Thematic Analysis Of Free-text Responses Research Articles

‘There’s more to life than staring at a small screen’: a mixed methods cohort study of problematic smartphone use and the relationship to anxiety, depression and sleep in students aged 13–16 years old in the UK

BackgroundDepression and anxiety are common in adolescents and have increased over the last decade. During that period, smartphone usage has become ubiquitous.ObjectivesThe study aim was to assess the association between...

Understanding International Students' Perspective of Health Service Quality: A Cross-Sectional Study in a Hungarian University.

Understanding patient's preferences is important to delivering good quality services. Patients' feedback provides healthcare providers with valuable information about the services provided. The increasing number of international students enrolling in Hungarian Universities raises the need to ensure the quality of services meets international students' requirements, which includes healthcare. This study aimed to assess service quality in the University Health Center (UHC) from the international student's point of view to be used to improve the quality of services. This cross-sectional study was conducted at the university health center. We used a mixed methods approach to collect both quantitative and qualitative data. We used the importance-performance analysis (IPA) for quantitative analysis to understand expectations and perceptions in service research. The qualitative analysis was conducted from responses to reflection questions. The qualitative data were then analyzed using thematic analysis. 437 international students participated in the study, but only 402 (91.99%) were analysed. The gaps between the importance and performance of service quality were negative in all dimensions (P-value < 0.001). This suggests that there is an unmet need for student expectations and university health center performance. From the Importance factor, the highest and lowest were related to safety (4.54 ± 0.56) and efficiency (4.31 ± 0.66) dimensions. The Performance factor's highest and lowest mean scores were also related to safety (4.22 ± 0.72) and efficiency (3.91 ± 0.87), respectively. From qualitative analysis, there are two major themes several secondary themes from the thematic analysis of free-text responses were identified. The importance and performance analysis could provide useful information to university policymakers about university health center service quality. There is a need for improvement and obviating the importance-performance gaps, especially in the efficiency dimension. Decision-makers can use the IPA analysis results to allocate limited resources more effectively, giving special attention to possible organizational weaknesses for further direction.

Barriers to implementation of smoking cessation support among healthcare professionals in the secondary healthcare sector: A qualitative and quantitative evaluation.

Smoking cessation support (SCS) in the hospital is essential; patients often struggle to maintain quit attempts, which necessitates assistance from healthcare professionals (HCPs). However, unknown barriers can obstruct the implementation of SCS in hospitals. This study aims to uncover barriers to the implementation of SCS in psychiatric, somatic, inpatient, and outpatient hospital settings. In the period from June to September 2021, HCPs in a large secondary care hospital in the Region of Southern Denmark completed an online, cross-sectional study, providing sociodemographic details and listing potential barriers to SCS. They also shared additional barriers in the form of free-text responses. Descriptive statistics and thematic analysis of free-text responses were performed. Of 1645 HCPs surveyed, 409 elaborated their response in the free-text field assessing unlisted barriers. Top listed barriers, reported by more than one-third of participants, included: 'lack of time' (45.1%), 'lack of patient motivation' (34.3%), and 'insufficient knowledge on how to support' (32.2%). Free-text responses revealed three barrier-related, which we grouped under the themes of: 'Concerned about the patient', 'Not part of my job', and 'Inappropriate setting'. This quantitative and qualitative study identifies barriers to SCS on multiple levels in the hospital setting, i.e. on the patient, provider, and organizational levels. These results can inform healthcare organizations and professionals in the implementation of SCS in routine hospital care.

Mentors Supporting Nurses Transitioning to Primary Healthcare Roles: A Practice Improvement Initiative.

