Snowball Sampling Strategy Research Articles

Investigation of stakeholder perceptions of the wheelchair service delivery process

Introduction: The wheelchair service delivery process (SDP) is a large complex system and therefore has many potential points of failure; determining priorities for improvement is challenging. The complexities introduce several barriers to accessing and maintaining wheelchairs for individuals with mobility impairments. Given the breadth and depth of the barriers, it is important to know in which areas to focus future policy reform efforts. Purpose:The purpose is to explore the perceptions of stakeholders regarding the performance of the wheelchair SDP in the United States and guide future policy reforms. Methods: A cross-sectional, observational, online questionnaire was deployed. Questions were positive statements regarding the wheelchair SDP and participants rated their agreement with the statements on a standard six-point Likert scale. A snowball sampling strategy was used and consisted of emailing 42 organisations representing 5 stakeholder groups: (1) consumers/caregivers; (2) clinicians; (3) manufacturers; (4) payers; and (5) suppliers. Results: 1,052 responses were collected: 41% clinicians, 30% suppliers, 24% consumers/caregivers, 3% manufacturers, 2% payers. Stakeholders view the wheelchair SDP as not performing well. Less than 18% of all responses indicate a positive perception. Funding and procurement was viewed in the least positive light, with 5% positive responses. Follow-up, maintenance, and repair was the second least positive component with 9% positive responses. Fitting, training, and delivery was viewed most positively with over 42% positive responses. Conclusion: The wheelchair SDP is not viewed as performing well by its stakeholders. Funding, procurement, maintenance, and repairs are viewed particularly negatively, representing opportunities for focused system reform efforts.

Pharmacists’ perspectives on methamphetamine use disorder in the Australian community setting

Background: Methamphetamine Use Disorder (MUD) poses significant harm to individuals and communities. In Australia, pharmacies have been involved in harm reduction services, primarily focusing on opioids. While much is known about pharmacists' attitudes toward opioid use disorder, there is limited understanding of their perspectives and management of MUD. This study aimed to explore pharmacists’ perspectives on the provision of services to clients with MUD. Methods: Recruitment of pharmacists involved a snow-ball and convenience sampling strategy across Sydney, Australia. Semi-structured interviews were undertaken to explore pharmacists’ perspectives on the treatment and management of MUD in the pharmacy setting. Transcribed interviews were qualitatively analysed using an inductive approach, coding themes from the data emerging. Results: Nineteen pharmacists completed the interviews. The strongest theme emerging from the transcripts described pharmacists’ reported unfamiliarity with MUD. Participating pharmacists almost unanimously perceived there was a lack of educational resources surrounding MUD, inadequate university curricular on MUD, and a lack of support for pharmacists’ role in any prospective MUD treatment programs. Conclusion: Studies indicate that pharmacists are often unfamiliar with MUD, which, along with insufficient educational resources, causes low confidence and hinders their ability to support individuals with MUD. Implementing targeted educational interventions for pharmacists is essential to improve their effectiveness in MUD treatment programmes.

Reflexión crítica en la juventud: una mirada a la interrelación entre la subjetividad política, la socialización política y el proyecto de vida

This article presents the results of a research study that aimed to understand the relationship between political subjectivity, political socialization, and the construction of individual and collective life projects among four young Colombians from the city of Bogotá, aged 20 to 27, who generate impact within their communities (2023). The qualitative study employed the hermeneutic-political ontological method, involving the participation of young individuals through the snowball sampling strategy and in-depth interviews. The findings highlight that critical reflection emerges as a key process through which young people recognize the precarities in their environments, which, in turn, drives their ability to plan life projects oriented toward collective benefit. From this perspective, young people understand politics in two dimensions—established and instituting—and it is through the tension between these dimensions that they construct their political subjectivity. Furthermore, their participation in various political socialization settings enables them to define and consolidate their beliefs and perspectives. Regarding life project planning, the young participants emphasize that uncertainty, combined with clarity about their objectives, plays a significant role in generating a positive impact on their communities. Finally, the interaction between political socialization settings and reflective processes is central to understanding how young people construct their life projects and develop their political subjectivity.

