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1.
PLoS One ; 18(6): e0286819, 2023.
Article in English | MEDLINE | ID: covidwho-20244405

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, changes in working life occurred, even in Sweden, where there was no general lockdown. The aim of this study was to examine how the COVID-19 pandemic was perceived as affecting the hindering and enabling factors among young employees with CMD to remain at or return to work, here as investigated from the perspective of young employees and managers. MATERIAL AND METHODS: A qualitative design was applied with semistructured interviews with 23 managers and 25 young employees (20-29 years old). The interviews were recorded and transcribed verbatim, and the parts of the interviews related to the aim of this article were analysed using conventional content analysis. RESULTS: The hindering factors were changed working conditions, decreased well-being when spending more time at home, and uncertainty. The enabling factors were decreased demands, increased balance, and well-functioning work processes. For managers it is important to be aware of warning signals indicating blurred boundaries between work and private life, to create and maintain well-functioning communication, and leave room for recovery. CONCLUSION: The hindering and enabling factors can be described as two sides of the same coin. Changes in the working conditions during the pandemic led to difficulties for both young employees and managers when the margins of maneuver were insufficient.


Subject(s)
COVID-19 , Mental Disorders , Humans , Young Adult , Adult , Pandemics , Return to Work , COVID-19/epidemiology , Communicable Disease Control , Qualitative Research , Causality
2.
BMC Public Health ; 23(1): 932, 2023 05 23.
Article in English | MEDLINE | ID: covidwho-20244245

ABSTRACT

BACKGROUND: The success of the COVID-19 vaccination roll-out depended on clear policy communication and guidance to promote and facilitate vaccine uptake. The rapidly evolving pandemic circumstances led to many vaccine policy amendments. The impact of changing policy on effective vaccine communication and its influence in terms of societal response to vaccine promotion are underexplored; this qualitative research addresses that gap within the extant literature. METHODS: Policy communicators and community leaders from urban and rural Ontario participated in semi-structured interviews (N = 29) to explore their experiences of COVID-19 vaccine policy communication. Thematic analysis was used to produce representative themes. RESULTS: Analysis showed rapidly changing policy was a barrier to smooth communication and COVID-19 vaccine roll-out. Continual amendments had unintended consequences, stimulating confusion, disrupting community outreach efforts and interrupting vaccine implementation. Policy changes were most disruptive to logistical planning and community engagement work, including community outreach, communicating eligibility criteria, and providing translated vaccine information to diverse communities. CONCLUSIONS: Vaccine policy changes that allow for prioritized access can have the unintended consequence of limiting communities' access to information that supports decision making. Rapidly evolving circumstances require a balance between adjusting policy and maintaining simple, consistent public health messages that can readily be translated into action. Information access is a factor in health inequality that needs addressing alongside access to vaccines.


Subject(s)
COVID-19 , Health Communication , Humans , Ontario , COVID-19 Vaccines , Health Status Disparities , Health Policy , Qualitative Research
3.
BMC Health Serv Res ; 23(1): 547, 2023 May 25.
Article in English | MEDLINE | ID: covidwho-20244153

ABSTRACT

Malawi, like many other countries, faces challenges in providing accessible, affordable, and quality health services to all people. The Malawian policy framework recognizes the value of communities and citizens, as co-creators of health and leaders of localized and innovative initiatives, such as social innovations.Social innovations involve and include communities and citizens, as well as bring about changes in the institutions responsible for care delivery. In this article, we describe the institutionalization process of a citizen-initiated primary care social innovation, named Chipatala Cha Pa Foni, focused on extending access to health information and appropriate service-seeking behavior.An interdisciplinary multi-method qualitative case study design was adopted, drawing on data collected from key informant interviews, observations, and documents over an 18-month period. A composite social innovation framework, informed by institutional theory and positive organizational scholarship, guided the thematic content analysis. Institutional-level changes were analyzed in five key dimensions as well as the role of actors, operating as institutional entrepreneurs, in this process.A subset of actors matched the definition of operating as Institutional Entrepreneurs. They worked in close collaboration to bring about changes in five institutional dimensions: roles, resource flows, authority flows, social identities and meanings. We highlight the changing role of nurses; redistribution and decentralization of health information; shared decision-making, and greater integration of different technical service areas.From this study, the social innovation brought about key institutional and socio-cultural changes in the Malawi health system. These changes supported strengthening the system's integrity for achieving Universal Health Coverage by unlocking and cultivating dormant human-based resources. As a fully institutionalized social innovation, Chipatala Cha Pa Foni has enhanced access to primary care and especially as part of the Covid-19 response.


