Thematic Approach Research Articles

“You’ve Got Me Feeling Emotions”: Affective Norms of Deliberation in the Philippine lgbtqia+ Rights Movement

Abstract In contentious politics and deliberation, emotions function as rhetorical resources to substantiate claims and as evaluative criteria to assess social ties among actors. For social movements, then, emotions are vital in framing demands and sustaining collective participation. Grounded on accounts gathered from Filipinx lgbtqia+ rights movement through oral history interviews and analyzed through narrative and thematic approaches, this article illustrates the role of emotions when adherents deliberate with various interlocutors. I argue that advocates utilize affective ties to expand access to deliberative institutions and to sustain discussions of their claims. I also submit that specific ideologies motivate the idealization of particular affective norms when activists engage specific interlocutors. Hence, emotions figure in the movement both as framing tools and deliberative norms that need to be deliberated as well.

Communication issues between caregivers and patients with concealment of advanced-stage cancer: A qualitative study.

Communication is a key element of palliative care. The concealment of advanced-stage diseases is a communication challenge. This study aimed to explore the patterns and difficulties in communication regarding the concealment of advanced-stage cancer between caregivers and patients. Methods: This qualitative study employed an interpretive phenomenological approach and was conducted at a district hospital in Thailand. Semi-structured in-depth interviews were performed to collect data from caregivers (i.e. family members) of patients regarding the concealment of advanced-stage cancer. The data analysis followed an inductive thematic approach. Ten in-depth interviews were conducted among the caregivers of patients aged 57-97 years. Four themes emerged: (i) reasons for concealing the diagnosis and prognosis (personality of patients and concerns about negative effects), (ii) communication patterns between caregivers and patients (communicating symptoms/signs instead of the diagnosis/prognosis and distorting information), (iii) difficulties and challenges in maintaining concealment (feelings of guilt, hesitation in sharing the information and suspicion of patients' awareness of their diagnosis/prognosis) and (iv) communication support from healthcare professionals (avoiding informing patients about their diagnosis/prognosis, supporting decision-making and disclosing the information). The concealment of advanced-stage cancer is perceived as an appropriate communication approach among some caregivers. Communicating information about advanced-stage cancer is dynamic. Some caregivers and families consider disclosing the information in the future. Healthcare professionals can support communication throughout care. Future studies should focus on decision-making and communication processes for better handling of information concealment or the conspiracy of silence in palliative care.

FP5.7 - Why I don’t want a career in surgery? - Uncovering obstacles and investigating barriers among year 3 UK medical students: A thematic analysis

Abstract Aims Surgical training and placements can be stereotyped negatively by medical students. Our study aimed to identify barriers to pursuing a surgical career amongst UK year 3 medical students, to improve surgical educational policies. Methods An optional, anonymous, single-question, open-text survey was administered to 190, year 3 UK medical student, after they had completed an 11 week surgical clinical placement, comprising Breast, Emergency Department, Interventional Radiology, Orthopaedics, Peri-op anaesthetics, Plastics, Vascular, Upper/Lower GI and Urology. The specific question asked was, 'Would you contemplate pursuing a career in surgery?' Responses from students NOT considering a surgical career were analysed qualitatively using a thematic approach to identify perceived barriers to a surgical career. Results 102 responses were received of which 35 were not suitable for analysis. Of the remaining 67 students, 30 (44.8%) demonstrated a negative view towards a surgical career. Following thematic analysis four main themes were identified:Pre-existing interest in another specialty.Nature of surgical training (long duration, competitive, poor work-life balance).Stressful clinical workload, high emotional pressure and burnout.Negative, masculine culture within surgical teams. Positively, despite not planning to pursue surgery - some students reported surgery was not as intimidating as they had expected it to be and surgeons did not meet stereotypes they were expecting. Conclusions Medical students continue to comment on negative surgical working environment experiences. Our study highlights areas that high pressure surgical training placements, need to actively improve in order to ensure a positive working and teaching surgical environment for our future medical workforce.

