Interview Themes Research Articles

Understanding the training, mentorship, and professional development priorities of early career embedded researchers.

Health systems are constantly evolving in response to existing and emerging health challenges and are increasingly adopting the Quintuple Aim to guide transformation and improvement efforts. Addressing health challenges and achieving the Quintuple Aim (enhancing patient experience, improving healthcare provider experience, promoting population health, optimising the value of healthcare services, and advancing health equity) may be enhanced with the use of a Learning Health Systems approach that fosters the real-time use of data and evidence to inform improvement efforts and harnesses embedded researchers to co-produce timely, relevant evidence to address priorities. Training programs have emerged to build embedded research capacity within health system organisations and have focused predominantly on the postdoctoral career stage, with little attention paid to the early career researcher (ECR) stage. The objective of this study was to understand ECR training and mentorship needs in the embedded research context to inform the creation new or adaptation of existing programs to build embedded ECR capacity. This study used a qualitative approach to garner insight from embedded and applied scholars and health systems leaders in Canada from various professional backgrounds and at various career stages using a combination of focus group discussions, key informant interviews, and an online survey. Thematic content analysis was used to examine the responses of study participants within the interview themes. Twenty-six (26) participants were included in the study. Results were organised according to four key themes: (1) key competencies and skills needed by embedded ECRs; (2) additional training and capacity development needs; (3) training delivery approaches; and (4) enablers and challenges faced by embedded ECRs. Results highlight the importance of supporting ECRs to develop their leadership and organisational management capabilities; their knowledge of and ability to use research approaches that are well-suited to real-world, complex, evolving environments; and their opportunities to learn with and from each other and mentors. Results underscore the perceived importance of context, including being embedded in a supportive environment that values research and evidence and of academic incentives that recognise and value real-world research impact. The challenges of responding to shifting organisational and system priorities were identified. Additional insights from health systems leaders were also highlighted. This study identified the multifaceted needs of embedded ECRs and the challenges they face within healthcare systems. Designing new programs or tailoring existing ones to address these needs would build their capacity, foster career progression, and ensure their impact as leaders of evidence-informed health system improvement which is crucial for achieving the Quintuple Aim.

Learning to Lead: An Exploration of Leadership Development in Obstetrics and Gynaecology

Despite the demonstrated value of leadership in medicine, there is limited research on how physicians develop leadership skills. We administered a national survey (225 respondents) and conducted eight interviews of residents, fellows, and staff physicians in obstetrics and gynaecology to explore leadership skill development. Most (87%) positively rated the effectiveness of their leadership skills; however, the majority (98%) stated they would benefit from further training. Interview themes indicated that leadership skills can be taught, leadership training and roles should be intentional, training should be longitudinal, and barriers to training can be overcome with changes to the current model.

Impact of mental health boarding on clinicians at a children's hospital: A qualitative analysis.

The child and adolescent mental health boarding crisis (i.e., prolonged stays in acute care hospitals for patients awaiting mental health treatment) continues to challenge acute care hospital staff and resources. We sought to understand clinician's experiences while caring for patients experiencing mental health boarding. We conducted semistructured qualitative interviews with clinicians who care for patients experiencing mental health boarding in an acute care freestanding children's hospital with no inpatient psychiatric unit. We used an inductive approach to determine interview themes and major findings. The study included 48 clinician participants from diverse specialties, including 13 social workers, 11 nurses, five psychiatric technicians, six pediatric residents, four attending pediatric hospitalists, four attending psychiatrists, one psychologist, and four other mental health specialists. We identified emergent themes in five domains: (1) frustrations with the mental healthcare system, (2) lack of training in mental healthcare skills, (3) feelings of helplessness, (4) ineffectiveness of medical model of care during mental health boarding, and (5) resilience and support factors. Caring for patients with mental health boarding has negative effects on clinicians, and health system efforts to prevent boarding could improve workforce retention and reduce burnout.