Subject(s)
Access to Primary Care , COVID-19 , Humans , Malawi , Delivery of Health Care , Qualitative Research
4.
Int J Environ Res Public Health ; 20(10)2023 05 10.
Article in English | MEDLINE | ID: covidwho-20244042

ABSTRACT

The outbreak of Coronavirus Disease 2019 (COVID-19) has threatened health and well-being in all populations. This impact is also deepening structural inequalities for migrant workers in Thailand. Due to their vulnerability and limited opportunity to access health services, they have greater risks in many health aspects compared to other populations. This qualitative study sought to examine the key health concerns and barriers during the COVID-19 pandemic on healthcare access among migrant workers in Thailand through the lens of policymakers, healthcare professionals, experts on migrant health, and migrant workers. We conducted 17 semi-structured in-depth interviews of stakeholders from health and non-health sectors in Thailand from July to October 2021. The interviews were transcribed and analyzed using both deductive and inductive thematic approaches. Thematic coding was applied. The results showed that financial constraints were a major barrier for healthcare access among migrant workers. These included affordability of healthcare and difficulty accessing funds (migrant health insurance). Structural barriers included some health facilities opening for emergency cases only. Insufficient healthcare resources were profound during the peak of positive cases. Cognitive barriers included negative attitudes and diverse understanding of healthcare rights. Language and communication barriers, and a lack of information also played an important role. Conclusion, our study highlights healthcare access barriers to migrant workers in Thailand during the COVID-19 pandemic. Recommendations for future resolution of these barriers were also proposed.


Subject(s)
COVID-19 , Transients and Migrants , Humans , Pandemics , Thailand/epidemiology , COVID-19/epidemiology , Health Services Accessibility , Qualitative Research , Health Facilities
5.
J Gerontol Nurs ; 49(6): 19-26, 2023 Jun.
Article in English | MEDLINE | ID: covidwho-20243197

ABSTRACT

Black American individuals have a higher rate of Alzheimer's disease and related dementias (ADRD) diagnoses compared to other racial/ethnic groups, and their family caregiver population is expected to increase rapidly over the next 2 decades. The current study aimed to explore Black American women's experiences caring for family members with ADRD. An interpretative phenomenology approach was used to gain a deeper understanding of the caregiving experiences of Black American women. Participants in the study were all Black American married women aged 63 to 81 years (mean = 71.3 years, SD = 6.6 years). Key themes that emerged from the study included: (a) Family Care Obligation, (b) Caregiving Journey, (c) Prioritizing Health Concerns, (d) Coping Behaviors, and (e) Support Needs and Challenges. Family caregivers require ongoing support, education, and guidance. Implications for nursing practice include focusing on family assessments, increased education and awareness, and collaboration with interdisciplinary teams to provide the best resources. [Journal of Gerontological Nursing, 49(6), 19-26.].