Low levels of hypertension screening in HIV care clinics in rural Uganda: A mixed methods study

Background The prevalence of hypertension among people living with HIV (PLHIV) has increased over the last decade globally. Given the dual burden of disease and significant prior investment in HIV care, integrating care for hypertension and HIV is recommended. However, data on hypertension screening, treatment, and control before such integration are lacking. Using a mixed-methods approach, we assessed the baseline status of hypertension screening, treatment, and control in 52 Ugandan public health facilities, participating in an ongoing cluster randomised trial of an integrated HIV/HTN care model. Methods From November 2020 to March 2021, we reviewed patient records and randomly sampled 50 PLHIV without a documented hypertension diagnosis per health facility and all PLHIV with a documented hypertension diagnosis per health facility. We surveyed the sampled participants, measured their blood pressure, and described the hypertension care cascade. We also conducted in-depth interviews with 24 patients and 12 providers to explore their experience with hypertension screening and care. We used an in-depth thematic approach to analyze the resulting qualitative data. Results Among 2,645 PLHIV, <1% (20/2,645) had their BP measured within 6 months before the survey. The prevalence of hypertension was 13.6% (359/2,645), including 278 (10.5%) new diagnoses and 32 (1.2%) prior diagnoses that were not documented in their health record. Of 49 with a previously documented hypertension diagnosis, 31 (63.3%) were on hypertension treatment, and 53.1% had controlled hypertension. In-depth interviews with providers and patients revealed a lack of blood pressure equipment, high patient load, limited technical hypertension knowledge, and patients' fear of anticipated long waiting times as reasons for low hypertension screening in the HIV clinics. Conclusion Regular screening for the detection of hypertension patients was hardly performed. There is an urgent need for interventions to advance the integration of hypertension care in HIV clinics.

Exploring the Impact of Stigma on Health and Wellbeing: Insights from Mothers with Lived Experience Accessing Recovery Services.

Stigmatisation is the process by which an individual is devalued based on their attributes, characteristics, and/or behaviour, with this often leading to prejudice, social and health-related harms, active discrimination, and microaggressions. The aim of this paper is to show how social harms can occur and how stigma is damaging to the health and wellbeing of a person in recovery. To do so, we focus on the harms that arise from the internalisation of labels that mothers who use drugs encounter in a treatment and recovery setting whilst in active recovery, and how this stigmatisation can manifest negative self-beliefs. Qualitative data was used from two semi-structured focus groups involving females with lived experience of substance use (n = 13). A reflexive thematic analysis approach was used to analyse the interview transcripts, and three themes were identified: (1) the enduring nature of stigma; (2) gender disparity and the need for mothers- and women-only spaces; and (3) stigma as a barrier to services and wellbeing. Findings revealed the enduring nature of stigma amongst mothers who were in active recovery, with women feeling judged more harshly than men and experiencing pressure to live up to a "good mother" ideal whilst in recovery. This paper demonstrates that mothers in recovery are still stigmatised and, as a consequence, approach services with increased sensitivity, with stigma often resulting in disengagement or reluctance to access healthcare settings. We conclude that staff in health, social, and primary care settings need to develop a strong therapeutic alliance with mothers in recovery and promote anti-stigma approaches in their practice, in order to mitigate stigma and reduce harms to health and wellbeing.

Renegotiation, uncertainty, imagination: Assemblage perspectives on reproductive and family planning with an Inborn Error of immunity

Advances within the new genetics expand our understanding of the scope and presentation of inherited conditions, particularly to include incompletely penetrant and variably expressive conditions. These features can complicate patients’ reproductive and family planning processes, in part because they expand the possibilities of life with an inherited condition. Despite many inquiries into reproductive planning with an inherited condition, accounts of experiential knowledge and reproductive planning fail to adequately describe the uncertainties experienced by people living with incompletely penetrant and variably expressive conditions. To address this gap, we conducted a qualitative, cross-sectional study using assemblage theory to characterize the impacts of experiential knowledge on reproductive planning for individuals living with Inborn Errors of Immunity (IEI) that exhibit incomplete penetrance and variable expressivity.Eligible participants were between ages 18 and 48, with a diagnosis of either GATA2 deficiency, PIK3CD gain-of-function disorder, or CTLA4 deficiency. Using an abductive thematic approach, attention was paid to the people, ideas, and non-human objects embedded within participants’ accounts of disease experience and reproductive planning. Organized around the objects of genetic diagnosis, the body, and hypothetical children, this analysis illustrates how disease can be conceptualized as an assemblage of human and non-human objects which provoke numerous actions and affective engagements in reproductive planning. These engagements include renegotiation, uncertainty, and imagination. By emphasizing the distribution of agency and action across systems, processes, and relationships, assemblage theory invites novel ways of understanding the role of experiential knowledge on reproductive planning.

