Semi-structured Interview Guides Research Articles

Challenges of implementation of the preventive chemotherapy neglected tropical diseases programme in Ghana.

The Neglected Tropical Diseases programme since its implementation has improved the lives of many in the tropical and sub-tropical areas. Though witnessed many successes, the programme is continually facing challenges thus, preventing the attainment of various objectives. This study seeks to assess the challenges of implementation of the neglected tropical diseases programme in Ghana. The thematic analysis approach was used to analyze qualitative data collected from 18 key public health managers selected through purposive and snowballing procedures from the national, regional and district levels of Ghana Health Service. Data collection was done through in-depth interviews using semi-structured interview guides in line with the objective of the study. The Neglected Tropical Diseases Programme though received funding from external sources, faces multiple challenges which cut across financial, human and capital resources to external control. Specifically, inadequate resources, dwindling volunteerism, poor social mobilization, weak governmental commitment and weak monitoring were major challenges to implementation. These factors work individually and in combination to impede effective implementation. Ensuring state ownership, re-structuring implementation approaches to include top-down and bottom-up approaches and building capacity in monitoring and evaluation are recommended in order to meet the programme objectives and ensure sustainability. This study forms part of an original study on Implementation of the NTDs programme in Ghana. Aside the key issues discussed, it presents first-hand information on major implementation challenges that are relevant to researchers, students, practitioners and the general public and will apply widely to vertically implemented programmes in Ghana.

Designing a Future eHealth Service for Posthospitalization Self-management Support in Long-term Illness: Qualitative Interview Study.

For patients with noncommunicable diseases (NCDs; eg, heart failure [HF] and colorectal cancer [CRC]), eHealth interventions could meet their posthospital discharge needs and strengthen their ability to self-manage. However, inconclusive evidence exists regarding how to design eHealth services to meet the complex needs of patients. To foster patient acceptability and ensure the successful development and implementation of eHealth solutions, it is beneficial to include different stakeholders (ie, patients and health care professionals) in the design and development phase of such services. The involvement of different stakeholders could contribute to ensuring feasible, acceptable, and usable solutions and that eHealth services are developed in response to users' supportive care needs when transitioning to home after hospitalization. This study is the first step of a larger complex intervention study aimed at meeting the postdischarge needs of 2 NCD populations. This study aimed to explore the perspectives of patients with HF and CRC and health care professionals on patient self-management needs following hospital discharge and investigate how a future nurse-assisted eHealth service could be best designed to foster patient acceptability, support self-management, and smooth the transition from hospital to home. A qualitative, explorative, and descriptive approach was used. We conducted 38 semistructured interviews with 10 patients with HF, 9 patients surgically treated for CRC with curative intent, 6 registered nurses recruited as nurse navigators of a planned eHealth service, and 13 general practitioners experienced in HF and CRC treatment and follow-up care. Patients were recruited conveniently from HF and CRC outpatient clinics, and the nurses were recruited from the cardiology and gastro-surgical departments at a university hospital in the southwest of Norway. The general practitioners were recruited from primary care in surrounding municipalities. Semistructured interview guides were used for data collection, and the data were analyzed using thematic analysis. In total, 3 main themes were derived from the data analysis: expecting information, reassurance, and guidance when using eHealth for HF and CRC self-management; expecting eHealth to be comprehensible, supportive, and knowledge promoting; and recognizing both the advantages and disadvantages of eHealth for HF and CRC self-management. The data generated from this interview study depicted the diverse needs for self-management support of patients with CRC and HF after hospital discharge. In addition, valuable suggestions were identified regarding the design and content of the eHealth service. However, participants described both possible advantages and disadvantages of a remote eHealth service. This study is the first step in the development of an eHealth service for posthospitalization self-management support for long-term illnesses. It concerns patients' supportive care needs and user requirements of an eHealth service. The findings of this study may add value to the planning and development of eHealth interventions for patients with NCDs.

