Semi-structured Interview Guides Research Articles

Information needs of informal caregivers in caring and rehabilitation for dioxin victims in Vietnam

BackgroundHealth outcomes among Agent Orange/dioxin (dioxin) victims are significant due to many individuals requiring daily assistance, informal care, and rehabilitation support. This study aimed to identify the information needs of informal caregivers of dioxin victims in Vietnam.MethodsA cross-sectional study was conducted in Quynh Phu district, Thai Binh province – an area with a large number of dioxin victims, from June 2019 to June 2020. Quantitative data were collected from 124 caregivers of victims via structured interviews. Qualitative data were collected using semi-structured interview guides with in-depth interviews (IDI) (n = 36) and two focus group discussions (FGD) (n = 12).ResultsThe results demonstrated that all caregivers of dioxin victims were family members, predominantly older (71.8%), 61.5 years old on average, living on low incomes (87.9%), and were farmers (80.7%). Almost all participants (96.8%) reported having information needs, particularly concerning dioxin’s harms, nutrition, dioxin-related policies and rehabilitation, and psychological support for patients. Caregivers reported that they would like to receive information via health staff counselling (85.0%), television (75.0%), and community loudspeaker (65.8%). Notably, the majority of caregivers reported the need for information regarding psychological support (70.0%). These findings are consistent with qualitative data, which identify an urgent need to provide information, especially through health staff and digital resources.ConclusionMany families with dioxin victims lived with little support and information, highlighting their high demand for information about care and rehabilitation. Thus, the healthcare system should promote information support, policy, and psychological support for caregivers and victims. An online support system for caregivers and victims is also recommended.

Medical imaging consultation practices and challenges at public hospitals in the Amhara regional state, Northwest Ethiopia: a descriptive phenomenological study

BackgroundMedical imaging plays a vital role in the accurate diagnosis, treatment and outcome prediction of many diseases and injuries. However, in many African countries, deserving populations do not have access to the proper medical imaging specialists’ services. As a result, clinicians continue to struggle to provide medical imaging via consultation. However, little is known about conventional referral consultation practices and their challenges. This study, therefore, aimed to explore the practice and challenges of medical imaging service consultation among health professionals and patients in the context of the Ethiopian public healthcare delivery system.MethodsDescriptive phenomenological study was employed to explore the practice of medical imaging service consultation among health professionals and patients in public hospitals of Amhara region from October 12, 2021 to December 29, 2021. Semi-structured interview guides were prepared separately for key-informant and in-depth interviews. A total of 21 participants (6 hospital managers, 4 medical directors, 4 department heads, 3 medical imaging coordinators and 4 patients) were selected using the maximum variation sampling technique. All interviews were audio-recorded, transcribed verbatim and subjected to inductive thematic analysis using Open Code 4.02 software.ResultsSix major themes emerged following the thematic analysis: (1) medical image service delivery practices; (2) medical imaging consultation modalities; (3) benefits and drawbacks of the consultation modalities; (4) challenges; (5) challenge mitigation strategies; and (6) future recommendations. Image films, compact disks, and telegram apps were the consultation modalities used by the referring clinicians to send the medical images to radiologists. Frequent failure of imaging machines, delayed equipment maintenance, inadequate infrastructure, shortage of budget, lack of radiologists, and low-quality of printed image films were among the challenges influencing the medical imaging consultation service.ConclusionsThis research explored onsite and referral imaging consultation practices. However, there are many challenges encountered by the referring clinicians and the radiologists during the consultation process. These challenges could potentially affect clinicians’ ability to provide timely diagnosis and treatment services which would ultimately affects patient health status and service delivery. Virtual consultation via teleradiology and enhancing clinicians’ competence through long-term and short-term trainings are recommended to improve the referral consultation practice.

