Staff Communication Research Articles

1069: LESSONS LEARNED USING A PERIOPERATIVE HANDOFF TOOL FOR PICU PATIENTS WITH AN OPEN MEDICAL STAFF

Introduction: Standardized peri-operative hand-offs in the ICU lead to improved communication during patient transfer but implementation is not well described in an open medical staff model with many surgeons without trainees. Our goal was to implement a hand-off tool in this model and determine whether it improved staff satisfaction and communication in the PICU. Methods: A PI project was implemented in a PDSA framework. A workgroup was formed with representatives from PICU, anesthesia, and surgery, who created a hand-off tool and educated their teams. Its use was expected on all transfers from OR to PICU and PICU to OR for a 10-month period (Phase 1) and compliance was monitored. Pre- and post-implementation surveys were completed by nurses and physicians to assess level of agreement with statements on adequacy and communication in the hand-off process. After Phase 1, the staff were re-educated on the project and the tool was placed in the chart of eligible patients. Data was then collected over a 2-month period (Phase 2). Results: In Phase 1, there were 179 patients and 40 (22%) underwent the standardized hand-off. In Phase 2, 27 of 40 patients underwent the standardized hand-off (68%,p< 0.0001). Pre-surveys indicated over 90% of physicians and nurses felt that standardized hand-offs could improve patient safety and reduce team confusion. Post-implementation, nurse satisfaction with the hand-off process and communication improved from 24 to 65% and 8 to 57% respectively (p< 0.002). Physician satisfaction increased (50 vs 85%), but was not significant. Conclusions: Use of a peri-operative hand-off tool was associated with significantly greater feelings of hand-off adequacy and good communication among nurses. Although physicians felt that its use could improve safety and communication, it was difficult to get their compliance. This was due to many surgeons in private practice who did not have trainees to assist them. Identifying nursing and physician leaders, continually re-educating the process, and easing access to the hand-off tool are critical to successful implementation.

Evaluation of a training programme for critical incident debrief facilitators.

Critical incident debriefs are a commonly used occupational health tool for supporting staff after traumatic work incidents. However, there is a dearth of literature evaluating training programmes for debrief facilitators. To evaluate a 5-day training programme to equip healthcare, social care and voluntary, community and social enterprise sector staff to act as post-incident peer supporters and debrief facilitators. A mixed-methods, single-arm, before-and-after study. Data were collected at baseline and post-training. The quantitative outcome measure was 'Confidence'; the sum of two items measuring confidence in (i) supporting peers after critical incidents and (ii) facilitating post-incident structured team discussions. At post-training, quantitative and qualitative feedback regarding experiences and perceptions of the training was also gathered. We recruited 45 participants between October 2021 and January 2022. Confidence in supporting peers following incidents and facilitating post-incident structured team discussions increased significantly following the training, t(35) = -6.77, P < 0.001. A majority of participants reported they would do things differently because of the training and that they found the training relevant, useful and engaging. Summative content analysis of qualitative feedback indicated that participants (i) believed the role plays were an important learning tool and (ii) thought it was important that the trainer was engaging. Some participants would have preferred in-person delivery. Participants valued training in post-incident peer support and debriefing skills. Organizations implementing post-incident support pathways could usefully include this training and ensure optimal uptake and engagement by (i) providing in-person and online delivery options and (ii) including role play as a learning technique.

Strategies, challenges and enabling factors when imaging autistic individuals in Swiss medical imaging departments

IntroductionAutistic individuals may require medical imaging but they can face barriers that are related to lack of adjustments in their care. This study aims to explore and understand strategies currently used by Swiss radiographers to image autistic patients and to propose recommendations for clinical practice. MethodsThe Swiss Ethics of the canton of Vaud committee approved the study. Data collection was gathered using a mixed method approach by an online survey and followed by selected interviews. Descriptive statistics and thematic analysis were used to analyse the data. ResultsA hundred completed responses to the survey were obtained and five individual interviews were conducted. Sixty participants reported having managed autistic patients. The main enablers identified were: the support from carers, adapting the behaviour of staff and customising communication. The main challenges were a lack of communication and the lack of knowledge about autism to appropriately manage the patient. Only five radiographers had received prior training in autism. ConclusionMedical imaging departments must develop protocols to overcome the lack of communication between services, radiographers, and autistic service users. The lack of radiographer knowledge about autism can impact autistic patient management, resulting in carers playing an important role during the examination. Customised education for radiographers about autism is needed. Implication for practiceThe development of a scheduling protocol for each imaging modality could improve communication with the patient. The organisation of the physical environment and the patient's preparation for the examination are critical to provide adequate imaging care. It is suggested that medical imaging professionals, autistic service users, and autism organisations collaborate to develop autism related guidelines for medical imaging examinations.