Father’s Involvement in the Mitigation of Child Sexual Abuse, in Mvita sub-county, Mombasa County

Child sexual abuse is a serious public health issue that violates their rights. This study sought to investigate the father’s involvement in the mitigation of child sexual abuse in Mvita Sub-County, Mombasa County. It was guided by the following specific objectives; to examine how fathers' income status influences the mitigation of child sexual abuse, to determine how fathers’ upbringing influences their involvement in the mitigation of child sexual abuse, to assess the extent to which father’s involvement in child upbringing mitigates child sexual abuse and to determine effective preventive strategies for supporting fathers’ involvement in mitigation of child sexual abuse in Mvita Sub -County, Mombasa County. The study was anchored by two theories: Attachment theory by John Bowlby (1958) and Ecological Systems Theory by Urie Bronfenbrenner (1979). A mixed-method research approach with a focus on convergent parallel mixed-method design was adopted. Both quantitative and qualitative data were gathered using semi-structured questionnaires and interview guides, respectively. The target population was 154,166 people while the sample size was 400 respondents. Quantitative data were analyzed using SPSS version 23 while qualitative data were analyzed using thematic content analysis and presented in narrations. The study findings indicated that the majority of the respondents strongly agreed that the father’s income status and involvement are directly linked to their ability to mitigate child sexual abuse. The study found that equal childcare and division of housework, the introduction of community protection programs, and sex education in schools could be effective preventive strategies for fathers in the mitigation of child sexual abuse. Based on the study findings, the researchers concluded that fathers’ involvement in child upbringing could help mitigate child sexual abuse in Mvita-Sub-County, Mombasa, Kenya. Keywords: Father’s involvement, Mitigation, Child sexual abuse, Mvita Sub-County, Mombasa &nbsp

Father’s Involvement in the Mitigation of Child Sexual Abuse, in Mvita sub-county, Mombasa County

Child sexual abuse is a serious public health issue that violates their rights. This study sought to investigate the father’s involvement in the mitigation of child sexual abuse in Mvita Sub-County, Mombasa County. It was guided by the following specific objectives; to examine how fathers' income status influences the mitigation of child sexual abuse, to determine how fathers’ upbringing influences their involvement in the mitigation of child sexual abuse, to assess the extent to which father’s involvement in child upbringing mitigates child sexual abuse and to determine effective preventive strategies for supporting fathers’ involvement in mitigation of child sexual abuse in Mvita Sub -County, Mombasa County. The study was anchored by two theories: Attachment theory by John Bowlby (1958) and Ecological Systems Theory by Urie Bronfenbrenner (1979). A mixed-method research approach with a focus on convergent parallel mixed-method design was adopted. Both quantitative and qualitative data were gathered using semi-structured questionnaires and interview guides, respectively. The target population was 154,166 people while the sample size was 400 respondents. Quantitative data were analyzed using SPSS version 23 while qualitative data were analyzed using thematic content analysis and presented in narrations. The study findings indicated that the majority of the respondents strongly agreed that the father’s income status and involvement are directly linked to their ability to mitigate child sexual abuse. The study found that equal childcare and division of housework, the introduction of community protection programs, and sex education in schools could be effective preventive strategies for fathers in the mitigation of child sexual abuse. Based on the study findings, the researchers concluded that fathers’ involvement in child upbringing could help mitigate child sexual abuse in Mvita-Sub-County, Mombasa, Kenya. Keywords: Father’s involvement, Mitigation, Child sexual abuse, Mvita Sub-County, Mombasa &nbsp

Nurses' Experiences Caring for Children With Neuroblastoma Receiving 131I-Metaiodobenzylguanidine Therapy: A Qualitative Descriptive Study.

