Client Support Research Articles

Bubble Wrap Is for Packages, Not for People: Balancing Duty of Care and Dignity of Risk

Abstract Supporting clients and their families to live ordinary lives lies at the heart of occupational therapy. But an ordinary life—no matter who is living it—is full of risks, and risks often make us a little anxious. What if I, as a practitioner, encourage a client to take a risk and something undesirable does happen? Will I have shirked my duty of care? Not all experiences we label risky lead to undesirable outcomes. Some simply involve challenges: pushing people beyond their comfort zone so they can achieve more than ever before. Self-esteem is born out of meeting challenges; so is respect. In supporting clients and families to meet the challenges of an ordinary life, we balance duty of care with dignity of risk.

Future proof competencies for nurses working in primary care; a mixed methods study

Abstract Background Healthcare services, also those provided by nurses, are challenged by the increasing care demands of an ageing population and people with chronic conditions. To improve care efficiency and quality, now and in the future, nurses must have competencies regarding self-management support of patients, electronic communication, preventive care, and engaging relatives in care. This study aimed to assess primary care registered nurses’ (RNs) time allocation to these competencies and their perceived needs for further development of these competencies. Methods A mixed methods design was used, involving a nationwide survey (n = 303) and focus groups (12 participants), both with RNs working in community care services or general practitioners (GPs) practices. Survey data were analysed descriptively, and focus group transcripts underwent qualitative thematic analysis. Results The majority of RNs invest significant time in client self-management support (90%), preventive care (82%), and involving relatives in care (74%). RNs also recognized an increasing demand for these competencies in the future and the need to motivate patients and relatives to self-manage their health. Furthermore, RNs reported that competencies regarding electronic communication skills will become extra important in the future, yet currently only 37% dedicate substantial time to this. RNs face challenges in effectively utilizing electronic communication with patients and thus need opportunities to improve digital skills. Additionally, RNs desire enhanced collaboration with other healthcare professionals, such as GPs and medical specialists. Conclusions RNs’ limited time allocation and perceived inadequacy in electronic patient communication, underscore the importance of targeted training in this area, and prioritizing this by healthcare organizations. In addition, fostering collaboration between nursing staff and other healthcare professionals could support future proof nursing in primary care. Key messages • Nurses demonstrate resilience in addressing healthcare challenges, emphasizing client care, prevention and family engagement. • Training nurses in competencies for electronic communication with patients is essential to meet the anticipated increase in demand for this aspect in their practice.

Abortion Law Changes and Occupational Therapy Practice in the United States.

The U.S. Supreme Court overturned Roe v. Wade in 2022, changing access to abortion in many states. The impact of these changes on occupational therapy practice has not yet been explored through empirical research. To explore the perspectives of occupational therapy practitioners on how restrictions to abortion in the United States may have influenced their clients' needs and thus their practice. This was a qualitative research study. We used an interpretivist epistemological approach and an inductive, thematic content analysis. Participants were recruited through state occupational therapy associations and social media. Two independent researchers coded data and had an initial agreement percentage of 88%. Data trustworthiness was enhanced through documentation of decisions, reflexive thinking about our positionality and the data, and team-based discussions. Occupational therapy practitioners (N = 15) working in states with new abortion law changes at the time of interviews. The four key themes of this study were as follows: (1) abortion restriction laws are affecting some occupational therapy clients' mental health, (2) clients are discussing reproductive health with occupational therapy practitioners across a variety of settings, (3) occupational therapy practitioners are using clinical judgment and their personal beliefs to support clients affected by abortion restrictions, and (4) occupational therapy practitioners are seeking guidance and evidence-based resources to best support clients in the wake of abortion-related legislation changes. Our findings underscore the relevance of reproductive health to occupational therapy practice and highlight the importance of preparing occupational therapy practitioners to respond to client needs related to abortion care. Plain-Language Summary: We sought to determine whether occupational therapy practitioners perceive that the 2022 abortion-related restrictions are affecting occupational therapy practice; specifically, we wanted to know whether and how practice is being affected and what resources occupational therapy practitioners might need to address clients' needs. Fifteen occupational therapy practitioners were interviewed and revealed that many of their clients were experiencing stress and anxiety (i.e., mental health challenges) specifically related to abortion access. We also found that occupational therapy practitioners who routinely discuss reproductive health with clients were commonly hearing from clients about abortion-related needs. Overall, this research uncovers a need for resources and guidance from state or national occupational therapy organizations so that occupational therapy practitioners can better support their clients given these new changes in abortion access. Positionality Statement: We are a team of three researchers who identify as cisgender women, and we reside in an urban area in the northeastern United States. Two of us identify as White, and one identifies as a person of color. We have all participated in reproductive health access advocacy and critically examined our own lenses as we engaged in this analysis.