Effective primary healthcare services have been identified by the World Health Organization as the most equitable approach to enhancing universal healthcare. Robust models of mentoring for registered nurses (RNs) transitioning to primary healthcare roles have yet to be described in the Australian context. A robust mentoring model can support RNs to fulfill their potential, bridging the gap between theory and practice. In 2015, the peak body for nurses in primary health care (PHC) began developing a transition to practice program, including embedded mentoring to support newly graduated and more experienced registered and enrolled nurses. This quality improvement study reports the experiences and perspectives of nurses participating as mentors in two separate offerings of the program delivered between 2019 and 2021. A two-phase concurrent mixed methods evaluation utilized data from pre- and post online surveys and post program meetings. Quantitative items underwent descriptive analyses. Thematic analysis of free-text responses and comments was conducted independently by two researchers. Mentors voluntarily provided self-report data and were informed that data is routinely collected to support continuous quality improvement processes for all programs. An Information Sheet informed mentors of data usage, confidentiality, and options to withdraw without penalty from the program at any time. Seventy-nine mentors were recruited to support two groups of nurses (N = 111). Mentor self-rated overall satisfaction with program participation was 86.67% (very or extremely satisfied). Mentors described being "witness to mentee growth," "having facilitated access to learning" and receiving "unexpected benefits" including personal and professional growth and enhanced enthusiasm for their role in PHC. The embedded mentoring reported in this article combined a focus on skills acquisition and professional identity with the provision of a range of resources and support activities. Sustainable mentoring programs will be an important mechanism for supporting the expanding roles required of nurses working in primary health.

A Randomized Controlled Trial of a Financial Navigation Program for Patients with Multiple Myeloma

Introduction Advances in multiple myeloma (MM) treatment improve survival but expose patients (pts) to significant financial toxicity (FT) due to lifelong administration of costly therapies. Financial support services (FSS) like nurse navigators (NN), financial advocates (FA), and social workers (SW) can offset healthcare costs by accessing patient assistance programs. However, these services are underused due to ad hoc referrals and reluctance to discuss financial issues. We developed a financial navigation program (FNP) that proactively identifies pts at risk of FT, comprehensively assesses their needs, systematically connects pts to resources, and follows-up to ensure needs are met. In a randomized controlled trial (RCT), we assessed whether this FNP reduces FT compared to usual care. Methods We recruited adult pts with MM receiving systemic treatment at the University of Pennsylvania at their follow-up appointments. Consenting pts completed the COmprehensive Score for financial Toxicity (COST) questionnaire; those at risk of FT (score&amp;lt;26) were randomized 1:1 to the intervention (FNP) or usual care. We aimed to randomize 82 participants to achieve 80% power based on prior studies (expected improvement in COST by 5 in intervention, 2 in usual care). Pts completed a baseline survey to assess socioeconomic and demographic factors, cost-coping behaviors, quality of life (QoL), and satisfaction. After 4 months, pts completed a similar, final survey. In the FNP, the NN assessed financial and transportation barriers to care by telephone, performed proactive outreach to FA and SW, and coordinated resources, followed by monthly follow-up calls. We measured patient-reported outcomes as change from baseline to study completion; the primary outcome was change in COST score. Secondary outcomes were changes in cost-coping behaviors, QoL, and satisfaction. We performed an intention-to-treat, bivariate analysis (t-test or χ 2 test) of each outcome and conducted rapid thematic analysis of free-text responses. We also observed consenting pts whose baseline COST≥26, and - in post-hoc analysis - assessed for differential change in COST score at follow-up among this cohort vs the randomized/at-risk population. Results We assessed 315 pts from Feb-Dec 2022 ( Figure): 193 consented, 106 randomized, and 83 were included in analysis (41 in intervention, 42 in usual care). Randomized pts were an average of 65 years, 53% female, 39% nonwhite, 78% college-educated, and 51% earned ≤$60,000/year. This contrasted with 8% non-white pts among the non-randomized (high baseline COST) group (p&amp;lt;0.001). Despite all randomized pts being insured, 55% reported that MM treatment costs posed a significant financial burden. Many (46%) were on lenalidomide containing regimens. The mean, baseline COST score was 14.4 (SD 7.5) in the intervention versus 16.0 (SD 6.5) in usual care (p=0.3). Most pts had baseline FSS use, with a higher proportion in usual care (76%) than intervention (51%), p=0.03. During a median follow-up of 4.9 months, 17% in usual care received FSS. In the intervention arm, 95% participated in the FNP, with 68% completing ≥3 follow-up calls within 4 months. Randomized (at risk) pts showed an average improvement in COST of 4.6 (SD 8.9), significantly different from the non-randomized (low risk) group's mean worsening of -15.8 (SD 7.2) at follow-up; p&amp;lt;0.001. The intervention arm had a greater but non-significant improvement in COST score (mean 5.7 [SD 8.8]) compared to usual care (mean 3.5 [SD 8.9]); p=0.3. There were no significant changes in cost coping behaviors, QoL, or satisfaction between the two randomized arms. There was a significantly higher number of financial assistance applications submitted among pts randomized to the FNP (34%) vs usual care (12%); p=0.02. Patient feedback indicated the FNP improved understanding of FSS and reduced stress. Conclusions In this study, we confirmed that most pts with MM experience financial hardship and are at-risk of FT, despite being insured. We observed significant racial disparities in this risk. Our RCT showed that by screening pts with the COST tool and proactively coordinating FSS for at-risk pts, we can potentially reduce financial hardship. We attribute the non-significant improvement in FT to an under-powered analysis from higher-than-expected improvement in COST among usual care pts. Our program is efficient and scalable and demonstrated high retention.