Background: Neuroblastoma, the most common extra-cranial solid tumor found in children, carries a high mortality rate due to challenges with metastatic disease at diagnoses and relapse. 131I-Metaiodobenzylguanidine (I-MIBG) therapy provides targeted radiotherapy to treat neuroblastoma, but requires children to be isolated for radiation exposure, with limited access to the healthcare team while hospitalized. There is minimal research outlining the nurses' perspectives on caring for this patient population. Therefore, the aim of this study was to describe the nurses' experiences caring for children receiving 131I-MIBG therapy, focusing on nursing care, challenges, radiation exposure, and preparation. Methods: Ten nurses were recruited using purposeful sampling for this qualitative descriptive study. Semi-structured interview guides and conventional qualitative content analysis guided the data collection and analysis. Results: Nurses overwhelmingly felt isolated from their patients and a decreased sense of connection with the child. Although nurses felt prepared, they had more anxiety with the first patient experience and identified that parent engagement was essential. Overall, nurses shared they had support from written materials outlining the protocols, and members of the multidisciplinary team. More concern for radiation exposure was expressed by nurses of childbearing age and with handling bodily fluids. Discussion: Findings suggest that nurses would benefit from simulation experiences to help prepare for radiation exposure safety, strategies to engage the family in the child's care, and interacting with a child in single-room isolation. Because programs differ around the US, additional research exploring nurses' experiences is warranted to evaluate the best successes in providing 131I-MIBG therapy.

Older patients’ perception of treating root caries with silver diamine fluoride – a qualitative study based on the Theoretical Domains Framework

ObjectivesCaries treatment with silver diamine fluoride (SDF) is effective, but often leads to irreversible tooth discoloration. This study aimed to investigate older patients’ perceptions of root caries treatment with SDF and to identify factors that influence their decision process. MethodsFifteen interviews were conducted in older patients (mean, min/max: 83, 71/92 years) with root caries experience, following a semi-structured interview-guide based on the domains of the Theoretical Domains Framework (TDF) including three case vignettes of SDF treatment. Transcripts of the interviews were used to perform deductive and inductive content analysis along the TDF and Capability-Opportunity-Motivation-Behavior model (COM-B) to assess influential factors. ResultsAll TDF domains and behavior determinants of the COM-B were covered, identifying twenty-two barriers, facilitators and conflicting themes. Main barriers for consenting to SDF treatment were patients’ perceptions of permanent staining of visible root caries lesions, as well as preconceptions about those of others and lack of knowledge about root caries and SDF. Main facilitators were trust in advice given by dentists, especially regarding new treatment options, that aesthetics were less important in non-visible areas and the importance of tooth preservation and feasibility of treatments when immobile or in need of care. ConclusionPermanent discoloration is an important barrier to older patients’ acceptance of SDF treatment for visible root caries. However, patients appear to accept SDF treatment under certain conditions, including less visible lesions or in comparison to more invasive treatment options. Clinical significanceOur findings contribute to understanding both barriers and facilitators when treating root caries in older patients with SDF.

‘It is the child with the big head’ – Primary healthcare providers’ perceptions of paediatric hydrocephalus in Blantyre, Malawi: A qualitative study

ABSTRACT Children in Africa are disproportionately burdened by the neurosurgical condition hydrocephalus. In Blantyre, Malawi, paediatric hydrocephalus represents the majority of surgical procedures performed in the neurosurgical department at Queen Elizabeth Central Hospital. To reduce morbidity and mortality, timely detection followed by referral from surrounding primary health centres is crucial. Aiming to explore perceptions and identify enablers and barriers to detection and referral, we conducted a qualitative study among primary healthcare providers (n = 30) from ten health centres in Blantyre district. Using a semi-structured interview-guide, we audio-recorded and transcribed the interviews before conducting a thematic analysis. One main finding is that there is a potential to improve detection through head circumference measurements, which is the recommended way to detect hydrocephalus early, yet healthcare providers did not carry this out systematically. They described the health passport provided by the Malawian Ministry of Health as an important tool for clinical communication. However, head circumference growth charts are not included. To optimise outcomes for paediatric hydrocephalus we suggest including head circumference growth charts in the health passports. To meet the need for comprehensive management of paediatric hydrocephalus, we recommend more research from the continent, focusing on bridging the gap between primary care and neurosurgery.