Intergenerational Food Insecurity, Underlying Factors, and Opportunities for Intervention in Momostenango, Guatemala.

Achieving sustainable food security in Guatemala, where nearly half the population is food insecure and 50% of children face chronic malnutrition, is challenging. This mixed-methods study aimed to identify the impacts of climate change on food production, community food security, and household food security. Twelve agricultural group leaders in six communities were interviewed using semi-structured guides. Key informant interview themes included subsistence agriculture, commercial production, challenges related to climate, capital, market, and capacity, as well as sustainable opportunities. Fifty-five mothers from 13 distinct communities around Momostenango were surveyed and interviewed. A significant finding is that 85% of households were food insecure, with 93% relying on agriculture. Food-secure families mostly worked on their own or leased land, whereas food-insecure ones combined farming with day labor. In times of food scarcity, strategies such as altering food consumption and reducing expenses were common. Severely food-insecure families were significantly more likely to reduce portion sizes (72%), whereas food-secure families typically resorted to less preferred foods. Overall, food insecurity was notably linked to larger families, older mothers with limited education, and reliance on agricultural day labor. Food insecurity is a long-term issue in rural areas, deeply rooted in structural socioeconomic constraints, and recurring across generations.

Delivering Medicaid Mental Health Services and Supports in Schools: Current Landscape and Opportunities to Expand.

Medicaid is a key policy lever for expanding access to mental health services and supports for children in schools, especially low-income and minority children. This study examines how Medicaid finances mental health promotion and prevention (tier 1), screening and selected interventions (tier 2), and treatment (tier 3) in schools, informing policy recommendations to expand school mental health. Seventeen key informant interviews were conducted virtually from March to October 2022 with research, practice, and policy leaders in school mental health and Medicaid. Interview transcripts were thematically coded to inform recommendations. Interview themes included that Medicaid is a key funder of mental health services, primarily in tier 3, and that braiding and blending funds is necessary to support services across all tiers in schools. Interviewees underscored the need to expand tier 2 in schools, to expand and diversify the behavioral health workforce (including via non-licensed providers, aligning school-employed provider licensure and billing requirements and building school-community referral relationships), strengthen teaming structures (including state children's cabinets, student case management, and education/Medicaid agency coordination), and leverage technical assistance and training to speed up adoption of new policies (including via guidance and templates that facilitate billing for school health services). Policymakers, practitioners, and advocates can use these findings to identify policies and strategies to expand school mental health and reduce inequities.

Development of the conceptual business model of a third-party logistics provider for Indonesian small contractors

Third-party logistics (TPL) providers have shown positive impacts on supporting large construction projects. Nevertheless, their role in smaller construction still requires further clarification. Small contractors, facing logistics challenges in material supply, are frequently underrepresented in research. We propose a TPL model designed as an intermediary between suppliers and small contractors for consolidating materials. In the initial phase, TPL's business model should be developed for its business foundation. Therefore, this study aims to develop TPLS's conceptual business model that addresses Indonesian small contractors. Three interview themes were employed in this research, involving three distinct groups of small contractors to explore their capacities within construction work, their assessments of specific materials, and their logistical practices. Based on the nine blocks of the Business Model Canvas (BMC), this study found that TPL can ensure material supplies for small construction projects by coordinating sourcing, providing temporary storage, and delivering materials through building strategic partnerships with material suppliers, transportation service providers, and warehousing facility providers. Furthermore, TPL's conceptual business model allows small contractors to gain better access to material supply while providing suppliers with certainty of material purchasing demand. Nonetheless, achieving successful TPL implementation requires dedication from every stakeholder in their assigned roles.