Anti-Black racism in Canadian health care: a qualitative study of diverse perceptions of racism and racial discrimination among Black adults in Montreal, Quebec

BackgroundRacism has been shown to impact the health of Black persons through its influence on health care, including its expression through implicit biases in provider training, attitudes, and behaviours. Less is known about the experiences of racism in contexts outside of the USA, and how race and racism interact with other social locations and systems of discrimination to shape Black patients’ experiences of racism in health care encounters. To help address this gap, this study examined diverse Black individuals’ perceived experiences of, and attitudes towards, anti-Black racism and racial discrimination in Canadian health care, specifically in Montreal, Quebec.MethodsThis descriptive qualitative study adopted a social constructionist approach. Employing purposive maximal variation and snowball sampling strategies, eligible study participants were: self-identified Black persons aged 18 years and older who lived in Montreal during the COVID-19 pandemic, who could speak English or French, and who were registered with the Quebec medical insurance program. In-depth interviews were conducted, and a Framework Analysis approach guided the systematic exploration and interpretation of data using an intersectionality lens.ResultsWe interviewed 32 participants, the majority of whom were women (59%), university educated (69%), and modestly comfortable financially (41%), but diverse in terms of age (22 to 79 years), country of origin, and self-defined ethnicity. We identified five major themes demonstrating substantial variations in perceived racism in health care that are influenced by unique social locations such as gender identity, age, and immigration history: (1) no perceptions of racism in health care, (2) ambiguous perceptions of racism in health care, (3) perceptions of overt interpersonal racism in health care, (4) perceptions of covert interpersonal racism in health care (including the downplaying of health concerns, stereotyping, and racial microaggressions), and (5) perceptions of systemic racism in health care.ConclusionsPerceptions of anti-Black racism and racial discrimination in Canadian health care are complex and may include intra-racial group differences. This study begins to address the dearth of empirical research documenting experiences of anti-Black racism in health care in Quebec, highlighting a continued need for serious consideration of the ways in which racism may manifest in the province, as well as a need for anti-racist advocacy. Advancing racial health equity requires greater sensitivity from providers and decision makers to variations in Black patients’ health care experiences, towards ensuring that they have access to high quality and equitable health care services.

Nurse Practitioners' Experiences of Transitioning to and Working in the Pioneering Nursing Role: An Interview Study.

Nurse practitioners (NPs) play a crucial role in healthcare by providing person-centred and high-quality care. Their contributions encompass enhanced accessibility to healthcare and reduced hospital admissions and cost-effectiveness. They usually hold a master's degree in nursing, incorporating expanded clinical skills to manage patients in different settings and address both nursing and medical needs. Despite the global development of the role, its implementation varies, presenting challenges related to role clarity, regulation and acceptance by other healthcare professionals. To explore how nurses who are or have been employed as NPs describe their experiences of transitioning to and working in the NP role in Sweden. A qualitative interview study. This study explores the experiences of 15 NPs in Sweden, using a snowball sampling strategy and semi-structured interviews. The data were collected through interviews in April and May 2022 and analysed with inductive content analysis. The present study explores the experiences of NPs as they transition from experienced nurses to NPs, emphasising motivations, educational challenges, acceptance and autonomy. Transitioning into the NP role initially brought isolation that evolved into acceptance. They recognised their strength in integrating medical and nursing competencies for holistic care. Leadership was pivotal, with managerial support crucial for the successful implementation of the role. Autonomy-related challenges, such as prescription rights and dependency on physicians, underscored the need for a protected professional title and national guidelines. This study enriches the evolution of the NP role in Sweden, offering vital insights into the ongoing national-level dialogues on NP role development in Sweden. The paper's relevance extends globally by providing valuable perspectives on NPs practicalities and fostering international understanding and advancement. Standards for reporting qualitative research. Not applicable.