786 A Collaborative, Online, 'Near-Peer' Teaching Programme for Medical Schools with Short Breast Surgery Rotations

Abstract Aim The quality of teaching for breast surgery, a niche specialty that medical schools dedicate little placement time to, can vary from hospital to hospital. This single-centre cross-sectional study investigated whether a new near-peer teaching programme could improve this. Method An online teaching programme was created and executed by final year medical students (‘near-peers’) for penultimate year students rotating through a week-long Breast Surgery placement at a major teaching hospital in London, United Kingdom. It consisted of asynchronous pre-tutorial Single Best Answer questions and an online small group tutorial and was conducted every three weeks for a year. A mix of qualitative and quantitative data were collected using feedback forms. Results Thirty students opted in. The pre-tutorial SBAs were rated 4.07 out of 5, while the near-peer interactive tutorial scored 4.77 out of 5. Students’ self-reported confidence, on a scale of 1 to 5, increased significantly by an average of 1.5 points (p &amp;lt;0.001). Students also rated this programme either the same or more highly than all other teaching modalities available during these their clinical placements. Thematic analysis of free-text responses showed that students enjoyed the interactivity of the sessions, the exam relevance of the content covered, and the utility of this programme in consolidating information at the tail-end of their placements. Conclusions This novel interactive teaching programme was designed and executed relatively easily by near-peers, was received favourably in our pilot, and can be easily implemented for other 'short-rotation specialties' in medical school (e.g., urology, vascular surgery, ENT).

Covid-19 vaccination during pregnancy: A mixed-methods study of attitudes in a sample of Italian women and the role of health professionals’ communication

ObjectivesWe examined Italian pregnant women's attitudes about the diphtheria, tetanus, and pertussis (DTP) vaccine, seasonal influenza, and Covid-19 vaccines, healthcare professionals’ (HP) communication, reasons and potential predictors for non-adherence. MethodsFrom August 2021 to January 2022, we carried out a cross-sectional study in Italy using an online self-administered questionnaire addressed to women of age and pregnant, designed using LimeSurvey and disseminated through social media. Questions explored vaccination attitude/perceptions, satisfaction, and trust in HPs’ information. Thematic analysis of free-text responses was performed using MaxQDA 2022. Statistical analyses were performed using STATA. Results1594 responses were obtained. 52% of women hesitated to be vaccinated against Covid-19 while pregnant. Information received by HPs was deemed incomplete by 56% of participants, unclear by 52%, and untrustworthy by 46%; 49% felt unsupported in their decision-making process. This variable was one predictor of vaccine hesitancy together with concern about vaccine safety in the multivariate model. The analysis of open-ended questions revealed a pervasive feeling of dissatisfaction. ConclusionThe perceived lack of adequate communication and support by HPs affected pregnant women’s decision-making process on Covid-19 vaccination. Practice implicationsHPs need to understand and communicate the importance of vaccination during pregnancy, learning to better tailor their messages.