EFL students’ motivational currents during Extensive Reading Programs: A retrodictive qualitative modelling

Motivation to read, the driving force to achieve one’s reading goals, plays a significant role in language learning as it relates to reading engagement and achievement. Its presence is prominently necessary for a longer learning period. This article explores the features of nine pre-service students’ motivational currents and how their motivation changes throughout the task performance in Extensive Reading Programs (henceforth ERPs). Data were collected from diaries, and a retrodictive qualitative model was applied to recount the experiences of the student participants’ motivational currents following Dörnyei’s Directed Motivational Currents (DMC). Themes of diaries and interviews were generated following the Interpretative Phenomenological Analysis. The findings show that the features of DMC are salient and functioning throughout the student’s learning experiences and facilitate the construction of their future identity as readers. Four patterns of motivational currents during the students’ learning were a steady wave, slight wave, moderate wave, and great wave patterns. The variability and stability of task performance motivation indicate that students’ motivational trajectories are unique, conditional, and context-bound. Identifications of the sources of motivators and demotivators provide hints for designing more engaging classroom activities, enriching the task features, and sustaining students’ motivation. This study concludes with possible directions for future motivation research.

Feasibility of a telehealth-based contingency management intervention for alcohol use disorders using the phosphatidylethanol (PEth) 16:0/18:1 alcohol biomarker: a pilot randomized trial

ABSTRACT Background: Phosphatidylethanol (PEth) is a blood-based biomarker for alcohol consumption that can be self-collected and has high sensitivity, specificity, and a longer detection window compared to other alcohol biomarkers. Objectives: We evaluated the feasibility and acceptability of a telehealth-based contingency management (CM) intervention for alcohol use disorder (AUD) using the blood-based biomarker PEth to assess alcohol consumption. Methods: Sixteen adults (7 female, 9 male) with AUD were randomized to Control or CM conditions. Control participants received reinforcers regardless of their PEth levels. CM participants received reinforcers for week-to-week decreases in PEth (Phase 1) or maintenance of PEth consistent with abstinence (<20 ng/mL, Phase 2). Blood samples were self-collected using the TASSO-M20 device. Acceptability was assessed by retention in weeks. Satisfaction was assessed with the Client Satisfaction Questionnaire (CSQ-8) and qualitative interviews. The primary efficacy outcome was PEth-defined abstinence. Secondary outcomes included the proportion of visits with PEth-defined heavy alcohol consumption, negative urine ethyl glucuronide results, and self-reported alcohol use. Results: Retention averaged 18.6 ± 8.8 weeks for CM participants. CM participants reported high levels of satisfaction (CSQ-8, Mean = 30.3 ± 1.5). Interview themes included intervention positives, such as staff support, quality of life improvement, and accountability. 72% of PEth samples from CM participants were consistent with abstinence versus 34% for Control participants (OR = 5.0, p = 0.007). PEth-defined heavy alcohol consumption was detected in 28% of CM samples and 52% of Control samples (OR = 0.36, p = 0.159). CM participants averaged 1.9 ± 1.7 drinks/day versus 4.2 ± 6.3 for Control participants (p = 0.304). Conclusion: Results support the acceptability and satisfaction of a telehealth PEth-based CM intervention, though a larger study is needed to assess its efficacy [NCT04038021].

"Your Kid Has Potential, But They Need Sleep": Teacher Perspectives on School-Based Sleep Promotion in Alberta, Canada.

Insufficient sleep is a growing public health concern. Thirty percent of Canadian children and youth are not meeting national sleep recommendations. Inadequate sleep can negatively influence students' academics and physical and psychosocial health. Schools have been identified as ideal health promotion settings to influence children's health including their sleep behaviors. The objective of this study was to explore teachers' perspectives on sleep behaviors and their role in school-based sleep promotion. Nineteen elementary teachers were purposively sampled from the greater Edmonton area, Alberta, Canada. Interpretive description was used as the guiding method, and data were generated through one-on-one semi-structured interviews. Inductive descriptive thematic analysis was used to identify interview themes. Three themes related to teachers' perspectives on sleep behaviors and school-based sleep promotion were identified: the importance of students' sleep, prioritizing sleep as part of teaching and learning, and a culture of healthy sleep habits. This study found that teachers considered sleep to be essential for elementary students' academic success and wellbeing, and a whole school approach was necessary to support a healthy sleep culture in schools.