"Communication Is Not Exactly My Field, but It Is Still My Area of Work": Staff and Managers' Experiences of Communication With People With Traumatic Brain Injury.

Communication between people with traumatic brain injury (TBI) and rehabilitation staff can be impacted by cognitive-communication disorders. Communication partner training (CPT) programs hold potential to improve communication between people with TBI and their communication partners. To tailor CPT programs to the rehabilitation environment, it is critical to understand the nature of communicative interactions for staff members. This study explores staff and managers' experiences of communication with people with TBI in the rehabilitation setting. Individual semistructured videoconference interviews were carried out with staff members (n = 22) and managers (n = 4) varying in terms of professions and length of work experience. Interviews were guided by a phenomenological approach to gain comprehensive knowledge of staff and managers' lived experiences of communication with people with TBI. Four themes with nine subthemes were generated: (a) cognitive-communication disorders challenge interaction (communication is socially inappropriate, the diversity of presenting symptoms associated with TBI is demanding), (b) staff struggle in communication (there is a breakdown of communicative collaboration, communication increases staff's workload, emotional well-being of staff is at risk), (c) communication context is crucial (tasks affect communication, extending the professional roles), and (d) staff want communication knowledge and skills (needs vary according to work experience, access to tailored strategies, and feedback). Staff and managers experienced communication with people with TBI as highly demanding. The socially inappropriate communication in people with TBI was perceived to disturb the collaborative aspects of communication and create negative emotional impacts for staff. Staff experiences varied according to discipline, work experience, rehabilitation tasks, and facility. Consequently, staff and managers expressed a need for specific communication strategies to help them overcome the communicative challenges. https://doi.org/10.23641/asha.21579159.

Association between the Big Five personality traits and medication adherence in patients with cardiovascular disease: A cross-sectional study.

The correlation between personality traits and health outcomes of primary prevention has been examined. However, there is a lack of evidence on the association between the assessment of personality traits and medication adherence for secondary prevention of cardiovascular disease. Thus, this study aimed to explore the association between personality traits and medication adherence, including compliance to prescribed medications and attitudes toward taking medications among patients with cardiovascular disease. This cross-sectional study included patients hospitalized for cardiovascular disease. We assessed the Big Five personality traits (conscientiousness, neuroticism, openness, extraversion, and agreeableness) of each patient at discharge using the Ten-Item Personality Inventory. In addition, we evaluated four aspects of medication adherence using a 12-item version of the medication adherence scale: medication compliance, collaboration with health care providers, willingness to access and use information on medication, and acceptance to take medication. Logistic regression analysis was performed to assess the correlation between the level of each medication adherence domain and each personality trait. The data of 128 patients with cardiovascular disease were analyzed. Higher conscientiousness score was significantly associated with a high compliance score (odds ratio per 1 point increase, 1.90; 95% confidence interval, 1.30-2.79; p = 0.001), high collaboration score (1.90; 1.31-2.76; p = 0.001), and high willingness score (1.74; 1.19-2.54; p = 0.004) after adjustment for potential confounders. Other combinations of personality traits and medication adherence showed no statistically significant correlations in multivariate analyses. The findings of this study suggest that assessment of personality traits, especially conscientiousness, may facilitate patient-medical staff communication for the improvement of medication adherence in patients with cardiovascular disease.