Subject(s)
Alzheimer Disease , Dementia , Female , Humans , Black or African American , Caregivers , Family , Qualitative Research , Middle Aged , Aged , Aged, 80 and over
6.
Int J Environ Res Public Health ; 20(11)2023 May 25.
Article in English | MEDLINE | ID: covidwho-20243003

ABSTRACT

COVID-19 exacerbated health disparities, financial insecurity, and occupational safety for many within marginalized populations. This study, which took place between 2019 and 2022, aimed to explore the way in which sex workers (n = 36) in Chicago were impacted by COVID-19. We analyzed the transcripts of 36 individual interviews with a diverse group of sex workers using thematic analysis. Five general themes emerged regarding the detrimental impact of COVID-19 on sex workers: (1) the impact of COVID-19 on physical health; (2) the economic impact of COVID-19; (3) the impact of COVID-19 on safety; (4) the impact of COVID-19 on mental health; and (5) adaptive strategies for working during COVID-19. Participants reported that their physical and mental health, economic stability, and safety worsened due to COVID-19 and that adaptive strategies did not serve to improve working conditions. Findings highlight the ways in which sex workers are particularly vulnerable during a public health crisis, such as COVID-19. In response to these findings, targeted resources, an increased access to funding, community-empowered interventions and policy changes are needed to protect the health and safety of sex workers in Chicago.


Subject(s)
COVID-19 , Sex Workers , Humans , COVID-19/epidemiology , Sex Workers/psychology , Chicago/epidemiology , Qualitative Research , Mental Health
7.
PLoS One ; 18(5): e0284422, 2023.
Article in English | MEDLINE | ID: covidwho-20235890

ABSTRACT

BACKGROUND: People with kidney failure require renal replacement therapy in the form of dialysis or a kidney transplant for survival. Many facets of their life, both within and outside the dialysis unit, are impacted by the management of this disease. It is important to comprehend the experiences of people undergoing hemodialysis in order to improve the care provided to them. Therefore, this study aimed to explore the experiences of patients undergoing maintenance hemodialysis in Ethiopia. METHODS: A qualitative descriptive study was conducted at two healthcare facilities in Ethiopia. Individual interviews with 15 participants (men and women aged 19-63), undergoing hemodialysis in Ethiopia, were analyzed using reflexive thematic analysis. RESULTS: The analysis resulted in five themes: Feeling grateful, Facing a restricted life, a Supportive environment, Dreaming of a transplant, and Leading a hassled life. The subthemes include Trust in treatment, Faith in God, Challenging fluid and dietary restrictions, Being too fatigued to socialize, Being stigmatized, Family and social support, Supportive healthcare, Lacking a donor and sponsor, COVID-19 as a barrier, Financial constraints, Inaccessibility to care and transport and Access line implantation. Despite being dependent on a machine and having to deal with food and fluid restrictions as well as financial challenges, participants were hopeful and dreamed of a transplant. CONCLUSION: From the study's participants, it was discovered that the experiences of people with kidney failure undergoing hemodialysis were generally, considerably negative narratives. Based on the results we recommend development of multidisciplinary teams to better meet patients' physical, emotional, and social needs while undergoing hemodialysis. Such a team should also involve the patient's family members when caring for patients on hemodialysis.


Subject(s)
COVID-19 , Renal Insufficiency , Male , Humans , Female , Ethiopia , Renal Dialysis , Qualitative Research
8.
J Nurs Educ ; 62(6): 343-350, 2023 Jun.
Article in English | MEDLINE | ID: covidwho-20235499

ABSTRACT

BACKGROUND: Nurses play key roles as vaccination agents and frontline workers who deal with prejudice and misinformation. This study examined the attitudes and perceptions of nursing students regarding corona-virus disease 2019 (COVID-19) vaccination and its social and institutional management. METHOD: This qualitative study consisted of an exploratory phase involving first- and fourth-year nursing students and a second phase using the PhotoVoice tool SHOWED mnemonic method followed by discussion groups with second-year nursing students. RESULTS: Three themes emerged: (1) hope tinged with fear; (2) too much information generating fear, uncertainty, and mistrust; and (3) leaders without recognition or voice. CONCLUSION: The results inform the body of knowledge in nursing science and enhance changes in clinical practice by providing new insights regarding the perceptions of nursing students on vaccination and its management, highlighting the need to train future nurses in health literacy and new ways to interact with community members. [J Nurs Educ. 2023;62(6):343-350.].