UK general practice service delivery research priorities: an adapted James Lind Alliance approach.

General practice is in a state of crisis in a number of countries. In the UK, a range of measures have been introduced to address the situation, including innovations such as practice networks, multidisciplinary roles, and digital technologies. However, identifying what still needs fixing could benefit from more evidence, particularly in relation to day-to-day service delivery. To identify the general practice workforce's top 10 research priorities to improve service delivery. This priority-setting study used an adapted James Lind Alliance methodology and involved staff working in general practice across the UK. The study comprised four phases: an online qualitative survey issued to the general practice workforce (clinical and non-clinical groups); thematic analysis of free-text responses; generation of indicative research questions; and the undertaking of ranking exercises with responders of the original survey. An online workshop was held with participants at the final stage of prioritisation. In total, 93 staff completed a survey in Phase 1, from which 20 themes were categorised and developed into research questions. Twenty- two staff responded to the first ranking activity and 11 took part in a second ranking activity to discuss themes that had a tied vote. The final top 10 research priorities were: volume of work; patient behaviour; consultations; employment pay and conditions; workload dumping and care of patients on waiting list; funding; overwhelming pressure; patient health education; complex patient needs; and interfaces with secondary care. However, there was no clear ranking of these 10 priorities; instead, they carried equal weight and were closely interconnected. Applying a marginal-gains approach, by seeking to explore all 10 priorities simultaneously as opposed to concentrating on one area at a time, may provide more noticeable improvements overall. Systems-based approaches that take account of the marked role that context has may be a particularly useful lens for future research.

Parent Perspectives on Defining Neonatal Serious Illness.

Objectives: We hoped to understand (1) how parents of seriously ill neonatal intensive care unit patients conceptualize neonatal serious illness, and (2) how parent and physician perspectives on neonatal serious illness might differ. Design: This was a prospective survey study. Setting/Subjects: Parent members of the Courageous Parents Network. Measurements: We circulated a modified version of a previously developed survey. Participants were presented with a list of potential definition components and asked to rank components by importance and suggest modifications to the definition as needed. Thematic analysis of free-text responses was conducted to identify key themes in parent responses Results: Eighty-eight percent of parent participants agreed or strongly agreed with our working definition of neonatal serious illness. Parents agreed with the content of the definition but suggested using different language (especially less jargon) when using the definition to inform conversations with parents. Conclusions: The majority of parents surveyed for this study supported our definition of neonatal serious illness, which suggests that it may be useful for clinical and research applications. At the same time, parent responses revealed important differences in perceptions about serious illness between parents and physicians. In addition, parents will likely use any definition of neonatal serious illness differently than clinicians. We therefore propose that our definition be used to identify neonates with serious illness for the purposes of research and clinical care, but should not be used verbatim for communication with parents.

Acceptability of Automated Robotic Clinical Breast Examination: Survey Study

In the United Kingdom, women aged 50 to 70 years are invited to undergo mammography. However, 10% of invasive breast cancers occur in women aged ≤45 years, representing an unmet need for young women. Identifying a suitable screening modality for this population is challenging; mammography is insufficiently sensitive, whereas alternative diagnostic methods are invasive or costly. Robotic clinical breast examination (R-CBE)-using soft robotic technology and machine learning for fully automated clinical breast examination-is a theoretically promising screening modality with early prototypes under development. Understanding the perspectives of potential users and partnering with patients in the design process from the outset is essential for ensuring the patient-centered design and implementation of this technology. This study investigated the attitudes and perspectives of women regarding the use of soft robotics and intelligent systems in breast cancer screening. It aimed to determine whether such technology is theoretically acceptable to potential users and identify aspects of the technology and implementation system that are priorities for patients, allowing these to be integrated into technology design. This study used a mixed methods design. We conducted a 30-minute web-based survey with 155 women in the United Kingdom. The survey comprised an overview of the proposed concept followed by 5 open-ended questions and 17 closed questions. Respondents were recruited through a web-based survey linked to the Cancer Research United Kingdom patient involvement opportunities web page and distributed through research networks' mailing lists. Qualitative data generated via the open-ended questions were analyzed using thematic analysis. Quantitative data were analyzed using 2-sample Kolmogorov-Smirnov tests, 1-tailed t tests, and Pearson coefficients. Most respondents (143/155, 92.3%) indicated that they would definitely or probably use R-CBE, with 82.6% (128/155) willing to be examined for up to 15 minutes. The most popular location for R-CBE was at a primary care setting, whereas the most accepted method for receiving the results was an on-screen display (with an option to print information) immediately after the examination. Thematic analysis of free-text responses identified the following 7 themes: women perceive that R-CBE has the potential to address limitations in current screening services; R-CBE may facilitate increased user choice and autonomy; ethical motivations for supporting R-CBE development; accuracy (and users' perceptions of accuracy) is essential; results management with clear communication is a priority for users; device usability is important; and integration with health services is key. There is a high potential for the acceptance of R-CBE in its target user group and a high concordance between user expectations and technological feasibility. Early patient participation in the design process allowed the authors to identify key development priorities for ensuring that this new technology meets the needs of users. Ongoing patient and public involvement at each development stage is essential.