Household economic burden of type-2 diabetes and hypertension comorbidity care in urban-poor Ghana: a mixed methods study

BackgroundNon-communicable diseases (NCDs) predispose households to exorbitant healthcare expenditures in health systems where there is no access to effective financial protection for healthcare. This study assessed the economic burden associated with the rising burden of type-2 diabetes (T2D) and hypertension comorbidity management, and its implications for healthcare seeking in urban Accra.MethodsA convergent parallel mixed-methods study design was used. Quantitative sociodemographic and cost data were collected through survey from a random community-based sample of 120 adults aged 25 years and older and living with comorbid T2D and hypertension in Ga Mashie, Accra, Ghana in November and December 2022. The monthly economic cost of T2D and hypertension comorbidity care was estimated using a descriptive cost-of-illness analysis technique from the perspective of patients. Thirteen focus group discussions (FGDs) were conducted among community members with and without comorbid T2D and hypertension. The FGDs were analysed using deductive and inductive thematic approaches. Findings from the survey and qualitative study were integrated in the discussion.ResultsOut of a total of 120 respondents who self-reported comorbid T2D and hypertension, 23 (19.2%) provided complete healthcare cost data. The direct cost of managing T2D and hypertension comorbidity constituted almost 94% of the monthly economic cost of care, and the median direct cost of care was US$19.30 (IQR:10.55–118.88). Almost a quarter of the respondents pay for their healthcare through co-payment and insurance jointly, and 42.9% pay out-of-pocket (OOP). Patients with lower socioeconomic status incurred a higher direct cost burden compared to those in the higher socioeconomic bracket. The implications of the high economic burden resulting from self-funding of healthcare were found from the qualitative study to be: 1) poor access to quality healthcare; (2) poor medication adherence; (3) aggravated direct non-medical and indirect cost; and (4) psychosocial support to help cope with the cost burden.ConclusionThe economic burden associated with healthcare in instances of comorbid T2D and hypertension can significantly impact household budget and cause financial difficulty or impoverishment. Policies targeted at effectively managing NCDs should focus on strengthening a comprehensive and reliable National Health Insurance Scheme coverage for care of chronic conditions.

A qualitative, theory-based exploration of facilitators and barriers for implementation of pharmacist prescribing in chronic kidney disease.

While there is an accumulation of evidence that pharmacist prescribing is safe and effective, there is a lack of research on processes of implementation into practice, particularly for patients with complex clinical conditions such as chronic kidney disease (CKD). The aim was to explore the facilitators and barriers to the implementation of pharmacist prescribing for patients with CKD in the United Kingdom (UK). Semi-structured interviews were conducted with UK Renal Pharmacy Group members who were independent prescribers. The Consolidated Framework for Implementation Research (CFIR) underpinned the interview schedule. Interviews were recorded, transcribed, and independently coded by two researchers. A thematic approach was used for analysis, with data generation continuing until saturation of themes. Ethical approval was granted. Data saturation was achieved following 14 interviews. Most interviewees were female (n = 11), all had secondary care as their main practice setting, and were highly experienced prescribers with 8 having 11 or more years of prescribing practice. Interviewees were positive regarding the development of their prescribing practice. Facilitators and barriers emerged across all 5 of the CFIR domains. Key facilitators were aspects of inner setting (e.g., organisational support and communication) while key barriers were also related to inner setting, specifically the need for adequate structural and financial resources. This theory-based study has illuminated the facilitators and barriers for the implementation of pharmacist prescribing in CKD. There is a need to consider the resources required for implementation of prescribing practice at an early stage of planning and development.