Subject(s)
COVID-19 , Education, Nursing, Baccalaureate , Students, Nursing , Humans , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines , Education, Nursing, Baccalaureate/methods , Attitude of Health Personnel , Creativity , Qualitative Research
9.
Cien Saude Colet ; 27(5): 1813-1826, 2022 May.
Article in Portuguese | MEDLINE | ID: covidwho-20237515

ABSTRACT

The scope of this study is to analyze the specificities of conception and execution of the different modalities of online focus groups (OFGs), a qualitative technique that is an alternative to a traditional focus group, due to the social distancing required by the COVID-19 pandemic. An integrative literature review was conducted in PubMed Central and BVS. National and international studies published in the last 10 years that describe and discuss OFGs were included. A total of 291 articles were identified and 24 were included after evaluation in stages. Four OFG modalities were found: synchronous or asynchronous by writing; synchronous by video/audio or audio. The OFG was used to research different health topics. The same platform can be used for realizing different OFG modalities, guaranteeing the participants' security and anonymity. The lack of a real-life atmosphere can impact participant engagement, but it can be resolved. An OFG can produce quality data, save time and expense, expand the participation of people who are geographically dispersed, but limit those with restricted internet access. This study can help researchers who intend to choose anOFG modality. Studies that assess the limits of OFGs in Brazil are suggested, as well those which address the asynchronous OFG by audio.


Objetiva-se analisar especificidades da concepção e realização das modalidades de grupo focal on-line (GFO), técnica qualitativa alternativa ao grupo focal tradicional frente ao distanciamento físico imposto pela pandemia de COVID-19. Realizou-se uma revisão integrativa da literatura nas bases PubMed Central e BVS. Foram identificados 291 artigos, a inclusão de 24 após avaliação por etapas. Foram identificados 291 artigos. Após avaliação por etapas, foram incluídos 24 artigos nacionais e internacionais dos últimos dez anos que descrevem e discutem a realização do GFO. As modalidades de GFO encontradas foram: síncrono ou assíncrono por escrito; síncrono por vídeo/áudio ou áudio. O GFO foi realizado em variadas pesquisas do campo da saúde. Uma mesma ferramenta pode ser usada para diferentes modalidades, garantindo a segurança dos participantes e o anonimato. A falta de atmosfera de vida real pode impactar o engajamento dos participantes, uma limitação manejável. As modalidades de GFO podem produzir dados de qualidade, economizar tempo e custo, ampliar a participação de sujeitos dispersos geograficamente, mas limitar em relação aos que têm dificuldades de acesso à internet. Este estudo auxilia pesquisadores na escolha de uma modalidade de GFO. Sugere-se pesquisas que avaliem os limites do GFO no Brasil e que abordem a modalidade assíncrona por áudio.


Subject(s)
COVID-19 , Pandemics , Data Collection , Focus Groups , Humans , Qualitative Research
10.
Cien Saude Colet ; 27(1): 193-203, 2022 Jan.
Article in Portuguese, English | MEDLINE | ID: covidwho-20237754

ABSTRACT

This paper aimed to identify and understand the meanings of family in a COVID-19 pandemic situation for adolescents in Northeastern Brazil. This qualitative research used the DE-T Procedure with 32 adolescents from Northeastern Brazil. Thirteen themes were observed, and the most incident were physical distance, expressed feelings, integrating family relationships, technological devices, and disintegrating family relationships. We finalize with the representation of family power in facing the pandemic and family suffering in the face of the public health problem that plagues the country.


Este artigo objetivou identificar e compreender os significados da família em situação de pandemia da COVID-19 para jovens do nordeste brasileiro. Trata-se de uma pesquisa qualitativa, com o uso do Procedimento DE-T. Participaram 32 adolescentes do nordeste brasileiro. Observou-se 13 temas, sendo os mais incidentes: distanciamento físico; sentimentos expressos; relações familiares integradoras; aparelhos tecnológicos; relações familiares desintegradoras. Conclui-se sobre a representação da potência familiar no enfrentamento da pandemia, bem como sobre o sofrimento e padecimento familiar frente ao problema de saúde pública que assola o país.