Information quality and students’ academic performance: the mediating roles of perceived usefulness, entertainment and social media usage

PurposeThis study evaluates the mediating roles of entertainment, perceived usefulness, and social media use on social information (content) and students’ academic performance.MethodologyPrimary data was collected from 445 students at King Khalid University in Saudi Arabia using the snowball sampling strategy was employed. For data analysis, structural equation modeling (PLS-SEM) was used.FindingsEntertainment partly mediates the link between social information quality “content” (IQ) and social media use (SMU) and SMU mediates the link between IQ and student’s academic performance (SAP). Perceived usefulness mediates the link between IQ and SAP. Suggesting that entertainment and perceived usefulness are crucially necessary for inspiring social media content to obtain optimum performance among graduate students. The study was limited to a single academic institution. Therefore, the results of the investigation cannot be generalized as a whole, and cannot track respondents’ social media activity over time. Thus, longitudinal data may be used in future investigations. Practical implicationsThe results of this study indicate that faculties can adapt and adjust their teaching methods and activities to incorporate social media, perceived usefulness, and entertaining content since it affects student performance. Social media (SM) has a significant influence on students’ social and academic performance. Thus, educational stakeholders, such as university authorities, the government, and parents and guardians, should recognize social media as a tool for achieving educational objectives.Originality/valueThe study enhances the application of UTAUT2 by examining how factors that influence the adoption of technology are connected to the subsequent influence of that adoption on students’ learning and conduct.

Exploring the Experiences, Perceptions and Social Dynamics of Electronic Cigarette Users: A Qualitative Study.

Electronic cigarettes, or e-cigarettes, are rapidly gaining popularity throughout the globe as safer alternatives to traditional cigarette smoking. There are significant public health concerns due to the uncertainty of long-term health consequences. This study aims to examine the experiences, attitudes and social dynamics of e-cigarette users to provide guidance for public health policies and interventions. In this qualitative descriptive study, semi-structured interviews were conducted. Fifteen e-cigarette users were recruited using a snowball sampling strategy, where initial participants referred other suitable users. All participants had at least 6 months of regular e-cigarette use. Data were collected through face-to-face interviews with open-ended questions. The interviews were transcribed verbatim and reviewed by the researchers. This review identified four main themes and eight sub-themes. The four main themes identified as a result of the analysis are as follows: (1) initiation and usage experiences; (2) perceptions of health effects; (3) social and environmental factors and (4) addiction and future plans. Participants primarily began using e-cigarettes out of curiosity, due to the appealing fragrance and the belief that they were less harmful than traditional cigarettes. Usage patterns varied among participants, with some reporting minimal cravings in the early morning hours. Opinions on the long-term health effects of e-cigarettes were diverse, with many participants acknowledging uncertainty. Peers and family members perceived e-cigarettes as more socially acceptable than traditional smoking, resulting in fewer negative reactions. Finally, participants' levels of addiction and intentions to quit varied, with some expressing a desire to reduce or cease usage due to health concerns. The findings of this study indicate that the adoption of e-cigarettes is influenced by a confluence of factors, including curiosity, the perception of reduced damage in comparison to conventional cigarettes and social acceptance. Notwithstanding these claimed advantages, users have a diverse array of beliefs and understandings concerning the enduring health consequences of e-cigarettes. The presence of varying levels of addiction and the corresponding aspirations to cease the behaviour highlight the necessity for focused public health interventions. E-cigarette users were actively involved in this study, providing essential insights and feedback throughout. Their first-hand experiences shaped the interview guide and contributed to the identification of key themes. Participants also reviewed and confirmed the accuracy of the interview transcripts, ensuring the reliability of the data.