Is MIStreatment of women during facility-based childbirth an independent risk factor for POstpartum Depression in Ethiopia and Guinea? A mixed methods prospective study protocol—MISPOD study

BackgroundWorldwide, 10% of postpartum women experience postpartum depression, which can lead to diverse sequalae at individual, family, and societal levels. In sub-Saharan Africa, it is estimated that 17% of women experience depression in the postpartum period, which could be an underestimate as 48% of women in the region do not receive postnatal care (81% in Ethiopia and 51% in Guinea) and a large share of postpartum depression remains undiagnosed and untreated as a result. Globally, despite a critical evidence gap, there are growing reports of postpartum depression among women mistreated (disrespected and abused) during childbirth in health facilities, making a strong case to examine the association between mistreatment and postpartum depression. This study in Addis Ababa (Ethiopia) and Conakry (Guinea) uses a mixed methods design to 1) examine the link between mistreatment and postpartum depression, 2) explore the health system capacity to provide respectful maternity care and maternal mental health services, and 3) explore the experiences of women in accessing care and support for postpartum depression.MethodsWe will conduct a prospective longitudinal survey of women (434 in Addis Ababa and 408 in Conakry) from the third trimester of pregnancy to eight weeks postpartum and carry out in-depth interviews with key health system informants (20–25 in each city) and women who recovered from a clinically confirmed episode of postpartum depression (15–25 in each city). Quantitative data from the women’s survey will be analysed using a multilevel mixed-effects model; qualitative data from key-informants will be analysed by using a hybrid thematic analysis approach, whereas data from women’s in-depth interviews will be analysed using the phenomenological approach. The inclusion of two different settings in our study (Addis Ababa and Conakry) will enable us to apply a comparative health systems lens to explore the dynamics of respectful maternity care and maternal mental health services within the broader health systems of the two countries (Ethiopia and Guinea).DiscussionThe findings from this study will inform actions aimed at mitigating the mistreatment of women in maternity settings and improving promotive, preventive, and treatment interventions for postpartum depression in Ethiopia and Guinea. The findings can also be extrapolated to other low-resource settings.

Comprehensive knowledge and supports from closest relatives are crucial to improve awareness and participation of Indonesian adolescent girls in anemia prevention program.

This qualitative study explored perceptions of anemia prevention among adolescent girls from low- to mid-socioeconomic backgrounds to identify educational needs for effective intervention. This qualitative study employed focus group discussions (FGDs) for data collection. Participants were recruited through purposive sampling based on specific criteria, with each FGD comprising 7-9 participants. A total of 3 FGDs were conducted, involving 23 high school female students. The discussions, guided by an interview guide, took place in classrooms at two different schools. Verbatim transcripts were created from the FGD recordings and analyzed using a thematic analysis approach. The study revealed several information gaps, including an incomplete understanding of anemia, prevention strategies, and its consequences. Comprehensive knowledge about the causes and effects of anemia, along with the importance of iron supplementation, was identified as essential educational needs for adolescent girls. Support from family members and teachers was deemed crucial during the implementation of anemia prevention strategies. The participants recognized anemia as a serious health issue and emphasized the importance of prevention. Key aspects of anemia prevention need to be integrated into nutrition education programs for adolescents. Addressing these information gaps can enhance the promotion of anemia prevention strategies and improve adherence among adolescents.

A qualitative study of negative sociocultural experiences of accessing primary health care services among Africans from refugee backgrounds in Australia: implications for organisational health literacy

BackgroundPrimary health care is the first point of contact for patients from refugee backgrounds in the Australian health system. Sociocultural factors, including beliefs and value systems, are salient determinants of health literacy and access to primary health care services. Although African refugees in Australia have diverse sociocultural backgrounds, little is known about the influence of sociocultural factors on their experiences of accessing primary health care services. Guided by the theoretical framework of access to health care, this study examined from the perspective of African refugees how culturally and religiously conditioned, constructed and bound health beliefs, knowledge and practices influence their experiences of access to, acceptance and use of primary health care services and information in Australia.MethodsThis exploratory, qualitative study involved 19 African refugees from nine countries living in New South Wales, Australia. Semi-structured interviews were conducted and recorded using Zoom software. The interviews were transcribed verbatim and analysed using a bottom-up thematic analytical approach for theme generation.ResultsFour main themes were identified. The themes included: participants' experiences of services as inaccessible and monocultural and providing information in a culturally unsafe and insensitive manner; the impact of the clinical care environment; meeting expectations and needs; and overcoming access challenges and reclaiming power and autonomy through familiar means. The findings generally support four dimensions in the access to health care framework, including approachability, acceptability, availability and accommodation and appropriateness.ConclusionAfrican refugees experience significant social and cultural challenges in accessing primary health care services. These challenges could be due to a lack of literacy on the part of health services and their providers in servicing the needs of African refugees. This is an important finding that needs to be addressed by the Australian health care system and services. Enhancing organisational health literacy through evidence-informed strategies in primary health systems and services can help reduce disparities in health access and outcomes that may be exacerbated by cultural, linguistic and religious differences.