Subject(s)
COVID-19 , Pandemics , Adolescent , Brazil/epidemiology , Humans , Qualitative Research , SARS-CoV-2
11.
BMJ Open ; 13(5): e065719, 2023 05 26.
Article in English | MEDLINE | ID: covidwho-20241385

ABSTRACT

OBJECTIVES: To understand how and why Australian cancer physicians interact with the pharmaceutical industry. DESIGN: Qualitative study using semistructured interviews, performed by a medical oncologist. Thematic analysis using a combination of deductive and inductive codes. SETTING: Given the evidence on industry influences on clinical practice and the importance to the market of oncology drugs, we sought to better understand cancer physicians' experiences. Practising consultant medical oncologists and clinical haematologists from four Australian states were interviewed over Zoom. PARTICIPANTS: 16 cancer physicians were interviewed between November 2021 and March 2022, from 37 invited (response rate 43%). Most were medical oncologists (n=12 of 16, 75%) and male (n=9 of 16, 56%). OUTCOME MEASURES: The analysis of all interviews was based on grounded theory. Transcripts were coded and then codes formed into themes with supporting quotes. The themes were then placed into categories, used to describe the broad areas into which the themes could be grouped. RESULTS: Six themes were identified that fell within two broad categories: cancer physicians' views and experiences of interactions and management of these interactions. Views and experiences included: the transactional nature of relationships, risks of research dependence, ethical challenges and varied attitudes based on interaction type. Management themes included: lack of useful guidance and reduced interactions during the COVID-19 pandemic. These led to an overarching seventh theme, on the desire for a 'middle road'. Cancer physicians identified the transactional nature of industry relationships and felt uncomfortable with several types of interactions, including those with sales representatives. Most wanted less contact with industry, and the forced separation that occurred with the COVID-19 pandemic was generally welcome. CONCLUSIONS: Cancer physicians may have difficulty balancing the perceived need to interact with industry in modern cancer care while maintaining distance to minimise conflicts of interest. Further research is needed to assess management strategies in this area.


Subject(s)
Drug Industry , Medical Oncology , Physicians , Humans , Male , Attitude of Health Personnel , Australia , Conflict of Interest , COVID-19 , Neoplasms , Pandemics , Qualitative Research , Female
12.
Support Care Cancer ; 31(7): 376, 2023 Jun 05.
Article in English | MEDLINE | ID: covidwho-20240047

ABSTRACT

PURPOSE: This study aimed to explore the challenges of access to treatment and quality of life in female cancer survivors living in rural areas of Iran within the global pandemic context (COVID-19). METHODS: We conducted a qualitative exploratory study where we recruited nine female-identifying individuals diagnosed with cancer, 23 family members, and five healthcare providers from a hospital affiliated with the Birjand University of Medical Sciences in Iran. Data was collected using semi-structured interviews and analyzed using Braun and Clarke's reflective thematic analysis. RESULTS: The three themes constructed were lack of strength from fighting on two fronts (subthemes: (i) fear related to longevity and life span, (ii) disruption of emotional relationships and family functioning, (iii) loneliness and fear of the future, (iv) village culture and double whammy, and (v) isolation and rejection in a rural community); changes during treatment (subthemes: (i) confusion related to treatment and (ii) the hope found during treatment "bottlenecks"); and spiritual growth and clarifying values (subthemes: (i) patience and resilience and (ii) clarifying life values and opportunities when facing uncertainty about the future). CONCLUSION: This study highlights the importance of further evaluating interventions to mitigate barriers to supportive care for female cancer survivors living in rural areas with low-resource contexts during the COVID-19 pandemic.