The intersection of drug use discrimination and racial discrimination in the management of chronic non-cancer pain in United States primary care safety-net clinics: Implications for healthcare system and clinic-level changes

BackgroundClinicians’ bias related to patients’ race and substance use history play a role in pain management. However, patients’ or clinicians’ understandings about discriminatory practices and the structural factors that contribute to and exacerbate these practices are underexamined. We report on perceptions of discrimination from the perspectives of patients with chronic non-cancer pain (CNCP) and a history of substance use and their clinicians within the structural landscape of reductions in opioid prescribing in the United States. MethodsWe interviewed 46 clinicians and 94 patients, using semi-structured interview guides, from eight safety-net primary care clinics across the San Francisco Bay Area from 2013 to 2020. We used a modified grounded theory approach to code and analyze transcripts. ResultsClinicians discussed using opioid prescribing guidelines with the goals of increased opioid safety and reduced bias in patient monitoring. While patients acknowledged the validity of clinicians’ concerns about opioid safety, they indicated that clinicians made assumptions about opioid misuse towards Black patients and patients suspected of substance use. Clinicians discussed evidence of discrimination in opioid prescribing at the clinic-wide level; racialized stereotypes about patients likely to misuse opioids; and their own struggles to overcome discriminatory practices regarding CNCP management. ConclusionWhile clinicians and patients acknowledged opioid safety concerns, the practical application of opioid prescribing guidelines impacted how patients perceived and engaged with CNCP care particularly for patients who are Black and/or report a history of substance use. We recommend healthcare system and clinic-level interventions that may remediate discriminatory practices and associated disparities.

The role of nurse-client relationships in maternal and child healthcare: a qualitative study in rural Tanzania.

The literature suggests that poor provider-client relationships in maternal and child healthcare (MCH) continue to impact healthcare service uptake, continuity of care, and MCH outcomes. However, there is a paucity of literature on the benefits of the nurse-client relationship for clients, nurses, and the health system, particularly in rural African contexts. This study examined the perceived benefits and disadvantages of good and poor nurse-client relationships in rural Tanzania respectively. We present the findings of a community-driven inquiry that was the first step of a broader study that sought to co-design an intervention package for strengthening nurse-client relationships in MCH in rural contexts using a human-centred design approach. This study used a qualitative descriptive design. Nine focus group discussions and 12 key informant interviews were conducted using semi-structured interview guides. Participants were purposefully selected nurses/midwives and clients attending MCH services, and MCH administrators. Data were managed using NVivo and analysed thematically. A range of perceived benefits of good nurse-client relationships and disadvantages of poor relationships emerged. Perceived benefits of good nurse-client relationships included: (i) benefits to clients (increased healthcare-seeking behaviours, disclosure, adherence, return to care, positive health outcomes, and referral tendencies); (ii) benefits to nurses (increased confidence, efficiency, productivity, job satisfaction, trust, and community reputation and support); and (iii) benefits to healthcare facilities/systems (increased client load and consequently income, fewer complaints and legal disputes, increased trust and facility delivery, and reduced maternal and child deaths). The disadvantages of poor nurse-client relationships were basically the opposite of their benefits. The benefits of good nurse-client relationships and the disadvantages of poor relationships extend beyond patients and nurses to the healthcare system/facility level. Therefore, identifying and implementing feasible and acceptable interventions for nurses and clients could pave the way for good nurse-client relationships, leading to improved MCH outcomes and performance indicators.

Challenges Locating the Scene of Emergency: A Qualitative Study of the EMS System in Rwanda

Background Timely prehospital emergency care significantly improves health outcomes. One substantial challenge delaying prehospital emergency care is in locating the patient requiring emergency services. The goal of this study was to describe challenges emergency medical services (EMS) teams in Rwanda face locating emergencies, and explore potential opportunities for improvement. Methods Between August 2021 and April 2022, we conducted 13 in-depth interviews with three stakeholder groups representing the EMS response system in Rwanda: ambulance dispatchers, ambulance field staff, and policymakers. Semi-structured interview guides covered three domains: 1) the process of locating an emergency, including challenges faced; 2) how challenges affect prehospital care; and 3) what opportunities exist for improvement. Interviews lasted approximately 60 min, and were audio recorded and transcribed. Applied thematic analysis was used to identify themes across the three domains. NVivo (version 12) was used to code and organize data. Results The current process of locating a patient experiencing a medical emergency in Kigali is hampered by a lack of adequate technology, a reliance on local knowledge of both the caller and response team to locate the emergency, and the necessity of multiple calls to share location details between parties (caller, dispatch, ambulance). Three themes emerged related to how challenges affect prehospital care: increased response interval, variability in response interval based on both the caller’s and dispatcher’s individual knowledge of the area, and inefficient communication between the caller, dispatch, and ambulance. Three themes emerged related to opportunities for processes and tools to improve the location of emergencies: technology to geolocate an emergency accurately and improve the response interval, improvements in communication to allow for real-time information sharing, and better location data from the public. Conclusion This study has identified challenges faced by the EMS system in Rwanda in locating emergencies and identified opportunities for intervention. Timely EMS response is essential for optimal clinical outcomes. As EMS systems develop and expand in low-resource settings, there is an urgent need to implement locally relevant solutions to improve the timely locating of emergencies.