Perspective on oral medication adherence among patients with acute graft-versus-host disease: a qualitative descriptive study

PurposeDespite the importance of adherence to immunosuppressants (IMMs) after an allogeneic haematopoietic stem cell transplant (HSCT) for the treatment of acute graft-versus-host disease (aGvHD), no studies to date have reported the experiences of such patients concerning medication adherence (MA). Therefore, the aim of the study was to explore the perspective on MA to immunosuppressive oral therapy among allogeneic HSCT patients with aGvHD.MethodsA qualitative descriptive study following a reflexive thematic analysis methodological approach was performed involving a purposive sample of 16 patients with aGvHD who were being cared for in the outpatient setting of a bone marrow transplant centre and were willing to participate. Semi-structured audio-recorded interviews were conducted, transcribed verbatim and thematically analysed; member checking was performed. COnsolidated criteria for REporting Qualitative research (COREQ) and the ESPACOMP Medication Adherence Reporting Guideline were followed.ResultsParticipants aged 25–74 years and mostly males (62.5%) were recruited for this study; 56.2% developed grade I, 37.5% grade II and 6.3% grade III aGvHD; 56.2% were receiving treatment with both cyclosporine and prednisone. Patients' perspectives have been summarised into four themes, named: “Transiting from an external obligation to a habit”; “Being in the middle between the negative and positive effects of the IMMs”; “Failure to systematically respect the rules”; and “Adopting personal strategies to become adherent”. After difficulties with the perception of feeling obliged, patients became used to adhering to IMMs. Although there were failures in systematically taking the medication correctly and there were episodes of non-adherence, the adoption of personal strategies helped patients to become adherent to their medication schedules.ConclusionsMA in patients with aGvHD is a complex behaviour and is often a challenge. These results can help healthcare professionals and centres to understand how best to design tailored strategies and behavioural interventions to maximise patients’ MA to IMMs.

Understanding Residents' and Supervisors' Views on Developing Support-Autonomy Balance Through Supervision Methods in Postgraduate Dental Training: AQualitative Study.

Supervisors continuously need to decide when to provide clinical opportunities for unsupervised patient care to facilitate residents' development in the complex clinical learning context. The aim of this study is to explore residents' and supervisors' views and understanding of the influence of clinical supervision on affording a balanced support-autonomy from the cognitive apprenticeship (CA) theoretical lens. Residents and supervisors, representing all disciplines, participated in five focus groups and four semi-structured individual interviews. Purposive and convenience sampling methods were used for recruiting participants. The reflexive thematic analysis approach was used for inductive data analysis. A total of 15 residents and 8 supervisors participated in this study. All agreed that CA teaching methods can be applied across all levels. Participants experienced changes in their supervision methods and supervisor-resident interactions at different levels of training. They related the selection of supervision to task-, resident- and supervisor-related factors. Learning facilitating factors in clinical learning environment were identified and suggestions to enrich residents' learning experiences were also reported. The current study found that a one-size-fits-all paradigm may not be effective for clinical supervision. It contributes to our understanding of how the CA model may be used to guide supervisor behaviour and how such practices can be modified to residents' level of development and competencies.

How does the role of complementary and alternative medicine in general practice differ between countries? Interviews with doctors who have worked both in Germany and elsewhere in Europe