Assessment of Solid Waste Management Privatization and Continued Pollution in Makadara Sub-County Residential Areas, Nairobi – Kenya

The study sought to assess how private waste companies have contributed to continued pollution in Makadara Sub-County, Nairobi City County. The study employed mixed method design, specifically concurrent triangulation strategy. Simple random sampling was used to select 218 resident leaders whereas purposive sampling was used to select 1 Sub-County environmental officer and 23 managers of private waste firms. Instruments for data collection were questionnaires, semi-structured interview guides and observation guide. Quantitative data was analysed using Statistical Package for Social Sciences (SPSS Ver. 27.0) and presented in tables and pie charts. Qualitative data was analysed using content analysis and presented through narrative forms and thematic text approach. The study findings revealed that Private Waste Companies (PWCs) contributed to continued pollution in Makadara Sub-County by insisting on prompt waste collection charges, littering and waste spillage, irregularity in waste collection, creation of mini-dumps and poor maintenance of waste collection points, and inadequate finances. The study concluded that insufficient funds was the main challenge facing private waste companies leading to continued pollution in the residential areas and therefore there was need to review the terms and conditions of operation between PWCs and the residents that gear towards environmental sanitation that is fit for human survival. The study recommended that the PWCs to increase frequency of waste collection while the City County Government to implement the policy on contracting private waste companies that operate in residential areas and develop a policy on public-private partnership which focuses on the government subsidizing PWCs that carry out waste management in low-income residential areas.

COVID-19 AND OLDER ADULTS IN ZIMBABWE: A STUDY OF THE CHALLENGES FACED BY THE OLDER ADULTS IN GWERU AND MUTARE

This study explores the challenges faced by the older adults during the COVID-19-induced lockdown periods in Gweru and Mutare, Zimbabwe’s third and fourth largest cities, respectively. Seventeen men and women above the age of 60 were interviewed following all COVID-19 protocols during the period April to August 2021. Semi-structured interview guides were used to gather data and Tesch’s (1990) method of thematic analysis was used to make sense of the data. Findings indicate that the older adults faced new challenges as a result of the strict lockdown and that the pandemic exacerbated the challenges that the elderly were facing. Intersectionality of challenges was also evident from the older people’s descriptions. A number of stressors were related to the pandemic restrictions, financial issues, health challenges, social challenges, and challenges of everyday living. Some participants reported mental health challenges and symptoms related to anxiety and depression. The COVID-19 pandemic presented unique psychological, economic, and social challenges to older persons in Zimbabwe. To curb such challenges in the future, there is a need to prioritize older adults during pandemic outbreaks and disasters. Adequate Universal pensions could assist in dealing with the economic challenges faced by older adults in Zimbabwe. There is a need to raise awareness and formulate structured programs on the well-being of older adults. Further research is required to map the extent of the psychological and socio-economic challenges faced by older adults in Zimbabwe.

Teaching Comprehensive Sexuality Education at Secondary School: Towards Promoting Healthy Sexual Decisions among Pupils, Luapula Province, Zambia

The study is an investigation into positive impacts of teaching Comprehensive Sexuality Education (CSE) on pupils’ healthy sexual decisions. This study was purely a qualitative one employing a case study design. A total of 5 schools in Luapula Province were sampled, comprising 10 teachers and 40 pupils who were purposively and randomly selected. Data was collected using questionnaires and semi-structured interview guides while analysis of data was done using SPSS and themes. The study revealed that CSE has many positive impacts on pupils’ healthy sexual decisions, choices and behavior change in general; and also established misconceptions about CSE. The study recommends that CSE must be a compulsory, age-appropriate, co-curricular subject to all pupils in secondary schools and that teachers must endeavor to explain its importance and/or positive impact to pupils. This study concludes that pupils are able to make healthy sexual decisions if exposed to CSE more often.

