was a significant motivator for attending ED, resulting in malalignment with current practice guidelines.No conflicts of interest Sources of fundingFunding for primary data: Health Education England & National Institute of Health and Care Research (ICA-CDRF-2018-04-ST2-040)

Comparative Analysis of Social Enterprise Development: A Case Study of Cambodia and Indonesia

Social enterprises have become a viable solution for tackling urgent social and environmental issues in developing economies. These organizations combine business strategies with a mission to generate positive social impact, particularly in areas that are often overlooked by traditional for-profit and government initiatives. Social entrepreneurship in the Southeast Asian Nations (ASEAN) region is gaining recognition as a means to address the growing income inequality and environmental degradation and empower women and girls. This study aims to investigate the social enterprise concept in Indonesia and Cambodia, with a specific emphasis on the legislation, operational model, and societal impact of these enterprises. The study employed a qualitative secondary data analysis through the search of existing literature related to social enterprise in both countries. The comparative examination of social businesses in Cambodia and Indonesia reveals shared impacts and diverse characteristics shaped by their socioeconomic and institutional contexts. Both nations possess social businesses that tackle social and environmental issues, foster job creation, strengthen communities, enhance the status of women, and safeguard cultural heritage. Disparities in priority areas, support systems, and economic contributions underscore the necessity to adapt social enterprise models to individual country situations. The study implies that key factors

From the periphery to inclusion within the health system: promoting community health worker empowerment as a way forward

BackgroundCommunity health worker programmes have the potential to contribute critically towards universal health coverage. However, CHWs globally have often continued to operate on the periphery of the health care system, viewed as a non-essential cadre. This results in a workforce that often remains disempowered and under-supported. This paper presents evidence from a study conducted in a rural part of South Africa, to better understand issues of CHW prioritisation, integration, and empowerment.MethodsWe applied an analytical lens based on empowerment theory and conducted a secondary analysis of qualitative data emerging from a sub-study of a cRCT evaluating the effectiveness of supportive supervision for CHWs within a large-scale national CHW programme. The cRCT was conducted between 2017 and 2022, and 39 CHWs were included in the study.ResultsWe organised our findings across the four domains of structural empowerment; information, resources, support, and opportunity, and mapped these domains against the domains of psychological empowerment. Our findings show how CHWs are still working in the periphery of the healthcare system. Without sufficient prioritisation, high level-support from national and district governments, and sufficient investments in programmatic domains—such as training, equipment, and supportive supervision—it is likely that the CHW cadre will continue to be seen as informal health care workers.ConclusionsCHW empowerment could be a lever to potentially transform the current health system towards universal coverage; however, this process can only happen with sufficient high-level prioritization and investment.

Integrated group antenatal and pediatric care in Haiti: A comprehensive care accompaniment model.

The J9 Plus (J9) maternal-child accompaniment program is based on four pillars: group antenatal care (GANC), group pediatric care, psychosocial support, and community-based care. We aimed to evaluate the impact of the J9 model of care on perinatal outcomes. We conducted a convergent mixed methods study of maternal-newborn dyads born in 2019 at Hôpital Universitaire de Mirebalais. Quantitative data was collected retrospectively to compare dyads receiving J9 care to usual care. A secondary analysis of qualitative data described patient perspectives of J9 care. Antenatal care attendance was significantly higher among women in J9 (n = 524) compared to usual care (n = 523), with 490(93%) and 189(36%) having >4 visits, respectively; p <0.001, as was post-partum visit attendance [271(52%) compared to 84(16%), p<0.001] and use of post-partum family planning methods [98(19%) compared to 47(9%), p = 0.003]. Incidence of pre-eclampsia with severe features was significantly lower in the J9 group [44(9%)] compared to the usual care group [73(14%)], p <0.001. Maternal and neonatal mortality and low birth weight did not differ across groups. Cesarean delivery [103(20%) and 82(16%), p<0.001] and preterm birth [118 (24%)] and 80 (17%), p <0.001] were higher in the J9 group compared to usual care, respectively. In the qualitative analysis, ease of access to high-quality care, meaningful social support, and maternal empowerment through education were identified as key contributors to these outcomes. Compared to usual care, the J9 Plus maternal-child accompaniment model of care is associated with increased engagement in antenatal and postpartum care, increased utilization of post-partum family planning, and lower incidence of pre-eclampsia with severe features, which remains a leading cause of maternal mortality in Haiti. The J9 accompaniment approach to care is an empowering model that has the potential to be replicated in similar settings to improve quality of care and outcomes globally.

A Mixed Methods Study Exploring Patient Safety Culture at Four VHA Hospitals

BackgroundThe Veterans Administration (VHA) launched an enterprise-wide High Reliability Organization (HRO) transformation effort in February 2019. Yet, many gaps exist in understanding the mechanisms through which HROs achieve positive outcomes. The goal of this paper is to assess content validity of Patient Safety Culture (PSC) scale through a secondary analysis of qualitative data collected from four purposively sampled VHA hospitals concurrently with the employee survey administered in 2019-2020. Methods: We used a concurrent triangulation mixed methods design secondary analysis of the qualitative data collected between 2019-2020 from a larger study that focused on understanding HRO implementation efforts at 4 of the 18 VHA HRO lead hospitals. We combined qualitative data from our summary qualitative reports with quantitative ratings in a cross-hospital matrix to explore the extent and manifestation of each of the PSC factors. Results: Scores were significantly different between the 4 hospitals for all four PSC factors. Twelve of the twenty PSC items (60%) significantly differed across the 4 hospitals. Despite the high rate of statistically significant differences in PSC scores, many differences were small. Qualitative data revealed supporting evidence for 16 of 20 PSC individual items, suggesting good coverage and content validity for the quantitatively derived PSC factors. Conclusions: PSC is a central pillar of HRO maturity. This study shows a newly developed VHA PSC factor had good content validity based on a mixed methods analysis. Future research is needed to better understand the relationship of PSC factors to HRO process and clinical outcomes.

CRISIS MANAGEMENT IN THE DIGITAL AGE

This study explores the impact of digital technologies on crisis management through a qualitative analysis of secondary data, including literature, reports, and case studies. Findings reveal that social media facilitates rapid information dissemination and real-time engagement, while data analytics enable proactive monitoring and crisis prediction. The study also highlights the role of transparency in fostering public trust and the challenges posed by misinformation. The analysis includes insights from Uzbekistan's digital transformation, emphasizing the need for continuous adaptation in crisis management practices.