“Stuck in a Loop”: A Qualitative Examination of Challenges for Children and Adolescents With Attention-Deficit/Hyperactivity Disorder and Anxiety

Children and adolescents (henceforth “children”) with both attention-deficit/hyperactivity disorder (ADHD) and anxiety experience greater difficulties than children with either alone, though qualitative methodologies are yet to be used to understand the challenges this population experience. We aimed to explore parent-reported daily impacts of co-occurring anxiety in children with ADHD (aged 8–13 years). Participants were enrolled in a trial evaluating an adapted anxiety intervention and were eligible if their child met diagnostic criteria for ADHD plus separation, social, and/or generalized anxiety disorder. A baseline measure of life impacts associated with child anxiety captured situations parents reported were difficult, due to their child’s anxiety. Reflexive thematic analysis of free-text responses ( N = 203) facilitated new insights via inductively generating key themes. Three overarching themes highlighted (1) child difficulties with everyday situations and processes due to their anxiety; (2) the nature of the child’s anxiety being pervasive and unrelenting; and (3) the strain placed on the child’s family system. This study enhances understanding of daily impacts associated with co-occurring anxiety and ADHD and may contribute to an improved understanding of support needs. Results reiterate the need to identify co-occurring difficulties in children with ADHD and support both children and their families.

Impact of covid-19 on subspecialty training in obstetrics and gynaecology

The Covid-19 pandemic brought substantial changes in clinical practice in Obstetrics and Gynaecology (O and G). Redeployment of staff and restrictions in elective services raised training concerns. We sought to assess the impact on subspecialty training, to identify issues to help mitigate the impact. We conducted cross-sectional anonymous electronic surveys of UK subspecialty trainees at three time points: June 2020, February 2021, September 2021. Surveys were analysed by descriptive statistics and thematic analysis of free-text responses. Response rates ranged from 30% to 40%, with higher response rates from urogynaecology trainees. Up to 72% reported an impact on training, most notable in gynaecological subspecialties, and particularly urogynaecology, which persisted over time. More than a third anticipated needing extra time to complete training. This raises serious future workforce and patient care concerns. Clinical recovery should consider training needs as essential when re-establishing services. Subspecialty trainees may need additional time to achieve competencies required of future consultants. IMPACT STATEMENT What is already known on the subject? Covid-19 led to dramatic changes in clinical practice in Obstetrics and Gynaecology. Previous studies on training in O and G during the pandemic in the UK and internationally highlighted issues from redeployment, trainee absence, and changes in service provision, that had potential to severely impact training. What do the results of this study add? Subspecialty training in Obstetrics and Gynaecology has been affected by the pandemic. Urogynaecology was worst affected and continues to be affected over the course of the pandemic. What are the implications of these findings for clinical practice and/or further research? Covid-19 recovery plans need to incorporate training requirements. Extended training due to the pandemic may affect consultant workforce numbers and thus service provision in tertiary care.