Exploring Family Resilience: Experience of Chinese Families During COVID-19 Lockdown

Informed by the family resilience theories, the purpose of this paper is to examine the resilience of family during COVID-19 lockdown crisis in Nanjing, China. In particular, the challenges these families face, the coping strategies they use, the roles of each member plays, and the resources they have are analyzed within the framework of the theories. The interviewed families were recruited with non-probability purposive and snowball sampling strategies in a gated community in Nanjing. Semi-structured in-depth interviews were conducted to all the family members, except those under 18, in a total of 11 families. The study finds that the fluid and dynamic family structures embedded in deeply-rooted kinship system and subsystem in everyday practice are useful and effective resources to help family members develop resilience against COVID-19 crisis. This paper advocates that more comparisons of cross-culture, cross-social categories and social status in different cities and countries can be further conducted to explore the particularity of how families develop their own family resilience to deal with the COVID-19 and/or other crises.

Lifestyle and health vulnerabilities of people with disabilities in the COVID-19 pandemic

Objective: To analyze the vulnerabilities related to lifestyle and health of people with disabilities in the COVID-19 pandemic. Methods: This cross-sectional study analyzed the characteristics and health perceptions of 250 people with disabilities based on home visits using the reference network or snowball sampling strategy. A questionnaire was used to collect data on type of disability, cause, duration, physical activity, smoking and alcohol consumption, use of continuous medication, and pre-existing diseases. The chi-square test was used to analyze the data for compliance, frequency, percentages and p-values. Results: People with motor disabilities, acquired over the course of their lives and related to disease complications, predominated. With regard to health vulnerabilities, lack of physical exercise and continuous medication use were predominant. However, most respondents reported that they did not smoke or drink alcohol. Conclusion: The health and lifestyle vulnerabilities of people with disabilities identified in this study could help in the development of actions aimed at promoting the quality of life and health of this population, as well as in the identification of risk factors to be considered when designing health policies.

PARTICIPANTS’ PERCEPTIONS OF THE CONTRIBUTION OF THE EXPANDED PUBLIC WORKS PROGRAMME TO SUSTAINABLE LIVELIHOODS

Public Employment Programmes (PEPs), which include the South African Expanded Public Works Programme (EPWP), are widely recognised as important social protection tools that address the challenges of persistent unemployment and dire poverty. PEPs offer a ‘win-win’ policy option by creating jobs while simultaneously generating assets and delivering services. In South Africa, the impact of PEPs has primarily been evaluated based on employment opportunities, thus creating a gap in the comprehensive assessment of their contribution to the broader livelihood of participants beyond job creation. To address this gap, a qualitative research method was employed, utilising a snowball sampling strategy and the Sustainable Livelihoods Framework as the theoretical foundation for the investigation. The findings of this study underscore the positive contribution of the EPWP to the livelihoods of its participants. However, the study also uncovered various challenges confronting the programme, such as non-compliance with program regulations, such as payment below minimum wage rates and difficulties in meeting youth employment targets amidst escalating youth unemployment rates in South Africa. The research recommends introducing a national EPWP policy with enforcement mechanisms and youth-focused programmes while strengthening local institutions to provide services and processes to enhance the impact of these programs and create a conducive environment for beneficiaries to improve their livelihoods and escape poverty.

Regular Physical Activity Can Counteract LONG COVID Symptoms in Adults over 40.