Adult characteristics, skills, and approaches that facilitate supportive relationships with youth: A qualitative investigation of Sources of Strength

IntroductionSources of Strength is a universal prevention program for youth that provides tools and educational opportunities to promote wellness and reduce risk. A major aim of Sources is to build youth-adult relationships to support youth in times of distress. However, no study to date has investigated how adults effectively build relationships with youth despite this being critical to successful implementation of Sources. The present study explores both student and staff perspectives of what characteristics, skills, and approaches encourage the development of supportive student-adult relationships to inform efforts for successful intervention implementation. MethodsThis qualitative supplement to a Randomized Controlled Trial (RCT) of Sources, recruited 23 students in grades 9 to 12 for individual interviews and 11 staff members for focus groups from 2 high schools implementing the intervention. Semi-structured interview guides were used, and emergent themes were identified through process and pattern coding. ResultsKey facilitators of supportive and effective adult-youth relationships included perceptions of adults as approachable, caring, encouraging, and understanding. Successful adult advisors used humor and were perceived as invested and engaged in the lives of youth. Maintaining accountability for youth, balanced with intervention and provision of resources additionally emerged as a critical factor supporting positive relationships with youth. Sources itself emerged as a catalyst for the growth of these positive and supportive youth-adult relationships. ConclusionsTrusted adults are instrumental as both operators within prevention programs targeting young people and as facilitators in adult-youth relationships through leveraging key skills and approaches. These findings can inform quality implementation of interventions, like Sources, that embed adult-youth connections as a central feature of the program model.

Barriers and Facilitators to Implementing a Digital Adherence Technology for Tuberculosis Treatment Supervision in Uganda: Qualitative Study.

Ensuring the completion of treatment for tuberculosis (TB) remains a key challenge in many high-burden countries. 99DOTS is a low-cost digital adherence technology that has emerged as a promising tool for monitoring and supporting TB treatment completion. We aimed to understand the feasibility and acceptability of 99DOTS, a mobile phone-based TB treatment support method, and characterize barriers and facilitators to its implementation during a pragmatic trial in Uganda. Between April 1 and August 31, 2021, we conducted in-depth interviews with people with TB and key informant interviews with health workers and district and regional TB officers involved in the implementation of 99DOTS at 18 health facilities in Uganda. Semistructured interview guides were informed by the capability, opportunity, motivation, and behavior (COM-B) model and explored perceptions of, and experiences with, 99DOTS, including barriers and facilitators to its use. Qualitative analysis was conducted using the framework approach. Interviews were conducted with 30 people with TB, 12 health workers, and 7 TB officers. All people with TB, health workers, and TB officers noted that 99DOTS supported and encouraged people with TB to take their anti-TB medication, facilitated treatment monitoring, and improved relationships between people with TB and health workers. Participants also liked that the platform was free, easy to use, and improved TB treatment outcomes. Barriers to 99DOTS implementation for some people with TB were related to limited literacy, including technology literacy; limited access to electricity to charge their mobile phone to make dosing confirmation calls; and poor network connection. Gender differences in 99DOTS uptake also emerged. Specifically, women with TB were described to be more concerned that 99DOTS use would expose them to TB stigma and to be more likely to have mobile phone-access issues than men with TB. By contrast, men with TB not only had access to mobile phones but also received substantial support from their female partners to take their anti-TB medication and make 99DOTS dosing confirmation calls. Finally, although women with TB were described to face more barriers to 99DOTS use than men with TB, the women's narratives centered on the ways the platform facilitated and improved their adherence, whereas the men's narratives did not. Overall, 99DOTS seems to be a feasible and acceptable strategy to support anti-TB medication adherence in Uganda. However, access to mobile phones, inability to charge mobile phones, and concerns about stigma should be considered and addressed as part of programmatic implementation to maximize uptake among all people with TB, particularly women and those with fewer financial resources.