Benefits of integrating palliative care: a qualitative exploration of the perspectives of palliative care providers in a tertiary health facility in Ghana

Integration of palliative care (PC) services entails combining administrative, organisational, clinical and service elements to ensure continuity of care between all parties participating in the care network of patients. There is a need to understand the benefits of integrating PC to inform policy making and advance advocacy, especially in resource-constrained settings such as Ghana where PC is sub-optimally implemented. Yet, existing research in Ghana is sparse on what benefits are likely to be experienced as a result of integrating PC. The study explored service providers' perspectives on the benefits of integrating PC in Ghana. The design was an exploratory descriptive qualitative research design. A total of seven in-depth interviews were conducted using semi-structured interview guides. The data were managed using NVivo-12. Inductive thematic analysis was carried out following Haase's modification of Colaizzi's approach to qualitative research analysis. The study follows the COREQ guidelines and the ICMJE recommendations. Two main themes emerged: patient-related outcomes, and system/institution-related outcomes. For the patient-related outcomes, the following sub-themes emerged: restored hope, appreciated care and better preparation for the end of life (EoL). The emerging sub-themes under the system/institution-related outcomes include the following: early initiation of care, enhanced communication between primary healthcare providers and the PC team and strengthening staff capacity to provide PC services. In conclusion, there are substantial benefits to be experienced from integrating PC. For the patients, it would restore shattered hopes, result in appreciated care and better preparation for the EoL. For the healthcare system, it would promote early initiation of care, enhance communication between primary healthcare providers and the PC team and strengthen service providers' capacity to provide PC services. This study, thus, furthers the case for a more integrated PC service in Ghana.

Examining Transparency and Accountability in the Management of Constituency Development Catalyst Fund in Tanzania: The Case of Mwanga Constituency in Kilimanjaro Region

The Government of Tanzania is spending approximately TZS 12.5 billion annually for accelerating development projects at a constituency level, following the enactment of the Constituency Development Catalyst Fund (CDCF) Act of 2009. The Fund’s unique feature rests in its management by elected members of pparliament supposed to oversee executives. This has raised eyebrows among academics and practitioners on the accountability of its management. This study, therefore, examines accountability and transparency in the management of CDCF in Tanzania using the Mwanga Constituency as a case study. The study employed a crosssectional research design utilizing a qualitative approach. Semistructured interview guides were used for data collection, and the data were subjected to content analysis. The key findings of the study manifest secretive management practices of the Fund that limit access to information to citizens. These practices overlook sound governance principles, and are unhealthy for efficient and effective management of public resources. Furthermore, the means for holding entrusted officials accountable were primarily limited to the ballot box and judicial mechanism. The study appeals to relevant authorities to devise means that would give the legal community free access to information. Thus the study recommends meritocratic employment than political value-laden management of the fund so that the community gets value for their money.

Provider and patient perspectives to improve lung cancer screening with low-dose computed tomography 5 years after Medicare coverage: a qualitative study

Lung cancer remains the leading cause of cancer-related deaths for both men and women in the U.S., yet uptake of preventive cancer screening for people with a heavy smoking history remains low. This qualitative interview study of patients and providers from a large ambulatory healthcare system in northern and central California reevaluated perceptions of lung cancer screening with low-dose computed tomography (LCS-LDCT) 5 years after Medicare coverage. We hypothesized that initial attitudes and barriers within the LCS-LDCT discussion and process have likely persisted with little change since Medicare coverage and we sought to understand how these attitudes continue to impact effective implementation and uptake of screening with the goal of identifying opportunities for improvement. Between 2019 and 2020, interviews were conducted with 10 primary care physicians and 30 patients using semi-structured interview guides. Providers and patients expressed that they were both aware and supportive of LCS-LDCT, a change from earlier studies, but continued to report little to no shared decision making nor use of a decision aid despite being Medicare requirements. Creation and incorporation of a single-page, graphic heavy decision aid may help address many of the persistent barriers around implementation for both providers and patients. Given recently expanded guidelines from the U.S. Preventive Services Task Force for LCS-LDCT screening and their coverage by Medicare, it is important for healthcare systems to understand provider and patient perceptions to further improve the implementation of LCS-LDCT to ultimately reduce lung cancer mortality.