Assessing Doula Preparedness for Supporting Clients in a Hospital-Based Volunteer Doula Program.

The purpose of this evaluation was to assess doulas' sense of preparedness after completing birth doula training. The extent to which doulas feel prepared to serve clients after training is unknown. This program evaluation took place within a hospital-based volunteer doula program in the southeastern United States. The analysis focused on comparing the self-reported preparedness of volunteer doulas trained through the Partners in Birth Training program, a doula training created by the doula program, with preparedness of volunteer doulas trained by nationally recognized training programs. A survey assessed doulas' preparedness to provide physical, emotional, and informational support. Of the 100 doulas active in the program at the time of survey administration, 48 had completed the Partners in Birth Training program, 26 (54%) of whom completed the survey. Of the 32 doulas who entered the doula program following training with national organizations, 19 (59%) completed the survey. The remaining 20 doulas in the program completed a third training option and were excluded from this evaluation. In comparing doulas' overall sense of preparedness between the 2 groups, results were similar, with the median response for both groups being mostly prepared (4 on a Likert scale from 1 to 5). Results suggest that localized doula training offered by hospital-based doula programs may be as effective at preparing doulas to serve in such programs as Other training organizations. Systematic evaluations can help researchers and doulas identify topics and pedagogical approaches to training that increase preparedness.

“Business as usual won’t work … ”: Therapists’ experiences and preparedness for providing refugees with trauma-related interventions

Objective Worldwide, the numbers of refugees and displaced people being exposed to traumatic and inhumane experiences are escalating, resulting in an enhanced need for appropriate psychological management of trauma in this at-risk group. This study explores therapists’ perspectives on and preparedness for supporting adult refugees with trauma-related interventions. Method Therapists (N = 17), with varying ranges of experiences supporting adult refugee clients, were recruited nationally, and participated in semi-structured interviews, exploring their experiences and preparedness for therapeutically supporting refugee clients with trauma-related interventions. Data were analyzed using reflexive thematic analysis. A Patient Public Involvement (PPI) approach was embedded within this study. Results Five major themes were developed throughout the analysis: (i) Therapists’ Fears and Apprehensions in Meeting Client Complexities, (ii) Preparation and Support for Competency Development, (iii) Adjusting Preconceptions of the Nature of Therapeutic Work, (iv) Humanity Within the Therapeutic Relationship, and (v) Balancing Therapeutic Meaningfulness and Hardships. Conclusion Therapist training must reflect trauma-informed care and inter-cultural awareness to allow therapists to feel better prepared within mainstream and specialist services. Further, therapists’ well-being needs to be prioritized to prevent vicarious trauma, burn-out and ultimately, improve interventions for clients.

Restructuring Non-teaching Hospitals into Teaching Hospitals in Iran: Component Change in General Hospitals

Background: The present study investigated how a general hospital is restructured in Iran when transforming from a non-teaching into a teaching hospital. Methods: This applied study was conducted based on a mixed-method design from 2020 to 2021 using a systematic search and review, document analysis, comparative and cross-sectional design, multiple voting technique, and qualitative phenomenological method. Results: The conceptual framework of the components of a hospital as a system includes inputs (governance and policy-making, goals and mission, clinical and support departments, physical space, clients, and human resources), processes (internal and external relations, key processes, type and level of services, and teaching mission systematization), and outputs (performance evaluation, internal and external customer satisfaction, human capital empowerment, organizational behavior, income-cost management, cost-effectiveness and efficiency, service quality, and legal and social responsibility). Conclusion: The findings from the present study depicted how the components of teaching and non-teaching hospitals are restructured when changing their functions. Restructuring an established organization, such as a hospital, is very challenging and requires multiple changes. This study had some implications including highlighting the need to formulate protocols for restructuring non-teaching hospitals into teaching hospitals or constructing new teaching hospitals, classifying teaching hospitals and clarifying their differences, focusing on the teaching mission in hospitals, and reviewing and updating the integration of medical education in providing health services.