Understanding the medication experience of patients with advanced non-small cell lung cancer taking epidermal growth factor receptor-tyrosine kinase inhibitors: A phenomenological study.

Patients with cancer taking oral antineoplastic medications may encounter problems including suboptimal adherence as well as physical and psychological disease burden. Despite increase in the use of oncology pharmacy services, there are wide variations between healthcare professionals and patient perceptions of patients' medication experiences. The objective of the study was to explore the medication experience of taking oral targeted therapy in patients with advanced non-small cell lung cancer (NSCLC). We purposively sampled advanced stage (stage III or IV) NSCLC patients taking epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) in a medical center in Taiwan. Face-to-face interviews using semi-structured interview guides were conducted. Interviews were transcribed verbatim and thematic analysis was applied. A phenomenological methodology was adopted to explore the underlying meaning of patients' lived experience. A total of 19 participants with a mean age of 68.2 years were interviewed. The duration of EGFR-TKIs use ranged from 2 weeks to 5 years. When first learned about the unexpected yet 'treatable' cancer, participants expressed strong emotional responses based on their intrinsic beliefs of the terminal disease and therapy. They walked along an unfamiliar trail while confronting physical and psychological challenges and made compromises to treatment. Gaining experiences from cancer journey, patients with cancer continuously seek the ultimate goals-'return to normal'. This study also revealed medication experiences of participants' journey from seeking information in the initial phase and living with cancer, to taking back control of their own lives. Healthcare professionals could better empathize with patients' loss of control and understand their perspectives when making clinical decisions. These findings can guide interdisciplinary teams to integrate patients' beliefs and conduct pre-screening assessments of health literacy levels to tailor communication. Subsequent interventions should be developed to identify barriers to medication self-management and empower patients by building social networks.

Clinicians' perceptions of family involvement in the treatment of persons with psychotic disorders: a nested qualitative study.

Family involvement in mental health care ranges from basic practices to complex interventions such as Family psychoeducation, the latter being a well-documented treatment for psychotic disorders. The aim of this study was to explore clinicians' perceptions of the benefits and disadvantages of family involvement, including possible mediating factors and processes. Nested in a randomised trial, which purpose was to implement Basic family involvement and support and Family psychoeducation in Norwegian community mental health centres during 2019-2020, this qualitative study is based on eight focus groups with implementation teams and five focus groups with ordinary clinicians. Using a purposive sampling strategy and semi-structured interview guides, focus groups were audio-recorded, transcribed verbatim, and analysed with reflexive thematic analysis. Four main themes were identified as perceived benefits: (1) Family psychoeducation-a concrete framework, (2) Reducing conflict and stress, (3) A triadic understanding, and (4) Being on the same team. Themes 2-4 formed an interconnected triad of mutually reinforcing elements and were further linked to three important clinician-facilitated sub-themes: a space for relatives' experiences, emotions and needs; a space for patients and relatives to discuss sensitive topics and an open line of communication between clinician and relative. Although far less frequent, three main themes were identified as perceived disadvantages or challenges: (1) Family psychoeducation-occasional poor model fit or difficulties following the framework, (2) Getting more involved than usual, and (3) Relatives as a potentially negative influence-important nonetheless. The findings contribute to the understanding of the beneficial processes and outcomes of family involvement, as well as the critical role of the clinician in achieving these and possible challenges. They could also be used to inform future quantitative research on mediating factors and implementation efforts.

Adolescent, caregiver and provider perspectives on tuberculosis treatment adherence: a qualitative study from Lima, Peru

ObjectivesTo understand the perspectives of adolescents (10–19 years old), their caregivers and healthcare providers regarding factors that impact adherence to tuberculosis (TB) treatment among adolescents.DesignWe conducted in-depth interviews using semistructured...

