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1.
Health Promot Pract ; 23(1_suppl): 174S-184S, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2138964

ABSTRACT

Live Well Allegheny: Lifting Wellness for African Americans (LWA2) is a coalition in Allegheny County, Pennsylvania, funded by the Centers for Disease Control and Prevention's (CDC) Racial and Ethnic Approaches to Community Health (REACH) initiative. LWA2 consists of partner organizations addressing chronic disease prevention in six Black communities through nutrition, physical activity, and community-clinical linkage strategies. This analysis focuses on qualitative data exploring the influence of COVID-19 on coalition functioning and communities. We conducted focus groups with residents in REACH communities and collected evaluation reports from partner organizations. Three focus groups assessed awareness of and participation in the REACH initiative, feedback, and the impact of COVID-19 when applicable. An additional focus group included questions related to flu vaccine messaging and the COVID-19 vaccine. These data sources provided insight regarding how COVID-19 affected planned tasks. Evaluation team members analyzed focus groups and collated summaries as part of a larger comprehensive evaluation. Partner organizations experienced an increase in food stamp applications, delays in opening farmers' markets, a shift to virtual preventive health programs, canceled in-person events, and programmatic interruptions that shifted long-term goals. Community resident concerns included difficulty accessing public transportation, decreased physical activity, fear of in-person interactions, and increased wait times for mental health services. Coalition members developed methods to continue functioning and sustaining program activities. Residents were able to engage differently with chronic illness prevention techniques. Reports from the ongoing analysis will be used to adapt coalition functioning.


Subject(s)
COVID-19 , Public Health , Humans , Focus Groups , Pennsylvania , COVID-19/prevention & control , COVID-19 Vaccines , Chronic Disease
2.
Health Expect ; 25(6): 3246-3258, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2136857

ABSTRACT

INTRODUCTION: Targeted lung cancer screening is effective in reducing lung cancer and all-cause mortality according to major trials in the United Kingdom and Europe. However, the best ways of implementing screening in local communities requires an understanding of the population the programme will serve. We undertook a study to explore the views of those potentially eligible for, and to identify potential barriers and facilitators to taking part in, lung screening, to inform the development of a feasibility study. METHODS: Men and women aged 45-70, living in urban and rural Scotland, and either self-reported people who smoke or who recently quit, were invited to take part in the study via research agency Taylor McKenzie. Eleven men and 14 women took part in three virtual focus groups exploring their views on lung screening. Focus group transcripts were transcribed and analysed using thematic analysis, assisted by QSR NVivo. FINDINGS: Three overarching themes were identified: (1) Knowledge, awareness and acceptability of lung screening, (2) Barriers and facilitators to screening and (3) Promoting screening and implementation ideas. Participants were largely supportive of lung screening in principle and described the importance of the early detection of cancer. Emotional and psychological concerns as well as system-level and practical issues were discussed as posing barriers and facilitators to lung screening. CONCLUSIONS: Understanding the views of people potentially eligible for a lung health check can usefully inform the development of a further study to test the feasibility and acceptability of lung screening in Scotland. PATIENT OR PUBLIC CONTRIBUTION: The LUNGSCOT study has convened a patient advisory group to advise on all aspects of study development and implementation. Patient representatives commented on the focus group study design, study materials and ethics application, and two representatives read the focus group transcripts.


Subject(s)
Early Detection of Cancer , Lung Neoplasms , Male , Humans , Female , Early Detection of Cancer/psychology , Focus Groups , Lung Neoplasms/diagnosis , Lung Neoplasms/prevention & control , Mass Screening/psychology , Scotland , Qualitative Research
3.
Health Expect ; 25(6): 2876-2892, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2136848

ABSTRACT

INTRODUCTION: Inclusion of informal carers in transitional care is challenging because of fast throughput and service fragmentation. This study aimed to understand informal carers' needs during the care transitions of older adults from inpatient care to the community. METHODS: A qualitative exploratory design was used with mixed-methods data collection. Seventeen semi-structured telephone interviews were conducted with family carers; one focus group was conducted by videoconference with two family carers and three community-based advocacy and aged care providers; and eight semi-structured telephone interviews were undertaken with healthcare practitioners from rehabilitation services. Data were thematically analysed. FINDINGS: All carers described the main social challenge that they needed to address in transitional care as 'Needing to sustain family'. Carers reported their social needs across five solutions: 'Partnering with carers', 'Advocating for discharge', 'Accessing streamlined multidisciplinary care', 'Knowing how to care' and 'Accessing follow-up care in the community'. Focus group participants endorsed the findings from the carer interviews and added the theme 'Putting responsibility back onto carers'. All healthcare practitioners described the main social challenge that they needed to address as 'Needing to engage carers'. They reported their social solutions in three themes: 'Communicating with carers', 'Planning with carers' and 'Educating carers'. DISCUSSION: Findings highlight the importance of reconstructing the meaning of transitional care and relevant outcomes to be inclusive of carers' experiences and their focus on sustaining family. Transitional care that includes carers should commence at the time of hospital admission of the older adult. CONCLUSIONS: Future sustainable and high-quality health services for older adults will require transitional care that includes carers and older adults and efficient use of inpatient and community care resources. Healthcare professionals will require education and skills in the provision of transitional care that includes carers. To meet carers' support needs, models of transitional care inclusive of carers and older adults should be developed, implemented and evaluated. PUBLIC CONTRIBUTION: This study was conducted with the guidance of a Carer Advisory Group comprising informal carers with experience of care transitions of older adults they support and community-based organizations providing care and advocacy support to informal carers.