Legal Service Post Application at the Soppeng District Attorney Office

With the development of technology, it makes work faster and more efficient, such as in legal services or the provision of legal services by the State Attorney (JPN) in writing or orally to the public, which includes individuals and legal entities as well as legal service posts. However, with the habit of people coming to the office to carry out consultations which take time for services, this prompted us to create a Web-Based Legal Service Post Application at the Soppeng District Attorney's Office. With the waterfall research method in application design there is analysis, design, implementation, testing and maintenance so as to produce a Web-Based Legal Service Post Application that can facilitate the community and prosecutor's staff in the legal service process so that this activity can be carried out without having to go directly to the office.

Financial department staff's interaction and business communication

Introduction. Staff's interaction and business communication play an important role both in the professional growth of each employee and in the work of the entire organization. Since the financial department interacts with almost all departments of the organization, the financial department staff's communication within the department and with other departments affects the work of the organization as a whole. Aim. To explore the features of the financial department staff's interaction and business communication as well as to select the instruments to conduct an empirical study of the financial department staff's interaction and business communication. Methods: theoretical analysis of the problem, analysis of empirical research methods and instruments. Results. The article substantiates the study of the financial department staff's interaction and business communication. The authors analyze the concepts of interaction and business communication, discuss the features of the financial department staff's interaction and business communication, the work of the financial department, the financial department staff's competencies and behavior, the financial department staff's business etiquette and ethics as well as analyze the methods and instruments for studying staff's interaction and business communication. Conclusions. Financial department staff should have good communication skills, because the atmosphere of friendliness, staff's care for the co-workers' needs and readiness to carry out work tasks improve work performance of not only the financial department, but also the organization as a whole. The proposed set of instruments will make it possible to determine the features of the financial department staff's communication, to find out the relationship between staff's interaction and the organization's management style, to diagnose the social and psychological climate in the department, as well as to analyze the personality traits that worsen staff's interaction and communication.

Patient- and Health-System-Related Barriers to Treatment Adherence for Patients with Drug-Resistant Tuberculosis in the Philippines: A Mixed-Methods Study.

In the Philippines, drug-resistant tuberculosis (DRTB) is a growing concern. Healthcare workers face challenges in retaining patients with DRTB in care. This study intends to understand their perspectives on the factors that influence patient treatment outcomes and to propose potential programmatic solutions for strengthening care services for the patients. A mixed-methods study was conducted in the Philippines between December 2017 and March 2018 to understand the major barriers for healthcare workers to provide quality care to DRTB patients across the care continuum. In the quantitative phase, healthcare workers participated in an online survey; in the qualitative phase, in-depth interviews were conducted with a select number of the survey respondents to better understand their survey responses. 272 healthcare workers participated in the survey, and of those, 11 were interviewed. Survey results identified economic constraints, patient perceptions of care, family-related concerns, and limited accessibility to healthcare services as the major patient-related barriers across the care continuum. Major health-system-related barriers were insufficient human resources, lack of financial and political support, and limited knowledge about DRTB by healthcare providers. Interviews revealed more elaborate, contextualized, and nuanced aspects of each of the major challenges. The elaborated patient-related barriers included expenses needed during treatment (e.g., transportation); fear of being stigmatized by family, community, or healthcare staff; worries about adverse drug reactions from medication; a lack of family support; and the location of patients' homes. The health-system-related barriers revealed through interviews included the limited capacities of facility staff to provide DRTB care due to insufficient human resources; the shortage of funds to support treatment completion (e.g., transportation allowance and food package for patients, service vehicles and mobile phone costs for outreach actions at the facility level); and discrimination by healthcare staff against patients with DRTB attributed to the staff's limited knowledge and experiences of treating the patients. This study identified the main barriers for DRTB facility staff in the Philippines from the perspectives of providers. Further exploration of the barriers and best practices in facilities may be useful for improving DRTB care in the Philippines.

Community Services and Social Involvement in COVID-19 Governance: Evidence from China.

