Semi-structured Interview Guides Research Articles

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.

School Built Environments and Bullying Behaviour: A Conceptual Model Based on Qualitative Interviews.

Interest in how the school built environment impacts bullying behaviour has gained momentum in recent years. While numerous studies have identified locations within schools where bullying frequently occurs, few studies have investigated the potential conceptual pathways linking school locations to bullying behaviour. This study aimed to (i) identify school built environment factors that may prevent or facilitate bullying behaviour in primary and secondary schools; and (ii) develop a conceptual model of potential pathways between the school built environment and bullying behaviour for future anti-bullying intervention research. Seventy individual semi-structured interviews were conducted between May and December 2020, with policymakers (n = 22), school staff (n = 12), parents (n = 18), and students (n = 18). School staff, parents and students, were recruited from six metropolitan primary and secondary schools in Perth, Western Australia. Interviews were conducted online and face-to-face using semi-structured interview guides. A thematic analysis was undertaken. Participants identified school bullying locations (e.g., locker areas, bathrooms, corridors) and built environment factors linked to bullying behaviour via (i) visibility and supervision; (ii) physical and psychological comfort and safety; and (iii) social-emotional competencies. The findings have policy and practice implications regarding the design of school built environments to prevent bullying behaviour.

Local pharmaceutical research and development capacity in a developing country: a qualitative exploration of perspectives from key stakeholders in Ethiopia

PurposeDespite its importance in ensuring sustainable healthcare, there are huge challenges with pharmaceutical research and development (R&D) especially for developing countries mainly due to the high investment costs naturally associated with such activities. In this regard, the pharmaceutical sector in Ethiopia, the most populous nation in East Africa, faces numerous challenges. The current study aimed at assessing the R&D capacity of the local pharmaceutical manufacturers from the perspectives of key informants working in the companies and supporting government offices and education institutions.MethodsA qualitative study design employing in-depth interviews using semi-structured interview guides with flexible probing techniques was used for data collection. The study involved purposively selected participants who represented major stakeholders such as managers in the R&D departments of pharmaceutical manufacturers, officers and leaders in concerned government agencies and researchers in a local university. All transcribed interviews were subjected to thematic analysis and the Qualitative Data Analysis software in family R (RQDA) was used for data analysis.ResultsA total of 14 participants were involved in the study and three major themes were identified from the interviews. Current R&D capacity, opportunities and challenges for involvement in R&D were the major themes. Under current R&D capacity, the weak R&D status of local pharmaceutical plants and minimal university–industry linkage were identified. The challenges of pharmaceutical R&D in Ethiopia included weak governmental and managerial support; difficult procurement processes for R&D input; and the high cost of R&D. Availability of trainable human power and planned government incentives were identified as the opportunities.ConclusionOverall, there is a low level of R&D capacity in local pharmaceutical industries and timely interventional strategies should be implemented through collaboration of academia, research institutions and pharmaceutical industries.

Clinical competency committee perceptions of entrustable professional activities and their value in assessing fellows: A qualitative study of pediatric subspecialty program directors

Objectives To examine the composition and processes of Clinical Competency Committees (CCCs) assigning entrustable professional activity (EPA) levels of supervision for pediatric subspecialty fellows and to examine fellowship program director (FPD) perspectives about using EPAs to determine fellows’ graduation readiness. Methods A qualitative study was performed using one-on-one interviews with a purposeful sample of pediatric subspecialty FPDs to yield a thematic analysis. Semi-structured interview guides were used for participants who self-identified as EPA users or non-users. Inductive analysis and coding were performed on transcripts until theoretical sufficiency was attained. Results Twenty-eight FPDs were interviewed. There was significant variability in the composition and processes of CCCs across subspecialties. FPDs felt that CCCs intuitively understand what entrustment means, allowing for ease of application of level of supervision (LOS) scales and consensus. FPDs perceived that EPAs provided a global assessment of fellows and are one tool to determine graduation readiness. Conclusions Although there was variability in the makeup and processes of CCCs across subspecialties, FPDs believe EPAs are intuitive and relatively easy to implement. Consensus can be reached easily using EPA-specific LOS scales focusing on entrustment. FPDs desire a better understanding of how EPAs should be used for graduation.