Impact of ethnobiology-based instruction and peer tutoring on the achievement of senior secondary school biology students in Ogun state southwest Nigeria

This study investigated the impact of Ethnobiology-Based instruction Peer Tutoring on Achievement of Senior Secondary School Biology Students in Ogun State. The study employed Explanatory sequential mixed-methods approach. The quantitative approach was quasi experimental pretest-posttest non-equivalent group design. Three research questions and one hypothesis was formulated to guide the study. The population of the study comprised of all Biology students in public Senior Secondary Schools in Abeokuta zone. Purposive sampling technique was used to select six Public Schools from two zones (Abeokuta South and Abeokuta North). Biology students in six intact classes of SSS III took part in the study. The sample size of 313 biology students with 101 students in the experimental group 1 (48 male and 53 female), 117 students in the experimental group 2 (57 male and 60 female) and 95 students in control group (38 male and 57 female) which were taught the same biology content for a period of four weeks. The experimental groups received instructions through the use of Ethnobiology-Based Instruction and Peer Tutoring while the control group was taught using lecture method. The data gathering instruments were Biology Achievement Test (BAT) and Students Semi-structured Interview Guide (SSIG). The reliability coefficient of the BAT was established using test- retest and yielded 0.87. Descriptive statistics in form of mean, standard deviation and histogram plot were used to answer the research question while the hypothesis was tested using ANCOVA at 0.05 level of significance. The inferential analysis of hypothesis one has a significant difference on Students’ academic achievement in Biology (F (2,309) = 386.85; p < 0.05), this indicated that the hypothesis is hereby rejected since a significant difference is obtained. The results from the study revealed that the treatments positively improved the academic achievements of students and the students taught using ethnobiology-based instruction had higher test result and outperformed those in Peer Tutoring and lecture method group, but the students in Peer tutoring group also performed better than those in lecture method group. This implies that Ethnobiology-Based instruction is more effective in enhancing Students’ performance in biology and it helps to break barriers to meaningful learning of biology. Based on the findings of this study, it was recommended that Biology teachers should relate learning to students’ cultural views and encourage peer tutoring.

Participation, challenges and needs in children with down syndrome during cancer treatment at hospital: a qualitative study of parents' experiences.

Studies report that it can be challenging to assess and treat side-effects and symptoms among children who have impairments and difficulties in expressing their needs. Children with Down syndrome have an increased vulnerability and an increased risk for contracting leukaemia. There is sparse knowledge about the parental experience of how treatment and side-effects affect children with Down syndrome with leukaemia, as well as the role of participation during treatment. This study aimed to explore the perceptions of parents of children with Down syndrome and leukaemia regarding their child's treatment, side effects and participation during hospital care. A qualitative study design was used, and interviews were conducted with a semi-structured interview-guide. Fourteen parents of 10 children with Down syndrome and acute lymphoblastic leukaemia from Sweden and Denmark, 1-18 years of age, participated. All children had completed therapy or had a few months left before the end of treatment. Data was analysed according to qualitative content analysis. Four sub-themes were identified: (1) Continuously dealing with the child's potential susceptibility; (2) Confidence and worries regarding decisions related to treatment regulation; (3) Challenges in communication, interpretation, and participation; and (4) Facilitating participation by adapting to the child's behavioural and cognitive needs. The sub-themes were bound together in an overarching theme, which expressed the core perception "Being the child's spokesperson to facilitate the child's participation during treatment". The parents expressed this role as self-evident to facilitate communication regarding the needs of the child, but also regarding how the cytotoxic treatment affected the vulnerable child. Parents conveyed the struggle to ensure the child's right to receive optimal treatment. The study results highlight parental challenges regarding childhood disabilities and severe health conditions, as well as communication and ethical aspects regarding to act in the best interests of the child. Parents played a vital role in interpreting their child with Down syndrome. Involving parents during treatment enables a more accurate interpretation of symptoms and eases communication and participation. Still, the results raise questions regarding issues related to building trust in healthcare professionals in a context where medical, psychosocial and ethical dilemmas are present.