Key stakeholders’ perspectives of illicit drug use and associated harms in the Northern Territory of Australia

BackgroundIn the Northern Territory (NT) of Australia, there are significant evidence gaps about illicit drug use and harms, despite having established monitoring and reporting systems. This paper reports on illicit drug use, associated harms, contributing factors, service needs and priorities in the NT from the perspective and experiences of key stakeholders engaged in providing services for, or advocating on behalf of, people who use illicit drugs in the NT.MethodsFace-to-face and online qualitative interviews were conducted with stakeholders across urban and remote locations in the NT. Key stakeholders were service providers, including acute and primary care clinicians, representatives of Aboriginal community controlled health organisations, lived experience advocates, peak body representatives and public health executives. Qualitative data were analysed thematically.ResultsFour researchers interviewed 21 participants across urban (62%), and remote areas (38%) of the NT. Themes identified were: (1) Illicit drug use and harms are diverse and distinct; (2) Client support needs are complex and influenced by co-morbidities, socio-demographic and cultural factors; (3) Priority population sub-groups need targeted strategies; (4) Local service strengths can be further developed and enhanced; (5) Local services need better resourcing; (6) Invest in progressive legislative and policy reforms; and (7) Improve routine monitoring and evaluation.ConclusionsKey stakeholders described illicit drug use, harms and contributing factors, which provided insights into the local challenges. Participants emphasised that clients have complex care needs, and further investment into targeted strategies are required to improve service engagement with priority groups. Service needs included greater understanding the role of dual diagnosis and its implementation and enhancing integrated and collaborative care in both primary health and acute care contexts. The voices of people with lived experience captured in this paper must inform local strategy and policy development relating to illicit drug use, in alignment with national strategy.

Effects of Sales Campaign Strategies on Customer Patronage of Nigeria Breweries Products in Jos South LGA of Plateau State

Customer patronage is borne out of a longing to be focused on a specialist co-op either founded on its administration quality or seen administration esteem. Albeit a few scientists have proposed that what decides a client's decision of choosing or disparaging items varies from one country to another as well as from one district to another because of contrasts in social, ecological and financial elements. The review analyzed the impacts of deals advancement methodologies on client support of Nigeria distilleries items in Jos South LGA of Level State. The review utilized a semi-organized survey planned with a 5-point Likert scaling. 143 duplicates of the survey were circulated among the respondents, who were sub merchants of Amstel Malt in Jos South LGA of Level State. The information gathered was dissected utilizing various straight relapse. The discoveries delighted that there is a huge connection between deals advancement procedures aspects (premium item, gift, extra-item and scaled down cost) on client support, implying that deals advancement techniques significantly affect client support. The review presumes that Nigeria bottling works ought to build their concentration and keep up with the level of the deals advancement methodologies (premium item, gift, extra-item and scaled down cost), since it impacts client's support. The review suggests that Nigeria distilleries ought to direct investigations to assess various degrees of allure of the markdown base advancement. Furthermore, that administration ought to execute extra-item methodologies that will empower clients see them as particularly unique and drive most extreme support.

Exploring the Experiences of Community-Based Doulas That Serve Immigrant, Migrant, and Refugee Clients in Arkansas

This study explored community-based doulas’ experiences working with immigrant clients and maternal health-care providers in Arkansas. A descriptive qualitative design was used. Three themes emerged: (1) experiences with immigrant clients; (2) experiences with maternal health-care providers; (3) suggestions to improve support for immigrant clients. Within the first theme, three subthemes emerged: (1) language barriers; (2) transportation; (3) access to food and housing. Within the second theme, two subthemes emerged: (1) dismissive; (2) takes time to build rapport. Within the third theme, two subthemes emerged: (1) listen to the client and improve communication; (2) more community-based doulas.