Qualitative analysis of a community pharmacy practice transformation initiative

AbstractObjectiveTo evaluate practice transformation team (PTT) members' perceptions of the Flip the Pharmacy (FtP) initiative as a strategy for implementing and improving community pharmacy‐based patient care.MethodsFtP is a national 2‐year practice transformation initiative for implementing enhanced patient care and medication optimization services at community pharmacies, launched in 2019 with 28 PTTs including over 500 pharmacy locations. Key informant interviews were conducted with team leads, coaches, and pharmacy champions from four PTTs that participated in the first FtP cohort. The interviews were conducted using semistructured interview guides based on the RE‐AIM framework and focused on participants' experiences in the first year of FtP. Interviews were audio‐recorded, transcribed, and analyzed using a rapid content analysis approach.ResultsFour leads, 8 coaches, and 8 pharmacy champions were interviewed from 4 PTTs from May to October 2021 and resulted in 10 themes: (1) community pharmacy practice experience is important when selecting coaches; (2) team readiness supports successful pharmacy practice transformation; (3) measures of patient care quality are needed; (4) payment and practice transformation opportunities happen in parallel; (5) successful practice transformation requires strategic involvement of the entire pharmacy team; (6) FtP practice transformation domains are synergistic; (7) change packages, coaching, and performance monitoring are core practice transformation supports; (8) pharmacy teams value opportunities to share and learn from each other; (9) sustaining patient care services is continuous; and (10) COVID‐19 accelerated practice transformation while creating new stress points.ConclusionParticipants in this study perceived the FtP initiative as a helpful strategy implementing and improving community pharmacy‐based patient care. Future research should explore the sustainability of the FtP initiative and similar community pharmacy practice transformation efforts.

A qualitative study of stakeholder and researcher perspectives of community engagement practices for HIV vaccine clinical trials in South Africa.

Community engagement increases community trust of research and improves trial participation. However, there is limited documented appraisal of community engagement practices. Several HIV vaccine efficacy trials have been conducted in South Africa, the country most affected by HIV, predominantly in collaboration with the HIV Vaccine Trials Network (HVTN). We explored stakeholder and researcher perspectives of the HVTN community engagement practices used in the Gauteng province of South Africa. In 2017, we conducted a qualitative study. Using semi-structured interview guides, we facilitated two group discussions with Community Advisory Board (CAB) members (n = 13), and 14 in-depth interviews with HVTN-affiliated employees (n = 8 in South Africa and n = 6 in the USA). Group discussions and in-depth interviews were audio-recorded, transcribed verbatim, translated into English, and coded using NVIVO 12 Plus software for thematic data analysis. Overall, median age of study participants was 22 (interquartile range 32-54) years, and 74% (n = 20) were female. Three main themes about community engagement emerged: (i) community engagement as an ongoing iterative relationship between researchers and community; (ii) methods of community engagement, encompassing community education by linking with external stakeholders and through awareness campaigns by pamphlet distribution and mass events, working with communities to develop recruitment messages, and working with CAB as a link to communities; and (iii) strategies to improve community engagement, for example, using simple language, linking with religious leaders and traditional healers, and communicating via conventional (newspapers, television, and radio) and social (videos and listicles) media. Our data indicate ways for researchers to improve relationships with community by understanding local needs, strengthening collaborations, and tailoring communication strategies. In this regard, CABs signify critical linkages between researchers and communities. CABs can relay relevant health research needs, advise on the creation of suitable materials, and link researchers more effectively with community leaders and media.