BackgroundAvailable data suggest that general practitioners (GPs) in Germany use complementary and alternative medicine (CAM) modalities more frequently than GPs in many other countries. We investigated the country differences perceived by general practitioners who have worked in Germany and in one of four other European countries with regard to the role of complementary and alternative treatments in primary care.MethodsIn this qualitative study we conducted semi-structured interviews with 12 GPs who had worked both in Germany and Italy, the Netherlands, Norway or the United Kingdom (UK; n = 3 for each of the four countries). Participants were asked how they perceived and experienced country differences regarding health system, relevance of CAM modalities, the role of evidence-based medicine (EBM) and science, and how they handle so-called indeterminate situations. For the analysis, we followed a thematic analysis approach according to Braun and Clarke with focus on themes that cover CAM.ResultsParticipants unanimously reported that they perceived CAM to be more relevant in general practice in Germany compared to the other countries. We identified four overarching themes in relation to the perceived reasons for these differences. Firstly, physicians with experiences in countries with a strong EBM and science orientation (Netherlands, Norway and the UK) considered the deeply ingrained view in national healthcare systems and GP communities that CAM modalities are not evidence-based as the main reason for the lower use of CAM by GPs. Secondly, extensive training of communication skills was cited as a reason that reduced the need for CAM in the Netherlands, Norway and the UK. Thirdly, differences in patient expectations and demands were perceived as a factor contributing to greater utilisation of CAM by German GPs compared to the other countries. Finally, country-specific reimbursement mechanisms were considered as a factor influencing the role of CAM in general practice.ConclusionsThe study results point to major differences between countries with regard to the role of CAM in GP care. Differences in basic attitudes in the discipline of general practice, patient expectations and system conditions appear to play an important role here.

Micro-credentials through the eyes of employers: benefits, challenges and enablers of effectiveness

Purpose This study explores the perceptions of Australian employers regarding the benefits and challenges of micro-credentials within higher education and enablers of their effectiveness.Design/methodology/approach A qualitative approach that included 11 semi-structured interviews with employers affiliated with an Australian university was used. A deductive thematic approach was employed to analyse the data.Findings Micro-credentials were generally seen to be beneficial for an array of people, including employees, employers, customers and communities – stakeholders in all environmental layers of micro-credentials’ ecological system. Findings also indicated that both challenges of micro-credentials and enablers of their effectiveness depended heavily on attributes of learners, employers and higher education providers. The conclusion is that, based on the evidence of this study, micro-credentials within higher education are worth trialling.Originality/value Although research interest in micro-credentials is growing, few empirical studies have investigated micro-credentials’ benefits, challenges and enablers of effectiveness, especially from the perspective of employers. The study carries practical and policy implications for those involved with micro-credential research and development.

Improving patient care transitions from the intensive care unit to the ward by learning from everyday practice. A multicenter qualitative study

ObjectiveTo explore and describe the everyday practices (Work-As-Done) that hinder and facilitate patient care transitions from the intensive care unit (ICU) to the ward. Research method/designMultiple qualitative case studies in the ICU and various specialized wards of three Dutch hospitals. Adult patients planned to be transferred were purposively sampled on a variety of characteristics along with their relative (if present), and the ICU and ward nurses who were involved in the transition process. Data were collected by using multiple sources (i.e., observations, semi-structured interviews and a qualitative survey) and then systematically analyzed using the thematic analysis approach until saturation was reached. FindingsTwenty-six cases were studied. For each case, the actual transfer was observed. Sixteen patients, five relatives and 36 nurses were interviewed. Two patients completed the survey. Fifteen themes emerged from the data, showing that the quality of transitions is influenced by the extent to which nurses anticipate to patient-specific needs (e.g., providing timely and adequate information, orientation, mental support and aftercare) and to the needs of the counterpart to continue care (e.g., by preparing handovers) besides following standard procedures. Data also show that procedures sometimes interfere with what works best in practice (e.g., communication via a liaison service instead of direct communication between ICU and ward nurses). ConclusionsSubtle, non-technical nursing skills play an important role in comforting patients and in the coordination of care when patients are transferred from the ICU to the ward. Implications for clinical practiceThese Work-As-Done findings and their underlying narratives, that are often overlooked when focusing on quality improvement, can be used as material to reflect on own practice and raise awareness for its impact on patients. They may stimulate healthcare staff in crafting interventions for optimizing the transition process.

Exploring the Perspectives of Unhoused Adults and Providers Across the HCV Care Continuum.