Supporting Client Transitions Out of UK Football Academies

Release from professional football (soccer) academies in the UK can result in experiences of psychological distress for the transitioning individual (i.e., the player) and their support network (e.g., family members). Despite the commonality of such transitions and their potential negative effects, it is surprising that practice insights on supporting the transition out of professional football academies are sparse. Therefore, the purpose of this article is to draw on case material to highlight approaches and challenges for sport psychologists supporting a range of clients during transitions out of an academy football club. In closing, we offer key recommendations for stakeholders and those delivering support in practice settings when seeking to support similar transitions.

Supporting clients via narrative storytelling and artificial intelligence: a practitioner guide for career development professionals

PurposeIn this practitioner-focused essay, we combine traditional narrative storytelling approaches with Artificial Intelligence’s (AI) innovative abilities to enable career development professionals to support individuals across their lifespan.Design/methodology/approachWe propose a three-phase career exploration approach, developed and tested in a real-world setting for career development professionals to support their clients to consider various career-related options as well as identify strengths and opportunities for personal development.FindingsIn phase one, the client recounts 7–10 positive narrative stories about engaging in activities they enjoyed. In phase two, the career development professional uses AI with tailored prompts to generate a personalised client report based on these narrative stories. In phase three, the report serves as the basis for further discussion and exploration with the client.Practical implicationsThe approach provides a practical guide for career development professionals to increase their capability to support their clients in response to technological advancement and the contemporary world of work. A training document incorporating a worked example of the approach is provided in “Supplementary Material Appendix 1”.Originality/valueOur approach acknowledges AI as a new actor and career development professionals as undervalued actors in supporting individuals to foster a sustainable career ecosystem.

Correlation of Nurse Therapeutic Communication to Family Anxiety while Waiting for Child Patients in the Inpatient Room

Background: Anxiety is often found in families whose children are hospitalized and hospitalized. This is because they are unable to build support for clients and they often see families having difficulty working with nurses or health workers. The aim of the research was to examine the relationship between family anxiety and the therapeutic communication of nurses in the inpatient room of the Klampis Health Center, Bangkalan Regency, Madura, while the patients were pediatric patients. Methods: Analytical correlational research design. Purposive sampling was used to select a large sample of 70 responders. Therapeutic communication is the independent variable, and anxiety is the dependent variable. Patients were given anxiety questionnaires and nurse therapy communication tools for data collection. Apply the Spearman Rank test to your analysis. Results: The results of the study of 70 respondents, most of the respondents amounted to 46 (65.7%) respondents stated that the nurse's therapeutic communication was good and not anxious when waiting for pediatric patients in the Inpatient Room of the Klampis Health Center, Bangkalan Regency, Madura. after a spearman rank test with a significance value of 0.000 and a correlation coefficient of 1.000, which means that there is a perfect correlation between nurse therapeutic communication and family anxiety while waiting for pediatric patients in the Inpatient Room of the Klampis Health Center, Bangkalan Regency, Madura. Conclusion: Nurses in the inpatient room who have good therapeutic communication can reduce the anxiety of the patient's family when their children are treated in the Inpatient Room of the Klampis Health Center, Bangkalan Regency, Madura. Her advice for nurses or health workers is expected to always provide good therapeutic communication in order to create a calm and comfortable atmosphere at the Public Health Center.

Community health worker perspectives: examining current responsibilities and strategies for success