This study explores how the services provided by different types of Chinese communities varied in their impact on the social involvement of residents during the COVID-19 pandemic. The literature revealed problems caused by travel restrictions, including using oversimplified measures for grassroots governance, which might result in decreased residents' social involvement during COVID-19. We argue that the services provided by "smart communities" in China not only adhered to the COVID-19 pandemic governance, but also promoted the social involvement of residents. Using a case study approach of the smart community Fang Xing and the traditional community Qili Tang, both of which are located in China, this article compared the traditional and smart community services based on 122 interviews with residents and frontline community staff members. The findings suggest that while the traditional community decreased the residents' social involvement by restricting certain services during the pandemic, the smart community was able to apply COVID-19 governance measures, considerably increasing the residents' social involvement. It offered an attractive option for residents to act as community service managers, and it prepared them for local-level pandemic governance. This study provides an understanding of the relationship between the community services and the residents' social involvement in terms of the community services. The smart community model can act as a reference for international community development during pandemic governance.

Barriers and enablers to accessing support services offered by staff wellbeing hubs: A qualitative study.

International efforts have been made to develop appropriate interventions to support the mental health needs of healthcare professionals in response to COVID-19. However, fewer staff have accessed these than expected, despite experiencing elevated levels of mental distress since the onset of the pandemic. Consequently, we aimed to examine the barriers and enablers for healthcare professionals in accessing interventions offered by a Staff Mental Health and Wellbeing Hub. Twenty-five semi-structured interviews were conducted with healthcare, social care and voluntary, community and social enterprise (VCSE) sector staff. Data were analysed using thematic analysis. Four key themes were identified: (1) Environment and Atmosphere in the Workplace; (2) The Impacts of COVID-19; (3) Confidentiality; and (4) Awareness and Communication of Resources. Organisational environments were perceived as an important enabler of accessing the hub services for mental health and wellbeing support. This included the importance of recognising and responding to the ongoing pressures of COVID-19- specific challenges. Ensuring and communicating aspects of confidentiality, and ensuring clear and consistent communication of the benefits of the Hub may encourage help-seeking for mental health challenges among healthcare professionals. Our findings highlight important considerations to increase uptake and engagement with services to support the mental health and wellbeing of healthcare professionals and associated staff and volunteers. Organisations aiming to increase employee uptake of these services should regularly circulate consistent and clear emails about what these services offer, provide training and information for managers so they can support staff to access these services and ensure access is confidential.

Patient Satisfaction With Healthcare Service Quality and Its Associated Factors at One Polyclinic in Hanoi, Vietnam.

Introduction: Patient satisfaction is one of the most important components of measuring healthcare quality. Objectives: The study aimed to evaluate the validity and reliability of the patient satisfaction scale with the quality of health services and its associated factors. Methods: A cross-sectional study was conducted to collect data on patient satisfaction with 301 outpatients at one polyclinic in Hanoi, Vietnam. Results: The overall outpatient satisfaction was 53.5%. There were five factors (facilities, services provision results, information transparency and administrative procedures, accessibility, and interaction and communication of staff) including one major factor with high Eigenvalues coefficient, 22.5 for satisfaction with facility, and four others with lower Eigenvalues coefficient, 3.2, 2.0, 1.5, and 1.2 for satisfaction with service provision results, information transparency and administrative procedures, accessibility, and interaction and communication of staff respectively. All satisfaction-factors show internal consistency reliability, with a Cronbach's Alpha of over 0.9. The insured are 3.5 times (95% CI: 1.9-6.2) more likely to be satisfied with health services than the uninsured. Conclusion: The patient satisfaction measurement tool should be used for intervention to improve the quality of health services at the clinic.

Appropriate Public Communication for the Community in Handling the Covid-19 Pandemic in Batu Bara District, North Sumatera Province

Communication and media are important in conveying public communication messages in an effort to overcome the Covid-19 pandemic in Batu Bara District, North Sumatera. To implement public communication during the Covid-19 pandemic, the policy must be able to provide the right choice for the people there. The research questions include, is the public communication policy that has been carried out by the local government in accordance with the expectations of the public in Batu Bara District? Next, what is the public communication model carried out by the local government, including its regent in handling Covid-19 in Batu Bara District? The research uses a qualitative approach and data collection techniques using Focus Group Discussion (FGD). The FGD participants consisted of the regent, and staff and residents of the local community whom we chose separately. The results of the FGD revealed that residents recognized from mass media reports and social media that conveyed that Batu Bara District managed to become one of the best districts in handling Covid-19 and received an award from the Governor of North Sumatera. Some residents expressed, "We expect our father (regent) to be among us". The regent added that for areas far from the district, Covid information was conveyed through religious leaders and community leaders in the village. This is also an appropriate model of public communication, because the local government gives a significant social role to religious leaders and community leaders as an extension of the district government in conveying information related to Covid-19.