Patients’ perceptions and knowledge of source isolation for multi-resistant organisms in an Australian metropolitan hospital: A bedside interview with questionnaire study

The aim of this study was to explore perceptions and knowledge of source isolation among hospitalised patients colonised or infected with multi-resistant organisms, to identify if information provided and delivery method are helpful and appropriate, and to identify areas for practice improvements. Purposive sampling was conducted. Between November 2019 and January 2020, bedside interviews with structured questionnaires (combining multiple-choice and free-text questions) were conducted with adult in-patients requiring isolation for multi-resistant organisms in a 180-bed metropolitan hospital in Brisbane, Australia. Data analysis included quantifying multiple-choice responses and thematic analysis of free-text responses. Thirty participants completed the interview questionnaire. Lack of awareness and understanding of multi-resistant organisms was evident. Participants reported a preference for face-to-face education (96.7%) and information brochures (86.7%), rather than phone call (33.3%) or informative video (0%). Qualitative responses revealed communication and information deficits exacerbated patients’ negative psychological impacts including embarrassment, loneliness, abandonment, confusion and fear. Participants identified that clinicians need better communication skills and knowledge of multi-resistant organisms to recognise and ameliorate the effect of source isolation on patients. In conclusion, patients in source isolation reported that they do not receive adequate information. Enhancing clinician knowledge of multi-resistant organisms and improving communication skills may help address the psychological needs of these patients.

The nature and prevalence of threats to medical student placement capacity in primary care: a survey of East of England GP practices.

GP practices deliver vital medical student teaching in the face of increasingly challenging circumstances. To understand the nature and scale of threats to medical student teaching capacity in primary care. An electronic survey of a predefined population of 120 East of England GP practices that host medical student placements. The survey was completed on behalf of the practice by the GP lead for medical student teaching. They were asked to pick (from a list of 16) the four main challenges they faced delivering medical student teaching placements, then explain their selection and suggest solutions. Thematic analysis of free-text responses was undertaken from an activity theory perspective. Responses were received from 114 of the 120 practices in the study population (95% response rate). The most commonly selected challenges to delivering placements were clinical/practice workload (picked by 92 practices), and lack of space in the practice (picked by 63 practices). Thematic analysis produced a model whereby a practice's decision to continue hosting students was influenced by level of motivation and burden of teaching, but only if a certain level of resource enablement is present. Analysis of free-text responses suggested that space pressures were perceived as being exacerbated by the need to accommodate more clinicians, especially advanced practitioners employed by primary care networks (PCNs) under the additional roles reimbursement scheme (ARRS). This study provides much-needed quantitative evidence to support the view that lack of space in GP premises is a major threat to the future of undergraduate general practice.

"There Was a Sense That Our Load Had Been Lightened": Evaluating Outcomes of Virtual Ethics Rounds for Veterinary Team Members.

Clinical ethics support services (CESS) are employed in healthcare to improve patient care and help team members develop skills to recognize and navigate ethically challenging situations (ECS). The objective of this study was to evaluate the impact of ethics rounds, one form of CESS, on veterinary team members. An anonymous, online mixed-methods survey incorporating a 15-item instrument designed to assess the outcomes of moral case deliberation originally developed for human healthcare workers (the Euro-MCD 2.0), was developed. The survey was administered to veterinary team members prior to and following participation in a 90-min virtual ethics rounds session. A total of 23 sessions of virtual ethics rounds were held. In total, 213 individuals participated, and 89 completed both surveys (response rate 41.8%). Most respondents were female (n = 70, 81%). Most were veterinarians (n = 51, 59%), followed by other veterinary team members (practice manager, animal attendant) (n = 18, 21%), veterinary nurses or animal health technicians (n = 10, 12%) and veterinary students (n = 8, 9%). Age ranged from 20 to 73 (median 41, IQR 32–52, n = 87). While there was no statistically significant difference between overall modified Euro-MCD 2.0 scores between T1 and T2, there were statistically significant changes in 7 out of 15 Euro-MCD 2.0 items in the domains of moral competence and moral teamwork. Reflexive thematic analysis of free-text responses identified themes including the types, impact and barriers to resolving ECS, the impacts of ethics rounds on veterinary team members and constraints preventing veterinary team members from speaking up in the face of ECS. While participants largely described the impact of ethics rounds as beneficial (for example, by facilitating clarification of thinking about ECS, allowing participants to see ECS from the perspective of others and providing a safe space for discussion), reflecting on ECS could be stressful for participants. Active participation in ethics rounds may be inhibited in the context of power imbalance, or in settings where bullying occurs. Overall, carefully facilitated ethics rounds has the potential to improve the ability of veterinary team members to identify and navigate ECS, and potentially mitigate moral distress.