THE ROLE OF CARE PARTNERS IN SUPPORTING INNER STRENGTH OF PERSONS NEWLY DIAGNOSED WITH MILD COGNITIVE IMPAIRMENT

Abstract Inner strength is one’s internal process of facing challenging circumstances, like receiving a mild cognitive impairment (MCI) diagnosis. However, the role of care partners in this process is unknown. This study explores the role of care partners in supporting inner strength at the time of diagnosis using qualitative methodologies. We interviewed persons diagnosed with MCI (N=5) at a Memory Center within 12 months and their care partners (N=5). We analyzed data in NVivo using reflexive thematic analysis methods. Trustworthiness was maintained through vetted semi-structured interview guides, verbatim transcription, field notes, peer analysis, and audit trails. Care partners supplant cognitive losses (e.g., redistribution of self, organizing and coordinating) to allow the person with MCI to thrive, which is built on a foundation of the care partner’s personal resources and the nature of their relationship with the person with MCI. Implications include incorporating care partners into diagnostic processes and tailoring caregiving supports.

Utilization of long-acting contraceptive methods and associated factors among married women in Farta Woreda, Northwest Ethiopia: a community-based mixed method study

BackgroundAlthough long-acting contraceptive methods are highly effective, safe, and provide uninterrupted protection from unintended pregnancy compared to short-acting methods, evidences suggest that majority of women were relayed on short-acting contraceptive methods. Thus, this study aimed to determine the level of long-acting contraceptive methods utilization and associated factors among married women in Farta Woreda, Northwest Ethiopia, 2021.MethodsA community-based cross-sectional study supplemented with qualitative data was performed among 556 married women from March 1 to 31, 2021. A semi-structured interviewer-administered questionnaire and interview guides were used to collect the data. The data were entered into Epi data version 4.6 and analyzed by SPSS version 23 software. The association between variables was analyzed using bivariate and multivariable binary logistic regression. The level of statistically significant association was determined at a P-value < 0.05. After translation and transcription, manual thematic analysis was applied to the qualitative data.ResultsThe magnitude of long-acting contraceptive methods among married women in Farta Woreda was found to be 14.3% [95% CI 11.5–17.6]. Previous use of long-acting contraceptive methods (AOR = 5.83, 95% CI 3.03, 11.21), positive attitude towards long-acting contraceptives (AOR = 2.74, 95% CI 1.48, 5.07), having formal education for husbands’ (AOR = 3.05, 95% CI 1.5, 6.21), and poor wealth index (AOR = 3.39, 95% CI 1.33, 8.67) were positively associated with utilization of long-acting contraceptive methods. Moreover, fear of side effects, misconceptions, and partner opposition were the most commonly identified barriers by the qualitative data.ConclusionUtilization of long-acting contraceptives among married women in Farta Woreda was low as compared to the 2020/21 national reproductive health strategy plan to increase the long-acting reversible and permanent contraceptive methods use to 50%. Previous use of long-acting contraceptives, positive attitude towards long-acting contraceptives, husband education, and household wealth index was found to be significantly associated with long-acting contraceptive utilization. Hence, it is better to work more on changing women's attitudes and increasing husband education.