Midwifery Basics Human Rights in Childbearing 3: Providing sensitive antenatal care for autistic women and birthing people

Autistic people face significant disparities in their experiences of healthcare services compared to non-autistic people, with autistic adults reporting lower satisfaction with staff communication, and higher odds of unmet healthcare needs relating to their physical health, mental health, and prescription medications.1 These difficulties are also apparent when accessing perinatal care services. It is essential that we address this ensuring the protected characteristic of disability under the Equality Act 2010 is honoured. In this article, Sophie Rayner, Nicolette Porter and Emilie Edwards discuss how midwives can provide sensitive antenatal care for autistic women and birthing people.

Perspectives on Self-Sampling for Cancer Screening From Staff at Federally Qualified Health Centers in Rural and Segregated Counties: A Preliminary Qualitative Study.

Self-sampling for colorectal and cervical cancer screening can address the observed geographic disparities in cancer burden by alleviating barriers to screening participation, such as access to primary care. This preliminary study examines qualitative themes regarding cervical and colorectal cancer self-sampling screening tools among federally qualified health center clinical and administrative staff in underserved communities. In-depth interviews were conducted with clinical or administrative employees (≥18years of age) from FQHCs in rural and racially segregated counties in Pennsylvania. Data were managed and analyzed using QSR NVivo 12. Content analysis was used to identify themes about attitudes towards self-sampling for cancer screening. Eight interviews were conducted. Average participant age was 42years old and 88% of participants were female. Participants indicated that a shared advantage for both colorectal and cervical cancer self-sampling tests was their potential to increase screening rates by simplifying the screening process and offering an alternative to those who decline traditional screening. A shared disadvantage to self-sampling was the potential for inaccurate sample collection, either through the test itself or the sample collection by the patient. Self-sampling offers a promising solution to increase cervical and colorectal cancer screening in rural and racially segregated communities. This study's findings can guide future research and interventions which integrate self-sampling screening into routine primary care practice.

COVID-19 and the role of Voluntary, Community, and Social Enterprises in northern England in responding to the needs of marginalised communities: a qualitative focus group study

BackgroundThe Voluntary Community and Social Enterprise sector has a crucial role in supporting the health and wellbeing of people who are marginalised or who have multiple complex needs. We aimed to understand perceptions of those working in the sector and examine the short-term, medium-term, and long-term effects of COVID-19 on Voluntary Community and Social Enterprise organisations in northern England as they respond to the needs of marginalised communities. This research formed one component of a regional multiagency Health Inequalities Impact Assessment. MethodsWe conducted qualitative focus groups with staff and volunteers from five organisations between March and July, 2021, via a video conferencing platform. Eight of nine focus groups were audio-recorded and transcribed verbatim. One focus group was not recorded due to concerns raised over anonymity and safeguarding, but non-ascribed fieldnotes were taken. Focus group transcripts were analysed using framework analysis. FindingsOne organisation supported children and young people; two organisations supported vulnerable women, young people, and families; one organisation supported refugees and asylum seekers, and one organisation supported disadvantaged individuals to improve their mental and physical health and wellbeing. Three central themes were identified: the exacerbation of pre-existing inequalities, adversity, and challenges for vulnerable and marginalised populations; the cost of being flexible, innovative, and agile for Voluntary Community and Social Enterprise staff and volunteers; and the voluntary sector as a lifeline (organisational pride and resilience). InterpretationThe considerable expertise, capacity, and resilience of Voluntary Community and Social Enterprise organisations and the crucial role they have in supporting marginalised communities has been clearly shown in their response to the COVID-19 pandemic. The Voluntary Community and Social Enterprise sector therefore has an essential role in the post-COVID levelling-up agenda. The implications of these findings for service provision are that the Voluntary Community and Social Enterprise sector must be recognised as an integral partner within any effectively functioning local health system and, as such, adequately resourced to safeguard sustainability and to ensure that attempts to involve the sector in addressing the social determinants of health are not jeopardised. FundingNational Institute for Health and Care Research (Applied Research Collaboration North East and North Cumbria (grant reference NIHR200173) and Public Health England. SSo is supported by a Health Education England and National Institute for Health and Care Research Integrated Clinical Academic Lecturer award (reference CA-CL-2018-04-ST2-010) and Research Capability Funding, National Health Service North of England Care System Support. VJM is funded by the National Institute for Health and Care Research School for Public Health Research (grant reference PD-SPH-2015).