A socioecological qualitative analysis of barriers to care in colorectal surgery

BackgroundAlthough specific social determinants of health have been associated with disparities in surgical outcomes, there exists a gap in knowledge regarding the mechanisms of these associations. Gaining perspectives from multiple socioecological levels can help elucidate these mechanisms. Our study aims to identify social determinants of health that act as barriers or facilitators to surgical care among colorectal surgery stakeholders. MethodsWe recruited participants representing 5 socioecological levels: patients (individual); caregivers/surgeons (interpersonal); and leaders in hospitals (organizational), communities (community), and government (policy). Patients participated in focus groups, and the remaining participants underwent individual interviews. Semistructured interview guides were used to explore barriers and facilitators to surgical care at each socioecological level. Transcripts were analyzed by 3 coders in an inductive thematic approach with content analyses. The intercoder agreement was 93%. ResultsSix patient focus groups (total n = 18) and 12 key stakeholder interviews were conducted. The mean age of patients was 54.7 years, 66% were Black, and 61% were female. The most common diseases were colorectal cancer (28%), inflammatory bowel disease (28%), and diverticulitis (22%). Key social determinants of health impacting surgical care emerged at each level: individual (clear communication, mental stress), interpersonal (provider communication and trust, COVID-related visitation restrictions), organizational (multiple forms of contact, quality educational materials, scheduling systems, discrimination), community (community and family support and transportation), and policy (charity care, patient advocacy organizations, insurance coverage). ConclusionKey social determinants of health-impacting care among colorectal surgery patients emerged at each socioecological level and may provide targets for interventions to reduce surgical disparities.

Elementary School Teachers Development of a Sense of Community in the Workplace through the Participation in a Fitness and Mindfulness Program

Introduction: Stress and burnout continue to have negative impacts on teachers. Wellness programs have reported to help improve teachers’ quality of life, social life, reduce stress, and increase awareness of healthy choices. The purpose of this paper is to explore teachers’ perceptions and experiences of a fitness and mindfulness program. Methods: Semi-structured interview guides were used in the three separate focus groups that were conducted following each of the three 9-week fitness and mindfulness programs serving as an intervention for elementary school teachers to reduce stress. Focus groups included all female participants between the ages of 22-64 years old with one to 21 years of experience in the classroom. The data were analyzed using thematic analysis. Results: Two themes and subsequent themes were found: (1) work-life balance (subthemes: Implementing mindfulness techniques; Feeling ok leaving work; Self-care) and (2) building community (subthemes: Developed community; Accountability; and Level of comfort). Conclusions: The finding revealed that teachers improved their work-life balance through self-care, implementation of mindfulness techniques, accountability, and comfort with co-workers. The participants reported developing a workplace community. Overall, the results support that elementary teachers perceived a 9-week fitness and mindfulness program to have a positive impact on workplace wellbeing.

The perspective of top management towards human capital measurement and disclosure in the Zimbabwean mining sector

Purpose: This study is set out to establish the perceptions of the Zimbabwean top management concerning the measurement and disclosure of human capital in the financial statements of listed mining companies. This study has been prompted by the fact that despite companies considering human capital as an important resource that drives value, and competitiveness and contributes to a company’s economic growth, its value remains not properly accounted for in the financial statements. This implies that human capital is not being accorded the importance it deserves in the financial statements. Methodology: This study adopted a qualitative research approach. Qualitative data were collected using semi-structured interview guides from the six largest Zimbabwean-based mining companies. The collected qualitative data was analysed through the thematic analysis process and the results established four main themes. Findings: Obtained results reveal that top management agreed that top management is of the view that human capital has a strong relationship with the value of a company and its financial performance. They also indicated that the value of a company, its competitiveness, and economic growth is largely dependent on employee competencies (skills and expertise). Recommendations: After a synthesis of results, this study suggests a context-based framework offering human capital metrics for enhancing its measurement and disclosure practices. This will help to provide a better valuation of human capital in the financial statements and also various stakeholders will be able to derive useful information for decision-making. Managerial Implications: The study gives more insight into the major roles played by the phenomenon in the achievement of companies’ strategic objectives which include value creation among others. Furthermore, it provides a better internal understanding from top management on how the companies gain competitive advantage and economic growth in the era of the fourth industrial revolution through utilisation of human capital. From the aforementioned, chances are high that the human capital reporting by the mining companies in Zimbabwe will be enhanced forthwith.