Factors influencing alopecia areata treatment decisions: A qualitative assessment

Alopecia areata (AA) is a disease of hair loss in which patients may benefit from comprehensive understanding of AA's disease process and therapeutic options during treatment decision-making. Determine factors influencing patients' AA treatment decision-making. Qualitative interviews were conducted using semi-structured interview guides. Interviews were coded using inductive thematic analysis. Twenty-one participants with AA were interviewed. Coding interrater reliability was κ=0.87-0.91, indicating strong-almost perfect agreement. Participants faced multiple barriers, including lack of access to health care (n=10, 47.6%) and lack of transparency about their condition and treatment options (n=9, 42.9%). Information about AA was sought from primarily the internet (n=15, 71.4%) and physician recommendation (n=15, 71.4%). When choosing AA treatments, patients often considered treatment efficacy (n=21, 100%), safety (n=21, 100%), and convenience of use (n=20, 95.2%). Referral and regional biases may be present and limit generalizability. Patients with AA face various challenges including medical uncertainty and lack of information. Patients need trustworthy and accessible sources of information regarding their treatment that also take into consideration their preferences and values.

Barriers and Facilitators to Successful Intensive Adherence Counseling in Rural Northern Uganda: An Exploratory Interview with HIV-Positive Clients Using the COM-B Framework.

Intensive adherence counseling (IAC) was introduced as a strategy to enhance adherence to antiretroviral therapy (ART) among HIV clients with non-suppressed viral loads. There has been sub-optimal viral load suppression among HIV clients in Uganda enrolled in IAC. However, there is a scarcity of literature on the barriers and facilitators of successful IAC. We aim to explore the barriers and facilitators to successful IAC among HIV-positive clients seeking care in public health facilities in rural northern Uganda. This was an exploratory qualitative study conducted among 15 purposively sampled HIV-positive clients enrolled in IAC in public health facilities offering ART services in northern Uganda. We conducted in-depth interviews using semi-structured interview guides based on the capability, opportunity, motivation, and behavior (COM-B) framework for behaviour change. Data were analyzed using the deductive thematic approach of Braun and Clarke following the COM-B framework. The majority of the participants were females (60%), married (53%), and attained primary education (47%). Barriers to successful IAC were Capability - alcoholism and promiscuity, Opportunity - stigma and discrimination, delayed viral load result, shortage of food, and heavy workload; and Motivation - deteriorating health and lack of incentives. Facilitators to successful IAC were Capability - good knowledge of ART, good memory, and reminder alerts; Opportunity - availability of ART, social support, availability of ART, prolonged ART refill, and good counseling; and Motivation - desire to live longer and healthy and the desire to fulfill dreams and goals. Successful implementation of IAC needs to consider the context of the person in care thus the need to strengthen individualized IAC sessions. HIV care providers can adopt the COM-B framework to perform individualized IACs and use the information to strengthen the counseling sessions.

Tuân thủ quy trình an toàn mổ lấy thai tại một bệnh viện năm 2020

Objectives: Describe the compliance with safe cesarean section procedures and influencing factors of the compliance in Thu Duc District Hospital, Ho Chi Minh City in 2020. Methodology: Cross-sectional study design, quantitative and qualitative data were collected. Direct observation of practicing safe surgical procedures during cesarean sections at the Department of Anesthesia and Resuscitation, Thu Duc District hospital was conducted. Interviews with hospital staff were conducted using semi-structured interview guides. The study was conducted from April to October 2020. The study sample size was 142 caesarean sections (C-sections). Results: The compliance rate of safe cesarean section procedure at each stage of surgery, was rather high: 95.8% at pre- . operative stage, 81.7% surgical stage, and postoperative stage was 92.2%. The compliance rate for safe cesarean section procedure was 81.7%. Some surgical safety actions are not performed in the emergency cases such as fetal distress. Recommendations: It is necessary to have specific guidance on the safety procedures for each level of emergency of C-section in the hospital. Keywords: surgical safety, cesarean section, procedure