A novel approach to the implementation of Making Every Contact Count

BackgroundMaking Every Contact Count (MECC) is an approach to behaviour change introduced by Public Health England in 2008. Derbyshire have implemented MECC using the Quality Conversation (QC) programme which is based around health coaching and psychology skills and delivered remotely by qualified coaches. This study is an initial evaluation of the QC programme. MethodsParticipants from Derbyshire health, social care, and voluntary organisations were invited to enrol on the QC programme. Before and after analysis of qualitative responses to example patient scenarios using an exact McNemar's test was done. A Wilcoxon signed-rank test was used to measure significant differences in quality conversation skills before and after the training programme. Participant data was analysed using SPSS software (version 28·0·0·0). Written consent for was provided by participants on completion of the feedback form. FindingsBetween July 1, 2020, and March 31, 2022, there were 1277 participants on the core QC training. There were significant differences in knowledge and confidence in using QC skills following training (eg, confidence in active listening, Z = –189·09; p <0·0001). There was a significant difference in the proportion of QC-consistent responses (eg, skills such as validation and open questions, p<0·0001). Further, there was a significant difference in self-rated confidence with responding to example patient scenarios pre and post-training (Z = –118·81; p <0·0001). At 2-month follow-up, 91% of follow-up respondents (N =225) strongly agreed or agreed that the learning from the QC programme had been relevant to their role. InterpretationQC is a novel approach to the implementation of MECC, through reframing the focus to supporting changes in staff communication behaviours. Findings presented suggests QC might represent a scalable approach to the effective implementation of MECC. This is an important finding given the potential of MECC to support health and social care systems to address health inequalities and support the personalisation agenda. FundingJoined Up Care Derbyshire Integrated Care System.

The relationship between eHealth literacy, social media self-efficacy and health communication intention among Chinese nursing undergraduates: A cross-sectional study.

With the popularization of the Internet, it has become possible to widely disseminate health information via social media. Medical staff's health communication through social media can improve the public's health literacy, and improving the intention of health communication among nursing undergraduates is of great significance for them to actively carry out health communication after entering clinical practice. To explore the relationship among eHealth literacy, social media self-efficacy, and health communication intention and to determine the mediating role of social media self-efficacy in the relationship between eHealth literacy and health communication intention. A cross-sectional descriptive correlation design was used in this study. Stratified cluster sampling was used to select 958 nursing students from four nursing colleges in Jiangsu Province, China, from June to July 2021. Data were collected using the eHealth Literacy Scale, the Social Media Self-efficacy Scale, and the Health Communication Intention Questionnaire. Sociodemographic data were also collected. Correlation analysis and regression analysis were used to determine the relationship between eHealth literacy, social media self-efficacy, and health communication intention. Health communication intention is positively correlated with eHealth literacy and social media self-efficacy. There is a significant positive correlation between eHealth literacy and health communication intention (β = 0.57, p < 0.001), and social media self-efficacy played a mediating role in the influence of eHealth literacy on health communication intention (the mediating effect accounted for 37.2% of the total effect). The study found that eHealth literacy and social media self-efficacy had an impact on health communication intention. Because there is a correlation between eHealth literacy and social media self-efficacy and health communication intention, in order to promote health communication intention of nursing students, it is also important to cultivate eHealth literacy and social media self-efficacy of nursing students. In view of these results, targeted educational programs must be developed to improve eHealth literacy and social media self-efficacy among nursing undergraduates, thereby promoting their health information transmission.