Household Energy Conservation Practices Used in Chalimbana Ward, Chongwe District

Energy conservation is a subject that has continued to attract global attention as it essential in ensuring that the growing energy demand does not pose a threat to the environment. In view of this, the aim of this study was to find out the household energy conservation practices used in Chalimbana ward of Chongwe district, Zambia. The study adopted a convergent mixed method research design. Qualitative data from 10 purposively sampled key informants was collected through in-depth-interviews using semi-structured interview guides. Additionally, quantitative data from 175 households selected through cluster sampling technique was collected using a questionnaire. The qualitative data was analysed though content analysis whereas quantitative data was analysed through descriptive statistics and multiple linear regression. The study found that most households in Chalimbana ward depend on traditional biomass energy (Charcoal and firewood). Through multiple linear regression, the study found that expenditure on household energy consumption in the study area is influenced is influenced by social economic factors such as family size, house size and education. To conserve energy, the households in this area use a variety of conservation methods of which the most used involves switching or putting off unused household energy appliances or sources. The energy used among these households causes air pollution, habitat loss, land use change, exposure to hazardous waste among other environmental atrocities While the study findings show that households in Chalimbana ward do practice energy conservation, this is not done at a substantive level that can yield sustainable environmental, economic and social benefits of household energy conservation.

A national qualitative investigation of the impact of service change on doctors’ training during Covid-19

BackgroundThe Covid-19 crisis sparked service reconfigurations in healthcare systems worldwide. With postgraduate medical education sitting within these systems, service reconfigurations substantially impact trainees and their training environment. This study aims to provide an in-depth qualitative understanding of the impact of service reconfiguration on doctors’ training during the pandemic, identifying opportunities for the future as well as factors that pose risks to education and training and how these might be mitigated.MethodsQualitative parallel multi-centre case studies examined three Trusts/Health Boards in two countries in the United Kingdom. Data were collected from online focus groups and interviews with trainees and supervisors using semi-structured interview guides (September to December 2020). A socio-cultural model of workplace learning, the expansive-restrictive continuum, informed data gathering, analysis of focus groups and coding.ResultsSixty-six doctors participated, representing 25 specialties/subspecialties. Thirty-four participants were male, 26 were supervisors, 17 were specialty trainees and 23 were foundation doctors. Four themes described the impact of pandemic-related service reconfigurations on training: (1) Development of skills and job design, (2) Supervision and assessments, (3) Teamwork and communication, and (4) Workload and wellbeing. Service changes were found to both facilitate and hinder education and training, varying across sites, specialties, and trainees’ grades. Trainees’ jobs were redesigned extensively, and many trainees were redeployed to specialties requiring extra workforce during the pandemic.ConclusionsThe rapid and unplanned service reconfigurations during the pandemic caused unique challenges and opportunities to doctors’ training. This impaired trainees’ development in their specialty of interest, but also presented new opportunities such as cross-boundary working and networking.

Experience of living with multimorbidity and health workers perspectives on the organization of health services for people living with multiple chronic conditions in Bahir Dar, northwest Ethiopia: a qualitative study

BackgroundMultimorbidity-the simultaneous occurrence of two or more chronic Non-Communicable Diseases) in an individual is increasing globally and challenging health systems. Although individuals living with multimorbidity face a range of adverse consequences and difficulty in getting optimal health care, the evidence base in understanding the burden and capacity of the health system in managing multimorbidity is sparse in low-and middle-income countries (LMICs). This study aimed at understanding the lived experiences of patients with multimorbidity and perspective of service providers on multimorbidity and its care provision, and perceived capacity of the health system for managing multimorbidity in Bahir Dar City, northwest Ethiopia.MethodsA facility-based phenomenological study design was conducted in three public and three private health facilities rendering chronic outpatient Non-Communicable Diseases (NCDs) care in Bahir Dar City, Ethiopia. Nineteen patient participants with two or more chronic NCDs and nine health care providers (six medical doctors and three nurses) were purposively selected and interviewed using semi-structured in-depth interview guides. Data were collected by trained researchers. Interviews were audio-recorded using digital recorders, stored and transferred to computers, transcribed verbatim by the data collectors, translated into English and then imported into NVivo V.12 software for data analysis. We employed a six-step inductive thematic framework analysis approach to construct meaning and interpret experiences and perceptions of individual patients and service providers. Codes were identified and categorized into sub-themes, organizing themes and main themes iteratively to identify similarities and differences across themes, and to interpret them accordingly.ResultsA total of 19 patient participants (5 Females) and nine health workers (2 females) responded to the interviews. Participants’ age ranged from 39 to 79 years for patients and 30 to 50 years for health professionals. About half (n = 9) of the participants had three or more chronic conditions.The key themes produced were feeling dependency, social rejection, psychological distress, poor medication adherence and poor quality of care.Living with multimorbidity poses a huge burden on the physical, psychological, social and sexual health of patients. In addition, patients with multimorbidity are facing financial hardship to access optimal multimorbidity care. On the other hand, the health system is not appropriately prepared to provide integrated, person-centered and coordinated care for people living with multiple chronic conditions.Conclusion and recommendationsLiving with multimorbidity poses huge impact on physical, psychological, social and sexual health of patients. Patients seeking multimorbidity care are facing challenges to access care attributable to either financial constraints or the lack of integrated, respectful and compassionate health care. It is recommended that the health system must understand and respond to the complex care needs of the patients with multimorbidity.