‘Situational barriers are keeping me from participating’, but are they situational? Examining low-educated adults’ psychosocial views on adult learning

Despite the attention devoted to situational and institutional barriers in studying participation in adult education, psychosocial barriers are often overlooked in research. However, low-educated, and non-participating adults are more likely to experience them. In this study, we examine low-educated, both participating and non-participating, adults’ psychosocial views on learning. We interviewed 15 adults by using vignettes to elicit discussion on a delicate and difficult to interview theme and carried out a qualitative content analysis. Our findings demonstrate that adults point to situational barriers for not participating and, contrary to what we anticipated, have positive general attitudes towards learning. However, there are several prerequisites to having this attitude. For instance, learning has to be useful, a learning trigger is needed, spare hours should not be devoted, and there should be no exams or tests. As a result, our research demonstrates the complex nature of perceived ‘situational’ barriers, which frequently pertain to psychosocial stances.

Understanding what drives genetic study participation: Perspectives of patients, carers, and relatives.

Genetic research's growing importance in understanding pulmonary arterial hypertension (PAH) and developing effective treatments prompted the RAPID-PAH study. This study sought feedback from stakeholders who participated in two genomic studies to enhance genetic study delivery and clinical integration. Stakeholders from nine UK PH centres, representing various roles, ages, genders, and mutation statuses, took part in 53 semi-structured interviews and focus groups. Transcripts were thematically coded using inductive analysis. Clustering analysis was conducted to identify patient groups that shared attitudes. In this paper, we focus on patients', carers', and relatives' perspectives. The key interview themes revealed insights into participants' attitudes toward genetic research and testing more generally, expertise and knowledge of the disease itself, motivations and barriers to participating in genetic research, awareness of and interest in consent procedures and the use of personal and genetic data, as well as the process of communicating individual genetic results. Factors influencing genetic research participation included altruistic motives, personal diagnostic experiences, and family-related hopes. Clustering analysis produced distinct clusters based on the presence of barriers and motivators for research participation; however, hardly any patients shared identical sets of attitudes, emphasising the need for personalised approaches to recruitment. Most patients reported poor engagement with study-related materials. Patients who received individual genetic results expressed satisfaction with the process, whereas those who did not were disappointed with the lack of feedback. Reflecting on patient perspectives, we offer recommendations to improve the genetic study delivery process. Enhancing genetic research integration into clinical practice requires tailored engagement, clear communication, and support from healthcare stakeholders.

DEMENTIA-FOCUSED ADULT DAY CARE IN AN URBAN SETTING: PROGRAM STAKEHOLDERS’ VIEWS OF CRUCIAL COMPONENTS

Abstract Dementia focused adult day centers (ADCs) provide socialization, physical activity, and cognitive activities for participants, and respite for caregivers. This study reports findings from a process evaluation of an ADC serving a predominantly African American population in a large midwestern city. The evaluation examined whether the program was being implemented as intended, what was working/not working, and participant engagement. We conducted in-depth interviews of staff, volunteers, and student interns and surveyed caregivers (n=17). Thematic analysis of the interviews revealed themes such as “structured flexibility” in running the daily activities, an ethos of care that mixes encouragement of participation with respect for autonomy, ongoing and positive activity, and individualized attention to participants. Other findings revealed the value of consistent and experienced staff and reliance upon and benefits for students and volunteers. Quantitative and qualitative responses to caregiver surveys supported the interview themes. Caregivers valued the socialization and creative stimuli provided to participants. Guidance from program personnel included modeling communication strategies and being “in the moment” with the participants. The findings suggest that further work to inform the development of quality care and programming to improve the quality of life of older African Americans with dementia and their caregivers is needed. Specifically, there is a need to 1) identify essential components of ADCs; 2) document the ways that key ADC service philosophies are realized and communicated; and 3) explore the key role of volunteers and students in terms of their roles, activities, and motivations for working with older adults with dementia.