Challenges of Type 2 Diabetes Mellitus Management From the Perspective of Patients: Conventional Content Analysis.

Patients with type 2 diabetes mellitus (T2DM) face significant challenges in the treatment process, which can have a negative impact on disease management. Proper management of the disease can reduce symptoms and complications, improve glycemic indices, and reduce mortality and readmission. Given the influential role of patients in prevention and self-care, this study was conducted to explore the challenges of diabetes management from the perspective of patients. Two rounds of focus group discussions with T2DM patients were conducted. The principal investigator of the study and a research assistant compiled a list of volunteer patients with names and contact information and selected participants based on their medical information. Participants were chosen via a purposive sampling technique. The questions were designed to encourage patients to share their views on how the treatment team communicates and participates in treatment, how they are trained, and the health care system. The discussion continued until data saturation. During 2 rounds of focus group discussions, the voices of the participants were recorded by 2 voice recorders, and one of the team members was a transcriber. After discussion, participant views were transcribed, and common issues were identified, sorted, and reported as categories and subcategories. According to the conventional content analysis, 88 primary codes were extracted from the detailed and in-depth description of the participants. The codes were summarized after repeated readings and classified based on their similarities and semantic relevance. Through analysis and comparison, 4 categories and 7 subcategories were identified: communication challenges (poor medical staff communication, lack of psychological support), challenges to participation in treatment (lack of patient participation), educational challenges (training program bugs, inadequate training), and challenges of the health care system (inefficiency of the care system, caregiver inefficiency). This study showed that the treatment team members should pay more attention to the challenges of care and treatment from the perspective of patients with T2DM. Therefore, recommendations for future policies to overcome these obstacles include establishing a multidisciplinary health care team; using trained health care workers to provide organized treatment and care services; holding individual counseling sessions with patients in need of counseling; and providing counseling services, involving patients in the treatment and self-care process, and designing a comprehensive diabetes education program with an emphasis on education. Necessary information should be provided to the patients, and effective communicate should address patient concerns.

Approach to advanced practice nursing student clinical during COVID-19.

Approach to advanced practice nursing student clinical during COVID-19.

A community-based health–social partnership program for community-dwelling older adults: a hybrid effectiveness–implementation pilot study

BackgroundA growing body of literature supports the efficacy of the health–social approach for the implementation of complex interventions to enhance self-care health management among community-dwelling older adults. However, there is little research on how interventions with this approach are implemented and disseminated in a real community setting.MethodsThis pilot study adopted an effectiveness–implementation hybrid design to 1) evaluate the effectiveness of a community-based Health–Social Partnership Program (HSPP) and 2) explore the reach, adoption, implementation, and maintenance of the HSPP in the community. Potential participants were recruited if they were aged 60 or above, owned a smartphone, and were cognitively competent. The participants received nurse-led case management with support from a social service team. Factors that hindered or facilitated the program delivery were examined to determine the implementation outcomes and sustained effects of the program. Data were collected at pre-intervention (T1), immediately post-intervention (T2), and 3 months post-intervention (T3).ResultsNinety-two older adults joined and completed the program. The recruitment rate was 76.7%. A significant interaction effect was found for the mean self-efficacy scores from T1 to T2 (Wald χ2 = 12.28, p ≤ .001). Barriers to widespread program implementation included manpower shortage, lack of experienced staff, and unpredictable environment, whereas facilitators, as suggested by the older adults, providers, and community staff members, included regular communication between the research and service teams, recruitment of participants through community centers with the support of the research team, and seamless partnership among the health–social partnership team members. Strong implementation fidelity was achieved with zero attrition rate.ConclusionMost conventional randomized controlled trials investigating the effects of community-based programs have tended to control the contextual factors rather than incorporate the program in a real setting. This pilot study was the first to use a hybrid model to test the effectiveness and outcomes of HSPP implementation. The results imply that the program has a high potential sustainability in the real-life context.Trial registrationThis study was registered at clinicaltrials.gov (NCT04442867; date of first registration 23/06/2020).