The Role of Local Action Groups (LAGs) in Facilitating Rural Economic Development in Two District Municipalities of the Eastern Cape Province, South Africa

Local Action Groups (LAGs) are a promising development approach that has gained prominence across the world. They are underpinned by participation of all local actors (community-led rural development) as the main precondition for generating and sustaining economic development in rural regions. Despite this potential, there has been a dearth of scientific studies that have investigated the potential role of LAGs as a rural transformation approach in the Eastern Cape Province of South Africa. Therefore, the current paper sought to identify existing local action groups and explore their role and potential to promote rural development. A concurrent mixed-methods approach was adopted to attain the study objective. Four hundred households were purposively drawn from two rural local municipalities, Amahlathi and Nyandeni, in the Eastern Cape Province. Survey questionnaires and semi-structured interview guides were used to collect data. Results showed that existing LAGs were mainly burial societies, cooperatives, farmers associations, women's organisations, and financial saving schemes. The main roles of these LAGs were to enhance food security, boost income generation, and foster social cohesion. However, despite their contribution, LAGs have not reached their full potential as a conduit for rural development owing to the limited involvement of relevant rural development stakeholders. Therefore, adequate targeted support is required from both the public and private sectors to unlock the potential of LAGs as a catalyst for rural development.

Abstract P398: Using Human-Centered Design Methodology to Identify Challenges and Inform the Development of a Digital Toolkit to Optimize Heart Failure Guideline-Directed Medical Therapy From Diverse Clinician, Patient, and Patient Health Partner Perspectives

Introduction: Despite overwhelming evidence that guideline-directed medical therapies (GDMT) for heart failure (HF) can reduce mortality and improve quality of life, significant gaps in treatment optimization persist. GDMT initiation and up-titration are especially critical for improving patient outcomes post-hospitalization. Objective: Identify challenges encountered post-hospitalization in optimizing GDMT for HF management by engaging key stakeholders in human-centered design (HCD) to guide the development of a digital toolkit to increase HF GDMT optimization. Methods: HCD is used to solve complex problems by soliciting input from stakeholders. We recruited: a) clinicians (physicians and advanced practice providers) who provide care to patients with HF across three health systems, b) patients with HF with Reduced Ejection Fraction (HFrEF, EF < 40%) discharged from the hospital within 30 days of enrollment, and c) patient health partners when available. We conducted separate virtual sessions for clinicians and patients/health partners using semi-structured interview guides to identify challenges, motivators and themes. Results: We enrolled 10 clinicians, 10 patients, and 2 patient health partners. The clinicians had a median age of 37 years (IQR: 35-41) and 12 years (IQR: 14-9) experience caring for patients with HF; 80% (8/10) were women, and 50% (5/10) were physicians. Patients had a median age of 53 years (IQR: 48-64); 40% (4/10) were women, 60% (6/10) were a racial/ethnic minority, and 50% (5/10) were married. Top challenges to HF GDMT optimization (e.g. number of medications) and digital toolkit features identified during the clinician HCD sessions are reported in Figure 1. Conclusions: The clinician and patient/health partner HCD findings will inform the development of the digital toolkit, including a patient-facing smartphone application and clinician dashboard, for HF GDMT optimization. We will also conduct HCD sessions in Brazil to further co-design the digital toolkit for low resource settings.