KNOWLEDGE, ATTITUDES, AND BELIEFS ABOUT HEARING HEALTH CARE OF OLDER BLACK WOMEN SEEKING HEARING HELP IN ENT SETTINGS

Abstract There are documented barriers to access and use of healthcare services faced by older Black adults in the US. Black women are more likely to report negative past experiences with the healthcare system and as a result have inherent mistrust of providers. Black women are also less likely to receive referrals for specialty and allied health care, but it is unknown if this trend is apparent for hearing healthcare. The purpose of the current study was to investigate the experiences of older Black women seeking help for hearing loss in an otolaryngology (ENT) clinic setting. Our interdisciplinary team consisting of experts in gerontology and Black women’s health, public health, audiology, and otolaryngology conducted a mixed methods study which included (1) semi-structured interviews (n=15) and (2) online administration of a validated hearing beliefs questionnaire (n=86). Interview themes uncovered included experiences with racism in healthcare, the role of religion in help-seeking, and the importance of seeking treatment for hearing loss. Triangulation of findings revealed consistency between themes and questionnaire results, including little to no expressed stigma surrounding hearing aid use and little resistance to hearing healthcare or hearing loss treatment. Our results suggest that primary care and ENT should feel confident in referring older Black women who are seeking help for hearing loss to audiology for treatment options. We will also discuss other known facilitators and barriers to serving this population in an ENT setting.

Perspectives on Autism Spectrum Disorder Diagnosis, Symptoms, Treatment and Gender Roles: A Qualitative Study of Similarities and Differences between Sexes.

This study aims to compare the experiences of women and men of different age groups with regard to their first autism spectrum disorder (ASD) diagnosis, symptoms, treatment, and gender roles to inform our understanding in clinical practice of differences as well as similarities. Semi-structured interviews were conducted amongst 22 women (n = 12) and men (n = 10) in three adult age groups regarding their diagnostic process, symptoms, treatment, and gender roles. Participants also filled out questionnaires on gender traits, social support, coping, and quality of life. Framework analysis guidelines were followed to identify subthemes within the three pre-defined key themes of the semi-structured interviews, and quantitative analyses were performed on the questionnaire results. Women often had caregiver roles and were more focused on social and family-oriented life aspects than men. Family and societal expectations may have been different for women from an early age onward and were considered burdensome by some, but not all. Views on ASD diagnosis, symptoms, and treatment were largely individually determined. The questionnaire results mostly showed no significant sex differences. Perceived gender roles differed between participants. In diagnosis and treatment, awareness of general gender differences and gender roles is important, but inter-individual differences and similar experiences in men should not be overlooked.

Tailored support for preparing employees with cancer to return to work: Recognition and gaining new insights in an open atmosphere.

A considerable number of cancer survivors face difficulties in returning to work (RTW). More insight is needed on how to support employees shortly after cancer treatment and help them make the transition back to work. To gain an in-depth understanding of how and under what circumstances a Cancer & Work Support (CWS) program, which assists sick-listed employees with cancer in preparing their RTW, works. A qualitative design was used, inspired by Grounded Theory and Realist Evaluation components. Semi-structured interviews were conducted with RTW professionals (N = 8) and employees with cancer (N = 14). Interview themes covered experiences with CWS, active elements, and impeding and facilitating factors. Interviews were transcribed and analyzed by multiple researchers for contextual factors, active mechanisms, and the outcomes experienced. Respondents experienced the support as human centered, identifying two characteristics: 'Involvement' ('how' the support was offered), and 'Approach' ('what' was offered). Four themes were perceived as important active elements: 1) open connection and communication, 2) recognition and attention, 3) guiding awareness and reflection, and 4) providing strategies for coping with the situation. Variation in the experiences and RTW outcomes, appeared to be related to the personal, medical and environmental context. Both professionals and employees really appreciated the CWS because it contributed to RTW after cancer. This research shows that not only 'what' RTW professionals do, but also 'how' they do it, is important for meaningful RTW support. A good relationship in an open and understanding atmosphere can contribute to the receptiveness (of employees) for cancer support.