BackgroundCommunity health worker (CHW) interventions have demonstrated positive impacts globally, with the COVID-19 pandemic further highlighting the potential of CHWs at the frontline to support prevention, outreach, and healthcare delivery. As the workforce expands, understanding the work and capabilities of CHWs is key to design successful interventions. This study examines the perspectives of experienced CHWs in Chicago about their current work and strategies for success.MethodsAs part of a community-academic partnership in Chicago, semi-structured interviews were completed with individuals who held positions aligned with CHW. Interviews were conducted between January and April 2022. Questions focused on participants’ work and factors contributing to their effectiveness to gain insights into workforce strategies for success to be applied in healthcare and community settings. De-identified transcripts were analyzed using inductive reasoning with codes organized into themes and subthemes under two domains identified a priori. The themes informed a logic model focused on the early stages to support the success of CHWs in their role.ResultsFourteen individuals participated in the study. The two predetermined domains in this study were: current work of CHWs and strategies for CHWs to be successful.Five themes were identified about CHWs’ current work: providing services, building alliances with clients, establishing and maintaining collaborations, collecting data, and experiencing challenges in role. From their perspectives, all these responsibilities enhance client care and support workforce sustainability efforts.Five themes emerged about strategies for the success of CHWs: background of CHWs, champions to support work of CHWs, materials to perform work of CHWs, preparation for CHW role, and characteristics of CHWs. Participants described key traits CHWs should possess to be hired, individuals who can champion and advocate for their work, and specific materials needed to fulfill responsibilities. They reported that training and familiarity with the community were integral to developing and refining the qualities and skills necessary to be effective in their role.ConclusionCHWs play an increasingly important role in enhancing healthcare delivery and improving health outcomes. This study offers a framework for policymakers, communities, and organizations to utilize for preparing CHWs to succeed in their roles.

Perceptions of patients towards oral health care in a spinal cord injury rehabilitation unit: A qualitative study.

Individuals with spinal cord injuries (SCIs) are at an increased risk of poor oral health compared to the general population. However, little is known about the related barriers and facilitators experienced by these individuals within the hospital setting. Understand the oral health knowledge, attitudes and practices of people with SCIs, barriers and facilitators to managing their oral health, and recommendations to improve oral care at acute/rehabilitation hospital settings. Semi-structured interviews were conducted with 11 participants, from a major metropolitan hospital in Sydney, Australia. The interviews were thematically analysed. Three themes were constructed. Participants believed that the onus was on them to manage their oral health. Individuals also had limited knowledge of its importance to general health, and placed a lower priority on oral health compared to other aspects of health. All participants identified a combination of factors, such as cost, time, resources and prior negative experiences, that contributed to the neglect of their oral care. Participants also discussed the need of support from the multidisciplinary team and family/carers to facilitate oral care and identified various appropriate oral health education formats. This study highlighted some areas where oral health knowledge among people with SCIs could be improved. It also identified the need for oral health training for the multidisciplinary team, as well as carers, to better integrate oral care during rehabilitation in the hospital. The development of oral health interventions would need to utilise a co-design approach to best support clients and their carers to facilitate oral care self-management.

Developing a survey to measure nursing students’ knowledge, attitudes and beliefs, influences, and willingness to be involved in Medical Assistance in Dying (MAiD): a mixed method modified e-Delphi study

BackgroundMedical Assistance in Dying (MAiD) was legalized in Canada in 2016. Canada’s legislation is the first to permit Nurse Practitioners (NP) to serve as independent MAiD assessors and providers. Registered Nurses’ (RN) also have important roles in MAiD that include MAiD care coordination; client and family teaching and support, MAiD procedural quality; healthcare provider and public education; and bereavement care for family. Nurses have a right under the law to conscientious objection to participating in MAiD. Therefore, it is essential to prepare nurses in their entry-level education for the practice implications and moral complexities inherent in this practice. Knowing what nursing students think about MAiD is a critical first step. Therefore, the purpose of this study was to develop a survey to measure nursing students’ knowledge, attitudes and beliefs, influences, and willingness to be involved in MAiD in the Canadian context.MethodsThe design was a mixed-method, modified e-Delphi method that entailed item generation from the literature, item refinement through a 2 round survey of an expert faculty panel, and item validation through a cognitive focus group interview with nursing students. The settings were a University located in an urban area and a College located in a rural area in Western Canada.ResultsDuring phase 1, a 56-item survey was developed from existing literature that included demographic items and items designed to measure experience with death and dying (including MAiD), education and preparation, attitudes and beliefs, influences on those beliefs, and anticipated future involvement. During phase 2, an expert faculty panel reviewed, modified, and prioritized the items yielding 51 items. During phase 3, a sample of nursing students further evaluated and modified the language in the survey to aid readability and comprehension. The final survey consists of 45 items including 4 case studies.DiscussionSystematic evaluation of knowledge-to-date coupled with stakeholder perspectives supports robust survey design. This study yielded a survey to assess nursing students’ attitudes toward MAiD in a Canadian context.ConclusionThe survey is appropriate for use in education and research to measure knowledge and attitudes about MAiD among nurse trainees and can be a helpful step in preparing nursing students for entry-level practice.