Projected Utility of the Ready Set Return Application

Introduction: An application (app) that summarizes best practices may promote standardized care among clinicians treating patients during anterior cruciate ligament (ACL) rehabilitation. The purpose of this study was to test the prototype of the Ready Set Return (RSR) app to determine receptiveness for use in clinical practice. Methods: Two mock patient cases were used to familiarize 19 physical therapists and athletic trainers with the RSR app. Then these participants provided feedback about the user experience, features, and content using Likert ratings and free-text fields through an online survey. Results: Most participants (89%-95%) would recommend the RSR app to others and noted that the app would allow them to stay up to date with current practice. Thematic analysis of free-text responses indicated that the app was easy to navigate and that evidence-based progressions and clinical milestones were useful in clinical practice. Users suggested enhancements that included adding patient access and specific treatment options. Discussion: Generalizable findings suggest that clinicians appreciated the details and images of specific tests and measures; automatic test scoring; and standardized benchmarks to progress care. Specific findings suggest the RSR app’s summary of evidence-informed practice may help standardize care, specifically for patients undergoing rehabilitation after ACL reconstruction. Conclusion: This subset of clinicians reacted positively to the prototype and felt that the RSR app would benefit their practice and patients. This feedback will guide the next iteration, advancing from a low-fidelity to high-fidelity prototype.

Social Health among German Nursing Home Residents with Dementia during the COVID-19 Pandemic, and the Role of Technology to Promote Social Participation.

The COVID-19 pandemic severely impacted the social health of nursing home residents with dementia due to social isolation. Consequently, the frequency of Behavioral and Psychological Symptoms in Dementia (BPSD) might increase. Technological solutions might help safeguard the social health of nursing home residents with dementia. This study investigates the impacts of the COVID-19 pandemic on clinical outcomes and the availability of social activities and technology to promote social participation in nursing home residents with dementia. The study analyzed cross-sectional data from a follow-up questionnaire nested in a larger national survey of care facilities in Germany. A mixed-methods approach integrated statistical analyses of closed-ended responses and thematic analysis of free-text responses. A total of 417 valid individual responses were received, showing an overall increase in observed BPSD—with anxiety and depression most frequently occurring. Many nursing homes canceled all social activities for residents with dementia, though a few had established procedures to facilitate social participation using technology. Requirements to promote social participation in this population using technology were identified at the micro-, meso-, and macro levels. Technology requirements permeated all three levels. During and beyond the COVID-19 pandemic, technology-driven solutions to promote social health among nursing home residents with dementia should be integrated into caregiving procedures.

Running During Pregnancy and Postpartum, Part A: Why Do Women Stop Running During Pregnancy and Not Return to Running in the Postpartum Period?

Background: In the absence of complications or contraindications, running is recognized as a safe mode of exercise for women who ran before pregnancy. Despite this, participation in running decreases during pregnancy and postpartum, with limited research conducted to examine why women who were runners before pregnancy cease running during pregnancy and do not return postpartum. Objectives: To understand the experiences of women who have recently given birth and were runners before pregnancy, specifically reasons for not running during pregnancy or returning to running postpartum, as well as postpartum running concerns. Study Design: Observational, cross-sectional, mixed methods. Methods: In total, 883 postpartum females completed an online questionnaire related to running habits, reasons for not running during pregnancy, not returning to running postpartum, and concerns returning to running postpartum. Most questions were closed-ended, with opportunity to provide free-text responses. Descriptive statistics of close-ended questions and thematic analysis of free-text responses were conducted. Results: Women did not run during pregnancy due to nausea/morning sickness, fatigue, fear of or experience of miscarriage and anxiety, nervousness, and fear. Women had not returned to running postpartum due to experience of symptoms/pain and complications postpartum and were concerned about leaking urine, vaginal heaviness, and not knowing how to return safely. Pelvic floor concerns were prevalent throughout pregnancy and postpartum. Conclusion: There is a need for evidence-based guidance for women to return to running postpartum gradually and safely. This includes greater pelvic health education and support, including access to treatment. Importantly, return-to-running guidance postpartum needs to be considered as an ongoing and longitudinal process.