An institution-wide mixed methods assessment of healthcare transition

BackgroundHealthcare transition (HCT) is the process of moving a patient from pediatric, parent-supervised care to an independent, adult-centered model. This study assesses current HCT activities and explores the educational and system-based needs for effective HCT processes in a single institution. MethodsWe interviewed division/care program leaders at one academic tertiary-care children’s hospital regarding HCT practices. We evaluated these groups using an interview guide and rubric scoring from the “GotTransition Current Assessment of HCT Activities” (scoring range from 8 [low HCT] to 32 [high HCT]). We audio-recorded and transcribed interviews. We calculated each group’s score on the rubric. Two coders qualitatively analyzed interview transcripts using a thematic analysis approach with deductive and inductive strategies. ResultsWe interviewed 28 participants, each representing one division/care program. The institutional mean on the HCT assessment was 15.5 ± 4.5 (median 17.5, range 8–28). Key interview themes included: 1) Significant heterogeneity in the HCT process exists within most divisions/care programs; 2) While some groups have their own HCT practices, there is no coordinated institutional HCT approach.; 3) Participants find HCT difficult if they perceive the lack of an equivalent adult specialist for a patient’s specific medical condition; 4) There is a lack of coordinated handoffs from pediatric to adult providers. 5) Participants desire ancillary staff to support HCT. ConclusionDespite known benefits of a structured approach, most leaders report heterogeneity in current HCT practices and a lack of institutional resources and adult provider partners to support optimal HCT. We present a reproducible methodology to evaluate HCT within a single institution, as well as baseline assessment data that may inform interventions.

Experiences of Adoptive Parents and Their Support Workers Accessing Remotely Delivered Therapeutic Support via the Adoption Support Fund during COVID-19: A Service Evaluation

This service evaluation explored experiences of adoptive parents and support workers accessing videoconferencing-based therapeutic support. Adoptive parents from 18 families who accessed remote therapeutic support between July and December 2020 completed questionnaires and semi-structured interviews were conducted with six social workers. Questionnaires were analyzed descriptively, and interviews were analyzed thematically. Parental responses indicated that accessing such support was accessible and met family needs. Three interview themes were identified: accessibility of support package, relationships and communication, and looking to the future. Findings suggest that a mixture of face-to-face and remote support is preferrable, however, modality preferences differ per family. Recommendations for services offering remotely delivered therapy via VC are made based on the findings, including (1) provide families with a choice of modality for therapeutic work, (2) provide more time to develop a therapeutic relationship, (3) consider a face-to-face meeting prior to online sessions, (4) provide training for staff and families on digital technology, (5) use remote support to provide brief packages of support, and (6) involve support workers to provide consistent support. Suggestions for further research are outlined.

Assessment of Quality of Life, Grief, and Psychosocial Need Among Bereaved Caregivers of Children with Cancer.

Cancer is the leading disease-related cause of death for children in the United States; however, limited data exists on caregivers' needs and evidence-based bereavement interventions are lacking. This is a cross-sectional study of primary caregivers of children who died from cancer. Participants completed five surveys assessing well-being and an optional semi-structured, in-depth qualitative interview. Caregiver's greatest unmet needs were finding meaning in the death, personal wellness, and social activities. Bereaved caregivers with greater unmet needs reported poorer quality of life in the energy/fatigue (p = .01), role limitations due to emotional problems (p = .01), pain (p = .01), and emotional well-being (p = .02) domains. Interview themes elicited include inadequate bereavement services, support for siblings, desired contact with the medical team, and connections to other bereaved caregivers. Findings support the need for intensive, evidence-based bereavement programs for families of children who died from cancer, to attempt to mitigate poor bereavement-related outcomes.