Hepatitis C virus (HCV), the most common blood-borne infection, disproportionately affects people experiencing homelessness (PEH); however, HCV interventions tailored for PEH are scarce. This study utilized a community-based participatory approach to assess perceptions of HCV treatment experiences among HCV-positive PEH, and homeless service providers (HSP) to develop and tailor the "I am HCV Free" intervention which integrates primary, secondary, and tertiary care to attain and maintain HCV cure. Four focus groups were conducted with PEH (N = 30, Mage = 51.76, standard deviation 11.49, range 22-69) and HSPs (n = 10) in Central City East (Skid Row) in Los Angeles, California. An iterative, thematic approach was used to ensure the trustworthiness of the data. Barriers and facilitators emerged from the data which have the potential to impact initiating HCV treatment and completion across the HCV care continuum. Understanding and addressing barriers and strengthening facilitators to HCV treatment will aid in HCV treatment completion and cure for PEH.

Prevention of Violence Against Children: A Qualitative Exploration of Colombian Policymakers', Programme Facilitators' and Caregivers' Perceptions.

Violence against children (VAC) is a global public health and human rights issue that can lead to long-lasting negative consequences for individual and societal outcomes. While extensive evidence indicates that parenting programmes might be effective in preventing VAC, there are several unsolved questions on how to ensure interventions are acceptable, feasible, effective and sustainable, particularly in low- and- middle-income countries (LMICs). In this study, we report findings from a qualitative examination of policymakers' (N = 10), early childhood and parenting programme facilitators' (N = 20) and parents' and other caregivers' (N = 38) perspectives on VAC prevention to examine the implementation ecosystem of parenting programmes in Colombia, including contextual risk and protection factors, features of existing programmes, and stakeholders' needs. We conducted interviews and focus groups using a semistructured format, along with a thematic approach, to analyse the data from each group of participants (i.e., policymakers, facilitators and caregivers) independently. Overall, the data revealed the critical role of intersecting and interacting factors at the micro (e.g., caregivers' capabilities and beliefs), meso (e.g., programme content and delivery approaches) and macro (e.g., policymakers' vision and existing infrastructure) levels in exacerbating risks/imposing barriers versus protecting/promoting VAC prevention. These findings provide evidence on the implementation ecosystem of prevention programmes to inform the design of novel strategies and programmes aimed at preventing violence and promoting families' well-being and young children's development.

Nurturing Entrepreneurial Leadership: An Empirical Study of Elite Schools in Pakistan

The main purpose of the current research was to find out the students’ perspectives about the various qualities of entrepreneurial leadership developed in the students of Elite schools. The study adopted a descriptive research design. The research population was to be comprised of all students of higher secondary classes studying in grade 11 and grade12 in Elite schools of South Punjab of Pakistan. 400 students of higher secondary section of the sampled schools were selected by using simple random sampling technique. Quantitative data was collected through five-point Likert scale. The collected data was analyzed by using SPSS version 21.0. The simple percentages mean score, independent t-test, and P –values were calculated. Qualitative data obtained from open ended questions was analyzed through thematic approach. The findings revealed that the learning environment of the Elite schools is a contributory factor in developing Entrepreneurial Leadership among the students. Majority of the students are satisfied with the Entrepreneurial Leadership skills developed by these schools. The same model can be applied to other public sector educational institutions of Pakistan.

From Gaps to Solutions: Semi-Structured Interviews to Identify Care Gaps in Breast Cancer Care and How to Solve Them with Digital Solutions.

Standardized treatment pathways should make it easier for medical staff and patients to achieve the best possible individual treatment outcome by making sure all relevant information are taken into consideration. The aim of this paper is to identify gaps in care along the treatment pathway through semi-structured patient interviews. Subsequently, it will be discussed if mobile health applications can close these identified gaps in care. Nine semi-structured interviews of patients with invasive lobular breast cancer were conducted in March 2023 in German at the breast cancer center at Charité Universitätsmedizin Berlin, which were subsequently transcribed word for word and processed using a thematic analysis approach. Eight recurring themes are identified in the patient interviews: 1. Limited capacity to absorb information, 2. Discrepancy between information needs and information provision, 3. Need for individual initiative, 4. Uncertainty, 5. not being seen and heard, 6. Patient's desires and suggestions for improvement, 7. Use of mobile health apps, 8. Support through an app for patients. The identified gaps in care of breast cancer patients can be largely addressed through the use of digital health solutions after the establishment of regulatory frameworks, thus improving care for patients with early breast cancer. The interviews were done within a registry for which ethical approval was obtained by the Ethics Committee of Charité Universitätsmedizin Berlin EA4/180/17.