Caregiver Burden of Autosomal Dominant Polycystic Kidney Disease: A Qualitative Study

There is limited published research on how autosomal dominant polycystic kidney disease (ADPKD) impacts caregivers. This study explored how caregivers of individuals with ADPKD perceive the burdens placed on them by the disease. Qualitative study consisting of focus groups and interviews. Discussions were conducted by trained interviewers using semi-structured interview guides. The research was conducted in 14 countries in North America, South America, Asia, Australia, and Europe. Eligible participants were greater than or equal to 18 years old and caring for a child or adult diagnosed with ADPKD. The concepts reported were coded using qualitative research software. Data saturation was reached when subsequent discussions introduced no new key concepts. Focus groups and interviews were held with 139 participants (mean age, 44.9 years; 66.9% female), including 25 participants who had a diagnosis of ADPKD themselves. Caregivers reported significant impact on their emotional (74.1%) and social life (38.1%), lost work productivity (26.6%), and reduced sleep (25.2%). Caregivers also reported worry about their financial situation (23.7%). In general, similar frequencies of impact were reported among caregivers with ADPKD versus caregivers without ADPKD, with the exception of sleep (8.0% vs 28.9%, respectively), leisure activities (28.0% vs 40.4% respectively), and work/employment (12.0% vs 29.8%, respectively). The study was observational and designed to elicit concepts, and only descriptive analyses were conducted. These findings highlight the unique burden on caregivers in ADPKD, which results in substantial emotional, social, and professional/financial impact.

A qualitative exploration of continuity of TB care in clinics after discharge from hospitals in Cape Town, South Africa

BackgroundContinuity of care remains a challenge for TB patients who are discharged from hospital and referred to primary health care clinics in South Africa. The aim of this study was to explore the experiences and perceptions of patients, health care workers and family members regarding continuity of TB care in a Cape Town health district.MethodsWe conducted one-on-one interviews, using semi-structured interview guides, with TB patients and their families and health care workers. We also conducted focus group interviews with other health care workers who performed similar duties. Field notes were kept and patients’ home circumstances were also physically observed. Data saturation was achieved after 31 interviews. We used Miles and Huberman’s qualitative data analysis framework to interpret the data.ResultsThemes identified in the interviews were grouped into two categories: (1) patients’ socio-economic circumstances including complex family relationships, good or lack of family support, inadequate income, and agency; and (2) health system challenges, including inadequate referral links between the clinic and the hospital and negative emotions as a result of poor service delivery experienced by patients.ConclusionSome TB Patients experienced poor continuity of care on discharge from hospitals to primary health clinics and perceived that this resulted from socio-economic conditions and health system-related problems that triggered negative emotions. Proper communication between the hospital and clinic regarding patients’ care, adequate counselling, and patient-centred treatment are required to address poor continuity of care among patients with TB down-referred to clinics.

Contexts of violence victimization and service-seeking among Latino/a/x immigrant adults in Maryland and the District of Columbia: A qualitative study

In the United States (US), Latino/a/x immigrants are particularly vulnerable to discrimination and violence, which are associated with a host of negative physical and mental health consequences. Despite this, Latino/a/x immigrants may have limited access to resources and services to prevent and address its consequences. In-depth interviews (n = 17) and one focus group discussion (n = 5) were conducted among a maximum variation sample of adult Latino/a/x immigrants living in Maryland and the District of Columbia, following semi-structured interview guides to explore experiences of discrimination and violence, their impact on health, and barriers and facilitators to help-seeking. Experiences of discrimination and violence victimization were diverse in type and severity. Many women and one gender non-binary participant described experiences of intimate partner violence as well workplace violence. Men frequently described violence that occurred in public and in the workplace. Nearly all participants reported workplace discrimination. Lack of legal documentation, experiences of impunity in country of origin, and lack of knowledge of the US legal system presented barriers, while peers, social groups, and bystanders facilitated violence reporting and help-seeking. Results highlight clear opportunities to prevent and respond to violence through improved availability and accessibility of information, as well as expansion or adaptation of existing services across sectors.