Patient and Care Team Perspectives on Social Determinants of Health Screening in Primary Care

Health systems in the US are increasingly screening for social determinants of health (SDOH). However, guidance incorporating stakeholder feedback is limited. To examine patient and care team experiences in early implementation of SDOH screening in primary care. This qualitative study included cross-sectional analysis of SDOH screenings during primary care visits from February 22 to May 10, 2022, primary care team member interviews from July 6, 2022, to March 8, 2023, and patient stakeholder engagement on June 30, 2022. The setting was a large southeastern US health care system. Eligible patients were aged 18 years or older with completed visits in primary care. Screening for SDOH in primary care. Multivariable logistic regression evaluated patient (eg, age, race and ethnicity) and care team characteristics (eg, practice type), and screening completeness. Interviews contextualized the quantitative analysis. There were 78 928 visits in practices conducting any SDOH screening. The population with visits had a mean (SD) age of 57.6 (18.1) years; 48 086 (60.9%) were female, 12 569 (15.9%) Black, 60 578 (76.8%) White, and 3088 (3.9%) Hispanic. A total of 54 611 visits (69.2%) were with a doctor of medicine and 13 035 (16.5%) with a nurse practitioner. Most had no SDOH questions answered (75 298 [95.4%]) followed by all questions (2976 [3.77%]). Logistic regression analysis found that clinician type, patient race, and primary payer were associated with screening likelihood: for clinician type, nurse practitioner (odds ratio [OR], 0.13; 95% CI, 0.03-0.62; P = .01) and physician assistant (OR, 3.11; 95% CI, 1.19-8.10; P = .02); for patient race, Asian (OR, 1.69; 95% CI, 1.25-2.28; P = .001); Black (OR, 1.49; 95% CI, 1.10-2.01; P = .009); or 2 or more races (OR, 1.48; 95% CI, 1.12-1.94; P = .006); and for primary payer, Medicaid (OR, 0.62; 95% CI, 0.48-0.80; P < .001); managed care (OR, 1.17; 95% CI, 1.07-1.29; P = .001); uninsured or with Access Health (OR, 0.26; 95% CI, 0.10-0.67; P = .005), and Tricare (OR, 0.71; 95% CI, 0.55-0.92; P = .01). Interview themes included barriers (patient hesitancy, time and resources for screening and referrals, and number of questions/content overlap) and facilitators (communication, practice champions, and support for patient needs). This qualitative study presents potential guidance regarding factors that could improve SDOH screening within busy clinical workflows.

Evidence-Based Opioid Education That Reduces Prescribing: The 10 Principles of Opioid Prescribing in Foot and Ankle Surgery

Over half of opioid misusers last obtained access to opioids via a friend or relative, a problematic reflection of the opioid reservoir phenomenon, which results from an unused backlog of excess prescription opioids that are typically stored in the American home. We aim to determine if a voluntary educational intervention containing standard opioid and nonopioid analgesic prescribing ranges for common surgeries is effective in altering postoperative prescribing practice. We utilized a mixed methods approach and sent out a questionnaire to American podiatric physicians, including residents (baseline group A), via email in early 2020 for baseline data; then, we interviewed foot and ankle surgeons and the primary themes of these semistructured interviews informed us to target residents for an educational intervention. We repeated the survey 3 years later in summer 2022 (preintervention group B). We created an opioid guide and emailed it to residents in fall 2022. Another repeat survey was done in spring 2023 (postintervention group C). We used the Mann-Whitney U test to examine differences between the groups among their reported postoperative opioid quantities for a first metatarsal osteotomy surgical scenario. Groups A, B, and C had 60, 100, and 99 residents, respectively. There was no significant difference (p = .9873) between baseline group A and preintervention group B. There was a difference (p < .0001; -5 median) between preintervention group B and postintervention group C (same residency year). In postintervention group C, a majority (91/99) reported viewing the guide at least once, and the number of residents that reported supplementing with NSAIDs also doubled compared to preintervention group B. This novel opioid educational intervention resulted in meaningful change in self-reported postoperative prescribing behavior among residents.