"Endless opportunities": A qualitative exploration of facilitators and barriers to scale-up of two-way texting follow-up after voluntary medical male circumcision in Zimbabwe.

In Zimbabwe, the ZAZIC consortium employs two-way, text-based (2wT) follow-up to strengthen post-operative care for voluntary medical male circumcision (VMMC). 2wT scaled nationally with evidence of client support and strengthened follow-up. However, 2wT uptake among healthcare providers remains suboptimal. Understanding the gap between mobile health (mHealth) potential for innovation expansion and scale-up realization is critical for 2wT and other mHealth innovations. Therefore, we conducted an exploratory qualitative study with the objective of identifying 2wT program strengths, challenges, and suggestions for scale up as part of routine VMMC services. A total of 16 in-depth interviews (IDIs) with diverse 2wT stakeholders were conducted, including nurses, monitoring & evaluation teams, and technology partners-a combination of perspectives that provide new insights. We used both inductive and deductive coding for thematic analysis. Among 2wT drivers of expansion success, interviewees noted: 2wT care benefits for clients; effective hands-on 2wT training; ease of app use for providers; 2wT saved time and money; and 2wT strengthened client/provider interaction. For 2wT scale-up challenges, staff shortages; network infrastructure constraints; client costs; duplication of paper and electronic reporting; and complexity of digital tools integration. To improve 2wT robustness, respondents suggested: more staff training to offset turnover; making 2wT free for clients; using 2wT to replace paper VMMC reporting; integrating with routine VMMC reporting systems; and expanding 2wT to other health areas. High stakeholder participation in app design, implementation strengthening, and evaluation were appreciated. Several 2wT improvements stemmed from this study, including enrollment of multiple people on one number to account for phone sharing; 2wT inclusion of minors ages 15+; clients provided with $1 to offset SMS costs; and reduced SMS messages to clients. Continued 2wT mentoring for staff, harmonization of 2wT with Ministry e-health data systems, and increased awareness of 2wT's client and provider benefits will help ensure successful 2wT scale-up.

Ontario Midwives’ Attitudes About Abortion and Abortion Provision

Objective: In Ontario and across Canada, midwives do not provide pregnancy termination but provide referrals and support for clients. This differs from a number of international jurisdictions where abortion has been added to the midwifery scope of practice, resulting in safe outcomes for women and improved access to services. This study sought to survey Ontario midwives’ general attitudes towards abortion and willingness to incorporate abortion into the midwifery scope of practice. Ethics approval for the study was obtained from the Ryerson University Research Ethics Board. Methods: An Internet-based cross-sectional survey was sent to all registered midwives in Ontario via the Association of Ontario Midwives. The survey consisted of seven sections, with a total of 43 Likert scale questions, 17 general questions, and space for open-ended comments at the end of each section. Comments were coded and analyzed for common themes. Results: The survey was distributed to 523 midwives, all of the midwives registered in Ontario at the time of the study (2011). A total of 359 midwives participated, representing a response rate of 68% of all registered midwives in Ontario. The majority of respondents identified themselves as pro-choice; however, there were “limits to choice” expressed by many participants. Abortion was considered less acceptable at later gestations or for specific reasons such as gender selection or minor fetal anomalies. Study participants were divided over whether abortion should be added to midwifery scope of practice. Comfort with providing abortion services decreased as procedures were perceived to be more invasive or as requiring more medical expertise. The addition of misoprostol to Ontario midwives’ pharmacopoeia for early medical terminations was the most favoured expansion for midwifery scope of practice. Respondents were less willing to add surgical techniques to midwifery scope of practice. Midwives identified the current models of compensation and practice in Ontario, issues related to hospital integration, and opposition from clients as significant barriers to the provision of abortion services. Limited education about abortion during midwifery training and the desire for more learning opportunities were additional themes that emerged in this study. Conclusion: This is the first study in Canada about midwives’ attitudes towards abortion and the inclusion of abortion within midwifery scope of practice. Further research in other Canadian jurisdictions would be useful to examine systemic issues, barriers, and attitudes at a national level. For abortion to be included within the scope of practice of Ontario midwives, issues related to the current model of care, compensation, and supplemental education would need to be addressed. This article has been peer reviewed.