S94 Patient-Level Factors Driving Medication Non-adherence in Crohn's Disease

Background: Chronic inflammation in Crohn’s disease (CD) often leads to complications such as fistulae and strictures. Further, 85% of people with CD will be hospitalized at least once in 5 years and 18% will require surgery within 5-years. Immune-modifying medications can decrease the likelihood of these downstream complications. Despite widespread availability of these drugs and a growing recognition of their value among gastroenterologists, approximately 40% of patients do not comply with optimized maintenance regimens for CD. Disease morbidity is markedly increased in medication non-adherent CD patients. Untreated CD results in increased rates of hospitalizations, disability, complications, and colon cancer, and decreased quality of life. Given the current dearth of literature surrounding medication decision-making, we sought to identify the factors that motivate adherence or non-adherence with immune modifying medications for CD. Methods: We conducted qualitative interviews in people with CD who were identified as adherent or non-adherent to immune-modifying medication recommendations by their treating gastroenterologist. Semi-structured interview guides were developed based on the Theoretical Domains Framework (TDF), an established framework for understanding barriers and facilitators of health behaviors. We conducted content analysis of the resulting qualitative data using a blended inductive-deductive approach to identify emergent themes that influence medication decision-making. Results: Twenty-four patients with CD completed interviews for this study. Interviews were independently coded and analyzed for themes. Two broad domains emerged comprising: 1) themes reflected in the TDF, and 2) novel themes specific to medication decision-making in CD. Themes specific to medication decision-making included knowledge about CD, beliefs about the consequences of medication use or non-use, prior experiences with medications, discomfort with uncertainty, strength of the patient-provider relationship, and overall disease acceptance. Adherent patients conveyed a sense of trust in science and healthcare provider expertise, while non-adherent patients were more likely to express beliefs in their ability to self-manage CD, concern about risks associated with medication, and a general ambivalence to treatment. Conclusion(s): There are clear cognitive, behavioral and relational factors that guide patients’ medication-related decision-making. Thus, it is likely that patients who are non-adherent to medication recommendations could benefit from an intervention designed to target these specific factors. A population-specific behavioral intervention will be paramount for improving medication adherence in people with CD at high-risk for complications, and would be an impactful tool for improving both disease-related outcomes and quality of life. A mechanism for early identification of potentially non-adherent patients in conjunction with a behavioral intervention to improve adherence has the potential to prevent the development of CD complications and decrease CD-associated morbidity.

Primary Care Clinician Perspectives on Patient Navigation to Improve Postpartum Care for Patients with Low Income.

Birthing individuals experience significant physical and psychosocial transitions during the postpartum period. Despite amplified health needs, many individuals do not successfully transition from obstetric to primary care. Patient navigation provides a patient-centered solution that has been applied to other health care specialties resulting in improved care coordination and patient engagement for populations in greatest need. Our objective was to understand primary care clinician perspectives regarding the role of navigators in improving postpartum care for individuals with low income. In this qualitative investigation, we conducted focus groups with primary care clinicians from family and internal medicine specialties. Semistructured interview guides addressed clinician perceptions of navigator roles during the postpartum period and recommendations for navigator training. Focus group discussions were digitally recorded, transcribed, and analyzed via a constant comparative method. Twenty-eight primary care clinicians, including 26 physicians and 2 advanced practice registered nurses, participated in 8 focus groups. Participants reported favorable attitudes toward implementation of a postpartum patient navigation program. Themes regarding useful navigation services included streamlining obstetric to primary care transition, enhancing visit effectiveness, creating personalized postpartum care, and providing patient- and clinician-focused education. Recommendations for navigator training included education on basic medical concerns that are common in the postpartum period, health information privacy and electronic health record use, health care systems, and community resources. Primary care clinicians were highly receptive to the concept of patient navigation as a process to improve health in the postpartum period through enhanced care coordination and improved patient knowledge, engagement, and self-efficacy.