Subject(s)
COVID-19 , Neoplasms , Humans , Female , Pandemics , Quality of Life , Iran , Neoplasms/therapy , Qualitative Research
13.
Rech Soins Infirm ; 151(4): 43-59, 2023.
Article in French | MEDLINE | ID: covidwho-20240016

ABSTRACT

Much the same as other healthcare services, when the COVID-19 pandemic hit, psychiatric hospitals implemented significant and rapid changes in the organization of their services. The aim of this research study is to describe and understand the experience of nurses and nursing supervisors in psychiatric units in the light of the occupational transformations caused by the first wave of the COVID-19 pandemic, as well as the impact of these events on their relationships with patients. A consensual qualitative research study based on Hill's model was implemented. Sixteen individual interviews were conducted with eleven nurses and five nursing supervisors. The themes discussed can be grouped into five areas: aspects of the caregiving relationship, positive aspects of caregivers' experiences, negative aspects of caregivers' experiences, reflections on the post-pandemic era, and the role of supervisors. These five areas can be subdivided into 11 categories and 31 subcategories. Values, attitudes, and behaviors centered around a humanistic caring approach are identified as integral to future development. They appear to be elements of both the transformation process and the desired outcome. In light of these findings, it seems that an immediate rethink of the organization of care is needed.


Dans les hôpitaux psychiatriques, des modifications importantes et rapides de l'organisation des services ont été décidées dès le début de la pandémie de COVID-19. Le but de cette recherche est de décrire et comprendre le vécu des infirmières et cadres de santé, en unités intrahospitalières de psychiatrie, confrontés aux bouleversements professionnels occasionnés par la première vague de l'épidémie, ainsi que l'impact de cet événement sur la relation avec les patients. Une recherche qualitative consensuelle selon Hill a été mise en œuvre. Seize entretiens individuels ont été réalisés auprès de onze infirmières et cinq cadres de santé. Les idées exprimées peuvent être regroupées en cinq domaines : les aspects du vécu se rapportant à la relation de soins, les aspects positifs du vécu des soignants, les aspects négatifs du vécu des soignants, les réflexions sur l'après-crise et le rôle du cadre remis en question. Ces cinq domaines peuvent être subdivisés en 11 catégories et 31 sous-catégories. Des valeurs, attitudes et comportements humanistes ­ caring ­ sont identifiés comme faisant partie d'un futur désirable. Ils semblent être à la fois des éléments du processus de transformation et du résultat souhaité. Il parait indispensable de repenser sans délais l'organisation des soins sur cette base.


Subject(s)
COVID-19 , Nurses , Humans , Pandemics , COVID-19/epidemiology , Patients , Qualitative Research
15.
BMJ Open ; 13(5): e069371, 2023 05 29.
Article in English | MEDLINE | ID: covidwho-20237451

ABSTRACT

INTRODUCTION: Digital healthcare in the UK was adopted out of necessity rather than choice during the COVID-19 pandemic. However, as we move forward, UK governments and healthcare services have acknowledged its evident benefits for patients, staff and the National Health Service (NHS), and are keen to sustain its improvements in the long term. OBJECTIVE: To understand the benefits, challenges and sustainability of a future-proof digital healthcare. DESIGN: A semi-structured interview study was conducted. SETTING: In NHS services in Wales, UK. PARTICIPANTS: With clinical and non-clinical staff across a mix of clinical specialties. OUTCOME MEASURES: Semi-structured interviews were conducted to address benefits, challenges and sustainability of a national video consulting (VC) service, and thematically coded using a quantification method of qualitative work. RESULTS: A total of 203 interviews were conducted and 3 dominant domains emerged, with 7 themes and 26 categories. LIMITATIONS: It is important to acknowledge that these findings were captured during a pandemic. CONCLUSIONS: NHS Wales has demonstrated that currently there are an equal measure of benefits and challenges to a national digital healthcare. However, with ongoing government and service support, improvement and evaluation, it has potential for a sustainable digital future, in which the benefits can outweigh the challenges.