To assess the impact of physical activity on the management and rehabilitation of LONG COVID, as well as to investigate the persistence of LONG COVID symptomatology in individuals over 40 years, beyond the pandemic. A total of 1004 participants (aged 53.45 ± 11.35) were recruited through an online snowball sampling strategy to complete a web-based survey. The following questionnaires were administered: Physical Activity Scale for Elderly (PASE), Shortness of Breath Questionnaire (SOBQ), Patient Health Questionnaire-9 item (PHQ-9), Generalized Anxiety Disorder 7-item (GAD-7), and Fatigue Scale for Motor and Cognitive Functions (FSMC). Significant gender differences were discovered, with women reporting higher symptoms than men (p < 0.001). Significant age differences were also found, with participants under 55 showing higher values than those over 55 (p < 0.001). No significant differences were found between aerobic and mixed physical activity (p > 0.05) while significant results emerged between physical activity groups and the no activity group (p < 0.001). The low-frequency group reported higher symptoms than the high-frequency group (all ps < 0.001). Regardless of the type of physical activity performed, our survey identified the frequency of training as a crucial factor to overcome LONG COVID symptoms; the challenge lies in overcoming the difficulties due to the persistent feelings of inefficiency and fatigue typical of those who have contracted the infection.

Medical Teachers' Roles from the Students' Perspective: A Moroccan National Survey-based Study.

The present study aimed to explore medical students' expectations from their teachers in Moroccan medical schools, regarding their primary educational roles. An online questionnaire was distributed to medical students from the five main public medical schools in Morocco using a snowball sampling strategy. Two thousand four hundred and eighteen complete answers were collected and analyzed. The respondents gave the highest scores to "information provider" and the lowest scores to "Planner." When asked about their most preferred role they would want to see in their teachers, 40.6% of the respondents chose "Facilitator." These results highlight that Moroccan medical schools should become more invested in training their faculty members to meet the rapidly changing demands and requirements of modern medical education.

“I feel like I’m walking on eggshells”: a qualitative study of moral distress among Chinese emergency doctors

BackgroundWhile the number of emergency patients worldwide continues to increase, emergency doctors often face moral distress. It hampers the overall efficiency of the emergency department, even leading to a reduction in human resources.AimThis study explored the experience of moral distress among emergency department doctors and analyzed the causes of its occurrence and the strategies for addressing it.MethodPurposive and snowball sampling strategies were used in this study. Data were collected through in-depth, semi-structured interviews with 10 doctors working in the emergency department of a tertiary general hospital in southwest China. The interview data underwent processing using the Nvivo 14 software. The data analysis was guided by Colaizzi’s phenomenological analysis method.Study findingsThis study yielded five themes: (1) imbalance between Limited Medical Resources and High-Quality Treatment Needs; (2) Ineffective Communication with Patients; (3) Rescuing Patients With no prospect of treatment; (4) Challenges in Sustaining Optimal Treatment Measures; and (5) Strategies for Addressing Moral Distress.ConclusionThe moral distress faced by emergency doctors stems from various aspects. Clinical management and policymakers can alleviate this distress by enhancing the dissemination of emergency medical knowledge to the general public, improving the social and economic support systems, and strengthening multidisciplinary collaboration and doctors’ communication skills.

Investigating artisanal fishers’ support for MPAs: Evidence from the Tuscan Archipelago (Mediterranean Sea)

In order to meet the “30 by 30” target of the EU Biodiversity Strategy, efforts for establishing new marine protected areas (MPAs) in European seas will increase in the upcoming years, thus affecting an increasing number of stakeholders. However, despite widely distributed across the globe, many MPAs fail to achieve their goals due to the little weight attributed to fishers’ perception as well as their scarce involvement in the different stages of MPA, from planning to management. Using the Tuscan Archipelago as a model system, we gathered artisanal fishers perceptions of MPAs and investigated potential drivers for MPA support. Information was also collected on the level of satisfaction on and involvement into current management of coastal environments, as well as fishers management proposals. Data was gathered from a sample of 27 artisanal fishers (representing 30 % of total fishers) through semi-structured interviews based on an opportunistic+snowball sampling strategy. Several fishers express positive perceptions towards the MPA concept, as long as fishers involvement is granted. Fishers open to the MPA concept are also available to change fishing gear and areas if an MPA includes their usual fishing grounds. Our results suggest that the effectiveness of MPAs in sustaining coastal biodiversity and associated harvestable stocks could be enhanced by the involvement of artisanal fishers in MPA establishment and management.