Pet loss support for clients and staff: the importance of clear communication

Anyone who works in the health and welfare sphere is aware of death, but it's not a topic that many people want to think about or find easy to work with. In relation to pets, the role that those in the veterinary world play in this ending brings many added pressures, from emotion and stress, to client reactions and moral injury, to name just a few. This article aims to address many of the areas that result from loss, and reiterates the importance of being mindful that empathy, compassion and communication relating to loss will vary from person to person and can improve or decline over time.

USA EXPERIENCE REGARDING THE REINTEGRATION OF WAR VETERANS INTO CIVILIAN LIFE

The article summarizes the experience of the United States regarding the reintegration of veterans into civilian life, namely: the peculiarities of regulatory and legal regulation and the main directions of veteran policy. It was established that the American legislation uses two terms –«veteran» and «active military serviceman», while in Ukraine – «combatant», «military serviceman», «war veteran», «war participant». The American practice of military reintegration into civilian life involves mandatory participation in the Transition Assistance Program (TAP). The main directions of military reintegration into civilian life in the USA, which are under the competence of the Department of Defense, the Department of Veterans Affairs and the Department of Labor, are: social adaptation; psychological support; professional retraining; support with housing. Social adaptation includes social communication, social support and formation of new social skills. Psychological support includes specialized support and treatment. Professional retraining of veterans is the acquisition of new professional qualifications through the acquisition of additional education or skills. Support with housing includes providing a loan for the purchase of housing, maintenance and adaptation of houses to new requirements in case of disability.It has been established that the USA is a country where «military social work» was formed, which is understood as a specialized practice of social work that provides support to military personnel, war veterans and their family members. Military social workers provide a range of services (counseling, crisis intervention, supervision), conduct training and coaching, and organize presentations of special client health support events to colleagues at all levels. Regarding the provision of social benefits, the USA has an exclusive approach to veterans policy – welfare programs for veterans operate separately from programs for the general population. The current system of benefits for veterans in the United States is complex.

Centering healthcare workers in digital health design: Usability and acceptability of two-way texting to improve retention in antiretroviral therapy in a public HIV clinic in Lilongwe, Malawi.

New initiates on antiretroviral therapy (ART) are at high risk of treatment discontinuation, putting their health at risk. In low- and middle-income countries, like Malawi, appropriate digital health applications (apps) must fit into local clinic, connectivity and resource constraints. We describe the human centered design (HCD) and development process of an open-source, hybrid, two-way texting (2wT) system to improve ART retention. We detail the critical role of diverse healthcare workers (HCWs) in the HCD process to inform app usability, create buy-in, and ensure appropriate optimization for the local context. We optimized 2wT usability and acceptability over three HCD phases: 1) informal feedback sessions with diverse 2wT stakeholders, 2) a small pilot, and 3) key informant interviews. Phase one included four sessions with diverse HCWs, including "expert ART clients", clinical, technical, supervisory, and evaluation teams to inform 2wT design. In phase 2, a small pilot with 50 participating ART clients aimed to inform implementation improvement. Phase three included interviews with ten HCWs to deepen understanding of 2wT acceptability and usability, documenting strengths and weaknesses to inform optimization. Multi-phase feedback sessions with HCWs helped refine 2wT language and message timing for both weekly and tailored client-specific visit reminders. The pilot led to improvements in educational materials to guide client responses and ease interaction with HCWs. In interviews, the HCWs appreciated the HCD co-creation process, suggested ways to increase access for low-literacy clients or those without consistent phone access, and felt integrating 2wT with other eHealth platforms would improve scalability. Inclusion of HCWs across phases of HCD design, adaption, and optimization increased 2wT usability and acceptability among HCWs in this setting. Engaging HCWs into 2wT co-ownership from inception appears successful in co-creation of an app that will meet HCW needs, and therefore, enhance support for 2wT clients to attend visits and remain in care.