Subject(s)
COVID-19 , State Medicine , Humans , Wales , Pandemics , COVID-19/epidemiology , Delivery of Health Care , Qualitative Research
16.
BJOG ; 130(8): 849-850, 2023 07.
Article in English | MEDLINE | ID: covidwho-20237239
17.
J Clin Nurs ; 32(13-14): 3730-3745, 2023 Jul.
Article in English | MEDLINE | ID: covidwho-20237058

ABSTRACT

AIMS AND OBJECTIVES: The aim of this study is to enhance the understanding of the core elements and influencing factors on the community-based epilepsy nurse's role and responsibilities. BACKGROUND: Internationally, epilepsy nurse specialists play a key role in providing person-centred care and management of epilepsy but there is a gap in understanding of their role in the community. DESIGN: A national three-stage, mixed-method study was conducted. METHODS: One-on-one, in-depth semi-structured qualitative interviews were conducted online with 12 community-based epilepsy nurses (Stage 1); retrospective analysis of data collected from the National Epilepsy Line, a nurse-led community helpline (Stage 2); and focus group conducted with four epilepsy nurses, to delve further into emerging findings (Stage 3). A thematic analysis was conducted in Stages 1 and 3, and a descriptive statistical analysis of Stage 2 data. Consolidated Criteria for Reporting Qualitative studies checklist was followed for reporting. RESULTS: Three key themes emerged: (1) The epilepsy nurse career trajectory highlighted a lack of standardised qualifications, competencies, and career opportunities. (2) The key components of the epilepsy nurse role explored role diversity, responsibilities, and models of practice in the management of living with epilepsy, and experiences navigating complex fragmented systems and practices. (3) Shifting work practices detailed the adapting work practices, impacted by changing service demands, including COVID-19 pandemic experiences, role boundaries, funding, and resource availability. CONCLUSION: Community epilepsy nurses play a pivotal role in providing holistic, person-centred epilepsy management They contribute to identifying and addressing service gaps through innovating and implementing change in service design and delivery. RELEVANCE TO CLINICAL PRACTICE: Epilepsy nurses' person-centred approach to epilepsy management is influenced by the limited investment in epilepsy-specific integrated care initiatives, and their perceived value is impacted by the lack of national standardisation of their role and scope of practice. NO PATIENT OR PUBLIC CONTRIBUTION: Only epilepsy nurses' perspectives were sought.


Subject(s)
COVID-19 , Epilepsy , Nurses , Humans , Pandemics , Retrospective Studies , Nurse's Role , Qualitative Research
18.
Health Syst Reform ; 9(1): 2215552, 2023 12 31.
Article in English | MEDLINE | ID: covidwho-20237013

ABSTRACT

The outbreak of the COVID-19 pandemic has boosted the global development of online healthcare platforms. An increasing number of public hospital doctors are providing online services on private third-party healthcare platforms, creating a new form of dual practice-online dual practice. To explore the impacts of online dual practice on health system performance as well as potential policy responses, we undertook a qualitative approach that uses in-depth interviews and thematic analysis. Following a purposive sampling, we interviewed 57 Chinese respondents involved in online dual practice. We asked respondents for their opinions on the effects of online dual practice on access, efficiency, quality of care, and advice on regulatory policy. The results suggest that online dual practice can generate mixed impacts on health system performance. The benefits include improved accessibility due to increased labor supply of public hospital doctors, better remote access to high-quality services, and lower privacy concerns. It can improve efficiency and quality by optimizing patient flows, reducing repetitive tasks, and improving the continuity of care. However, the potential distraction from designated work at public hospitals, inappropriate use of virtual care, and opportunistic physician behaviors may undermine overall accessibility, efficiency, and quality. Countries should mitigate these adverse consequences via regulations that are appropriate to their healthcare system context, policy priority, and governance capacity.


Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , Pandemics , China , Qualitative Research , Disease Outbreaks
19.
CMAJ Open ; 11(3): E504-E515, 2023.
Article in English | MEDLINE | ID: covidwho-20236159

ABSTRACT

BACKGROUND: The "long tail" of the COVID-19 pandemic will be reflected in disabling symptoms that persist, fluctuate or recur for extended periods for an estimated 20%-30% of those who had a SARS-CoV-2 infection; development of effective interventions to address these symptoms must account for the realities faced by these patients. We sought to describe the lived experience of patients living with persistent post-COVID-19 symptoms. METHODS: We conducted a qualitative study, using interpretive description, of the lived experiences of adults experiencing persistent post-COVID-19 symptoms. We collected data from in-depth, semistructured virtual focus groups in February and March 2022. We used thematic analysis to analyze the data and met with several participants twice for respondent validation. RESULTS: The study included 41 participants (28 females) from across Canada with a mean age of 47.9 years and mean time since initial SARS-CoV-2 infection of 15.8 months. Four overarching themes were identified: the unique burdens of living with persistent post-COVID-19 symptoms; the complex nature of patient work in managing symptoms and seeking treatment during recovery; erosion of trust in the health care system; and the process of adaptation, which included taking charge and transformed self-identity. INTERPRETATION: Living with persistent post-COVID-19 symptoms within a health care system ill-equipped to provide needed resources profoundly challenges the ability of survivors to restore their well-being. Whereas policy and practice increasingly emphasize the importance of self-management within the context of post-COVID-19 symptoms, new investments that enhance services and support patient capacity are required to promote better outcomes for patients, the health care system and society.


Subject(s)
COVID-19 , Drowning , Adult , Female , Humans , Middle Aged , Pandemics , COVID-19/epidemiology , SARS-CoV-2 , Qualitative Research
20.
Health Expect ; 26(4): 1768-1782, 2023 Aug.
Article in English | MEDLINE | ID: covidwho-20234823

ABSTRACT

INTRODUCTION: Maternity services underwent much change during the COVID-19 pandemic. Research on the impact on miscarriage care and experiences during this time is sparse. Within a national evaluation of recurrent miscarriage care, we qualitatively explored stakeholder views and experiences of recurrent miscarriage services in Ireland. This study describes the impact of the COVID-19 pandemic on those experiences and perceptions of care. METHODS: People with professional and lived experience of recurrent miscarriage and service engagement were actively involved in this qualitative study from idea generation to analysis and reporting. We recruited women and men with two or more consecutive first-trimester miscarriages, and people involved in the management/delivery of recurrent miscarriage services and supports. We used purposive sampling to ensure that perspectives across disciplinary or lived experience, geographical, and health service administrative areas, were included. We conducted semi-structured interviews, virtually all due to COVID-19 restrictions, between June 2020 and February 2021. These were audio-recorded, and data were transcribed, and subsequently analyzed using reflexive thematic analysis. RESULTS: We interviewed 42 service providers and 13 women and 7 men with experience of recurrent miscarriage. We actively generated two central themes during data analysis. The first-'Disconnected'-describes how many women navigated miscarriage diagnosis and management and care in subsequent pregnancies alone; many felt that this resulted in increased trauma. At the same time, men struggled with not being present to support their partners and described feeling disconnected. The second theme highlighted 'The perceived dispensability of recurrent miscarriage services and supports'. Some service providers felt that service reduction and redeployment demonstrated a lack of value in the service. Virtual clinics facilitated access to services, but a preference for in-person care was highlighted. CONCLUSION: Our analysis provides rich insights into the significant impacts that the COVID-19 pandemic has had on the way recurrent miscarriage care is provided and experienced, with important implications for early pregnancy, miscarriage and recurrent miscarriage care. Services have undergone significant changes and, while these may be temporary, how services should be delivered in the future requires consideration, particularly given the deficits in care and care experiences highlighted prepandemic. PATIENT OR PUBLIC CONTRIBUTION: Members of the multidisciplinary RE:CURRENT Project Research Advisory Group (including four parent advocates, two of whom are co-authors on this article) were actively involved throughout the study, including the generation of topic guides and the refining of themes.


Subject(s)
Abortion, Habitual , COVID-19 , Male , Female , Pregnancy , Humans , Ireland , Pandemics , Abortion, Habitual/therapy , Abortion, Habitual/epidemiology , Qualitative Research
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