Unraveling substance abuse among Malawian street children: A qualitative exploration.

This qualitative study adopts a phenomenological and symbolic interactionist approach to comprehensively explore substance abuse among street children in Lilongwe, Malawi. The research aims to uncover the complex sociocultural, economic, and environmental determinants influencing substance abuse within this marginalized cohort. Through in-depth semi-structured interviews, the study engages with street children to understand their subjective experiences, perceptions, and interpretations of substance abuse within their community context. Employing convenience, purposive, and snowball sampling strategies, the research collected data from street children, acknowledging their transient nature and societal challenges. Thematic analysis was conducted on interview transcripts to derive comprehensive insights. Results revealed five key thematic areas: familial absence and emotional void, societal normalization and peer pressure, economic hardships, coping mechanisms, environmental accessibility, and peer influence and belongingness. These themes highlighted the intricate interplay between personal experiences, socio-environmental factors, and peer dynamics, shaping the prevalence and persistence of substance abuse among street children. This study's implications for practice underscore the need for tailored interventions and support mechanisms addressing substance abuse within this demographic. It emphasizes the urgency for context-specific strategies and policy formulations aimed at ameliorating the challenges faced by street children dealing with substance abuse in Malawi. Ultimately, this research contributes to a deeper understanding of substance abuse among marginalized street children, advocating for compassionate and contextually sensitive interventions within this overlooked drug abusers' population subset.

Enterprise chatbots in managers' perception: a strategic framework to implement successful chatbot applications for business decisions

PurposeThe contemporary business environment is characterised by an increasing reliance on artificial intelligence, automation, optimisation, efficient communication and data-driven decision making. Based on the limited academic literature that examines the managerial perspective on enterprise chatbots, the paper aims to explore organisational needs and expectations for enterprise chatbots from a managerial perspective, assesses the relationship between managerial knowledge and managerial opinion regarding enterprise chatbots, and delivers a framework for integrating chatbots into the digital workforce.Design/methodology/approachThe paper presents a quantitative design. An online, self-administered survey yielded 111 valid responses from managers in service and manufacturing organisations based on convenience and snowball sampling strategies. Given the nature of the data and the research questions, the research was conducted using principal component analysis, parallel analysis, correlation, internal consistency and difference in means tests.FindingsThis research explores the managerial perspective on enterprise chatbots from multiple perspectives (i.e., adoption, suitability, development requirements, benefits, barriers, performance and implications), presents a heat map of the average level of chatbot need across industries and business units, highlights the urgent need for education and training initiatives targeted at decision makers, and provides a strategic framework for successful chatbot implementation.Practical implicationsThis study equips managers and practitioners dealing with enterprise chatbots with knowledge to effectively leverage the expected benefits of investing in this technology for their organisations. It offers direction for developers in designing chatbots that align with organisational expectations, capabilities and skills.Originality/valueInsights for managers, researchers and chatbot developers are provided. The work complements the few academic studies that examine enterprise chatbots from a managerial perspective and enriches related commercial studies with more rigourous statistical analysis. The paper contributes to the ongoing discourse on decision-making in the context of technology development, integration and education.

`It's not just linguistically, there's much more going on': The experiences and practices of bilingual paediatric speech and language therapists in the UK.