Investigating the Implementation of SMS and Mobile Messaging in Population Screening (the SIPS Study): Protocol for a Delphi Study.

BackgroundThe use of mobile messaging, including SMS, and web-based messaging in health care has grown significantly. Using messaging to facilitate patient communication has been advocated in several circumstances, including population screening. These programs, however, pose unique challenges to mobile communication, as messaging is often sent from a central hub to a diverse population with differing needs. Despite this, there is a paucity of robust frameworks to guide implementation.ObjectiveThe aim of this protocol is to describe the methods that will be used to develop a guide for the principles of use of mobile messaging for population screening programs in England.MethodsThis modified Delphi study will be conducted in two parts: evidence synthesis and consensus generation. The former will include a review of literature published from January 1, 2000, to October 1, 2021. This will elicit key themes to inform an online scoping questionnaire posed to a group of experts from academia, clinical medicine, industry, and public health. Thematic analysis of free-text responses by two independent authors will elicit items to be used during consensus generation. Patient and Public Involvement and Engagement groups will be convened to ensure that a comprehensive item list is generated that represents the public’s perspective. Each item will then be anonymously voted on by experts as to its importance and feasibility of implementation in screening during three rounds of a Delphi process. Consensus will be defined a priori at 70%, with items considered important and feasible being eligible for inclusion in the final recommendation. A list of desirable items (ie, important but not currently feasible) will be developed to guide future work.ResultsThe Institutional Review Board at Imperial College London has granted ethical approval for this study (reference 20IC6088). Results are expected to involve a list of recommendations to screening services, with findings being made available to screening services through Public Health England. This study will, thus, provide a formal guideline for the use of mobile messaging in screening services and will provide future directions in this field.ConclusionsThe use of mobile messaging has grown significantly across health care services, especially given the COVID-19 pandemic, but its implementation in screening programs remains challenging. This modified Delphi approach with leading experts will provide invaluable insights into facilitating the incorporation of messaging into these programs and will create awareness of future developments in this area.International Registered Report Identifier (IRRID)PRR1-10.2196/32660

Patient satisfaction with the first contact physiotherapy service: Results from the national evaluation survey

Musculoskeletal (MSK) First Contact Physiotherapists (FCPs) are diagnostic clinicians able to assess and manage undifferentiated and undiagnosed MSK presentations. The FCP role in primary care has been introduced to allow patients with MSK pain to see a FCP directly rather than wait to see a General Practitioner (GP) first, which improves capacity within primary care. A national evaluation was undertaken of the FCP model. This article reports the thematic analysis of the free-text responses of patients who participated in the national evaluation. An online platform collected patient-reported experience and outcomes following the FCP consultation and at 1, 2 and 3months follow-up. Free-text responses to the Friends and Family test, reasons for consulting another health care professional (HCP) and general comments were thematically analysed and grouped according to their responses. Over 13months, 680 of 2825 registered patients (24%) completed the initial questionnaire and 54% (n=370) completed the 3-month follow-up. During the course of the evaluation, 785 participants provided free-text responses. Themes identified from free-text responses were: communication and knowledge, clinicians' characteristics, efficiency, treatment provided, assessment skills and service provided in comparison to GP care. Complaints represented 4% (n=26 comments) of total feedback. The main reasons for consulting other HCPs after seeing a FCP were persistent pain, delays in referrals or already attending NHS physiotherapy. Thematic analysis of free-text responses in the national FCP evaluation provides context and detail to the positive outcomes reported by patients after consulting a FCP in primary care.