Despite the high prevalence of bilingualism in the United Kingdom, few speech and language therapists (SLTs) are bilingual themselves. Most SLT research on bilingualism has generated knowledge to inform service delivery for bilingual clients, but few studies have investigated how being a bilingual SLT influences one's professional experiences and practices. Better understanding the unique positionality of bilingual SLTs can yield critical insights to meaningfully address issues of diversity, inclusion and equity in the profession. To investigate the experiences and practices of bilingual paediatric SLTs in the United Kingdom through the lens of Cultural-Historical Activity Theory-International Classification of Functioning, Disability and Health (CHAT-ICF), a new theoretical framework developed to conceptualise the activities of professionals working in the field of disability. In this qualitative study, 19 bilingual paediatric SLTs practising in the United Kingdom were interviewed individually. Participants were recruited through a snowball sampling strategy, and semi-structured interviews conducted online. The data were analysed using reflexive thematic analysis and following a hybrid inductive-deductive approach to map the results onto the CHAT-ICF framework. Six overarching components of the CHAT-ICF framework hosted the 12 sub-themes identified to capture the experiences and practices of bilingual SLTs: (1) Subject (intersectionality); (2) Tools (language skills, education, clinical resources); (3) Rules (systemic barriers, sense of responsibility); (4) Community (sense of inclusion); (5) Division of labour (parents, colleagues); and (6) Practice (empathy with children, holistic mindset, flexible approaches). The use of the CHAT-ICF theoretical lens revealed two fundamental structural phenomena: (1) the distribution of sub-themes across many components of CHAT-ICF demonstrated that being a bilingual SLT is a multifactorial experience; and (2) the chain reactions between sub-themes illustrated the dynamic nature of bilingual SLTs' experiences which can be harnessed to challenge marginalisation and promote equity in the profession. This is the first qualitative study to date to provide in-depth insights into the experiences and practices of bilingual SLTs in the United Kingdom. These insights can be mobilised to inform the meaningful inclusion of bilingual SLTs in workforce planning efforts and service development. Recommendations include using intersectional lenses, providing cultural and anti-racism awareness training to SLTs, developing more diverse clinical resources and flexible approaches for bilingual families, valuing bilingualism in recruitment processes and increasing accountability at the leadership level. Research giving voice to bilingual SLTs, and other underrepresented demographics in the SLT workforce, can catalyse action to promote a more diverse and inclusive profession in line with the Royal College of Speech and Language Therapists' strategic vision 2022-2027. What is already known on the subject Most research on bilingualism in speech and language therapy is focused on issues related to service provision and delivery for bilingual clients with little consideration for bilingual speech and language therapists' (SLTs) unique positionality. A few survey studies have shown that bilingual SLTs report significantly higher competency and greater confidence when working with clients who speak multiple languages, but there are significant gaps in understanding how bilingualism impacts other aspects of their professional experiences. What this paper adds to existing knowledge This is the first study to provide in-depth insights into the experiences and practices of bilingual SLTs in the United Kingdom. We show that being bilingual profoundly impacts many aspects of their professional experiences, including their clinical identity, skillset, sense of inclusion in the workplace, work relationships and clinical approaches. Bilingual SLTs expressed developing trust relationships with bilingual families and adopting flexible approaches to account for their clients' environmental factors, all of which can contribute to more equitable SLT services. This study also makes a novel contribution by proposing and using the Cultural-Historical Activity Theory-International Classification of Functioning, Disability and Health (CHAT-ICF) framework to conceptualise and investigate SLTs' experiences and practices. What are the potential or actual clinical implications of this work? This study provides evidence-based recommendations to inform progress towards the Royal College of Speech and Language Therapists' strategic vision 2022-2027 and the diversification of the profession. Actions to support bilingual SLTs and diversify the profession include shifting a rigid mindset of linguistic and cultural `competence' to self-growth and awareness, developing more diverse clinical resources and flexible approaches for bilingual families, valuing bilingualism in SLT recruitment processes and career progression and increasing accountability and leadership around issues of diversity in the workplace. The novel CHAT-ICF framework has the potential to be used to support therapists' reflexivity in their practice or structure audits of rehabilitation services. Intersectionality theories and transformative processes can catalyse positive change in clinical services and research around bilingualism.

Experiences of teachers in vocational programmes in special needs schools, City of Cape Town.

Vocational programmes run by teachers in the special needs school context can play a significant role in the vocational development of learners with severe intellectual disability (SID). This study aimed to answer the question 'what are the challenges faced by teachers in the implementation of vocational programmes in selected public special needs schools for learners with SID in the Metropolitan (Metro) District within the City of Cape Town?' The objectives were to describe the challenges as perceived by participants, to highlight common and contrasting challenges in the different schools and to share recommendations on support needed. A qualitative descriptive study was conducted. A combination of purposive and snowball sampling strategies was used to select six teachers from six special needs schools. One-on-one semi-structured interviews with teachers were performed. An interview schedule was used as a tool and all interviews were transcribed and translated into English verbatim. Thematic analysis was applied. The findings showed that teachers encounter inadequate resources, a lack of training, and poor support systems. This study highlights the issues of existing policy and the lack of a mandatory policy on vocational programmes in South Africa. The participants' experiences added to the existing literature by providing valuable insights into the obstacles teachers encounter in this relatively new curriculum. A multifaceted policy framework that is well funded and implemented is much needed to address the challenges identified. The findings may contribute to the development and strengthening of policies on vocational programmes within the South African context.

Building Perspectives for Resilient Health System: Lessons Learned from the Experience of Patients and Health Professionals during COVID-19

The study seeks to explore experiences and perceived needs of patients in source isolation and healthcare professionals’ management of COVID-19 patients to inform practice in the event of emerging health disaster. Participants were recruited through snowball and purposive sampling strategy. We conducted semi-structured telephone interviews to understand their subjective evaluations of these events. We applied inductive thematic analysis, which yielded six themes. The health events resulting from COVID-19 varied and shaped patient perspectives. Response to care received and trust in healthcare providers was encouraging, including expressions of gratitude and resilience towards discomfort brought on by isolation. Processing COVID-19 in isolation describes how patients cognitively and psychologically dealt with the illness. Clinicians’ experiences of working in isolation centred around workflow management, maintaining safety, focus on patient-centric approach and expanding roles of health workers, even as complacency towards COVID-19 was on the rise. Effective deployment of resources, efforts of experienced clinicians and staff, along with cooperation and resilience of patients, paves the way for the system to endure through the crisis. These lessons can be preserved for practice as global health entities are pushing for pandemic response, preparedness and prevention through measures such as the pandemic treaty.

Responding to outbreaks of illness linked to unpasteurized milk: A needs assessment of state health and agriculture departments.

Consumption of unpasteurized milk can result in severe illness or death. In the United States, the number of people who regularly consume unpasteurized milk is relatively low, but outbreaks resulting from unpasteurized milk outnumber outbreaks linked to pasteurized milk. The sale of unpasteurized milk for human consumption through interstate commerce is prohibited at the federal level, but laws among states vary considerably with respect to the sale of unpasteurized milk. Each state has a different perspective on responding to and preventing outbreaks of illness linked to consuming unpasteurized milk. We conducted a needs assessment of state health and agriculture departments to gather information on state-level strategies to prevent illnesses linked to consuming unpasteurized milk, characterize challenges states face, and identify areas where partners can support state efforts to prevent illnesses. We deployed a survey from 6 January 2021 to 1 March 2021, using a snowball sampling strategy and had 158 respondents. Of 115 respondents, 46 (40%) believed that state laws were ineffective in preventing illnesses, and 92 (80%) agreed that consumers continue to find ways to get unpasteurized milk despite laws restricting sale. Respondents from 19 states were aware of future legislative or regulatory efforts surrounding unpasteurized milk in their state, with 14 (74%) indicating these efforts would expand consumer access. The most common outbreak prevention strategies respondents mentioned included sharing knowledge and experiences with other public health and agriculture officials, providing information to inform legislative efforts, and communicating to the public about outbreaks. Most respondents (41/50, 91%) were interested in pursuing further efforts to prevent unpasteurized milk-associated illnesses in their state. The results from this needs assessment can be used to inform future strategies for preventing illness outbreaks associated with unpasteurized milk consumption.