Subject(s)
Caregivers , Transitional Care , Humans , Aged , Qualitative Research , Health Personnel , Focus Groups
4.
J Nurs Adm ; 52(12): 653-658, 2022 Dec 01.
Article in English | MEDLINE | ID: covidwho-2135769

ABSTRACT

OBJECTIVE: The aim of this study was to describe leaders' experiences of remote leadership during the 1st year of the COVID-19 pandemic. BACKGROUND: The COVID-19 pandemic accelerated remote work. However, there is little research on the experience of remote leadership in the healthcare setting. METHODS: Data were collected using focus group interviews and analyzed by thematic analysis. RESULTS: A total of 8 leaders from a psychiatric care setting participated. The following themes were identified: increased work efficiency, work well-being, lack of organizational support, the need to be present, and the desire for a hybrid leadership model for the future. CONCLUSIONS: Remote leadership includes both benefits and challenges for healthcare leaders and organizations. Leaders in this study emphasized the need to be present for the clinical personnel and proposed a hybrid leadership model. To succeed in combining remote and face-to-face work and leadership in a new model, organizations need to provide clear guidelines and training for remote work and leadership.


Subject(s)
COVID-19 , Leadership , Humans , Pandemics , Delivery of Health Care , Focus Groups
5.
Int J Environ Res Public Health ; 19(21)2022 Oct 28.
Article in English | MEDLINE | ID: covidwho-2090163

ABSTRACT

The Community Engagement Alliance (CEAL) Against COVID-19 Disparities aims to conduct community-engaged research and outreach. This paper describes the Texas CEAL Consortium's activities in the first year and evaluates progress. The Texas CEAL Consortium comprised seven projects. To evaluate the Texas CEAL Consortium's progress, we used components of the RE-AIM Framework. Evaluation included estimating the number of people reached for data collection and education activities (reach), individual project goals and progress (effectiveness), partnerships established and partner engagement (adoption), and outreach and education activities (implementation). During the one-year period, focus groups were conducted with 172 people and surveys with 2107 people across Texas. Partners represented various types of organizations, including 11 non-profit organizations, 4 academic institutions, 3 civic groups, 3 government agencies, 2 grassroots organizations, 2 faith-based organizations, 1 clinic, and 4 that were of other types. The main facets of implementation consisted of education activities and the development of trainings. Key recommendations for future consortiums relate to funding and research logistics and the value of strong community partnerships. The lessons learned in this first year of rapid deployment inform ongoing work by the Texas CEAL Consortium and future community-engaged projects.


Subject(s)
COVID-19 , Humans , Texas/epidemiology , COVID-19/epidemiology , COVID-19/prevention & control , Community Networks , Universities , Focus Groups
6.
Nutrients ; 14(20)2022 Oct 18.
Article in English | MEDLINE | ID: covidwho-2071665

ABSTRACT

Weighed food records together with an in-person interview approach constitute the most basic methods used to estimate energy and nutrient intakes in dietary surveys. In the background of the coronavirus disease-2019 pandemic, the need for non-face-to-face dietary surveys using information and communication technology (ICT) is increasing. We aimed to evaluate ICT-based dietary record surveys and identify factors that may enable this survey method to become more widely used in the future. We conducted a non-face-to-face survey of dietary records of 44 Japanese individuals, maintained by dietitians using dietary photography and video conferencing services. We conducted a focus group interview with the six dietitians who conducted that survey. Their opinions on the factors necessary to popularize ICT-based dietary survey method were analyzed. In the focus group interview, dietitians highlighted fewer restrictions on time and place as positive aspects. Negative aspects included insufficient skills to operate computers, difficulty in hearing, and understanding facial expressions using ICT. We identified three main factors for enabling widespread use of ICT-based dietary record survey: individual skill, device and technology, and social environmental factors. This suggests that a comprehensive approach is necessary for popularizing the use of ICT in dietary surveys.


Subject(s)
COVID-19 , Nutritionists , Humans , Diet Records , Focus Groups , Japan , Technology
7.
Front Public Health ; 10: 962478, 2022.
Article in English | MEDLINE | ID: covidwho-2065646

ABSTRACT

Objectives: During COVID-19 the re-opening of educational institutes was frequently debated, however with the decline in the number of COVID-19 cases, The Aga Khan University (AKU) in Karachi, Pakistan opened its campus for medical and nursing students after more than 6 months of closure. To ensure gradual resumption of activities on-campus, a combination of interventions was diligently deployed to minimize student infection rates. Scarce literature exists on students' perceptions regarding decisions implemented by university leadership. The aim of the study was to determine the efficacy of these interventions. Methods: We conducted a convergent, parallel, mixed-methods observational study targeting medical and nursing students. An online questionnaire was disseminated to elicit students' degree of (dis)agreement on a four-point Likert scale. Focused group discussions (FGDs) were conducted to comprehend reasons for (dis)agreement. Results: Total of 183 students responded to questionnaire (59.0% nursing, 67.8% female), 11 FGDs were conducted with 85 students. Interventions with highest agreement were mandatory face masks policy (94.54%), weekly mandated COVID-testing (92.35%) and students' Academic Bubble (91.26%); highest disagreement was for Sehat Check application (41.53%); and stay strong campaign (40.44%). Four themes emerged from FGDs: Effective safety interventions, Safety interventions with limited effectiveness, Utility of Sehat Check Application and Future recommendations for informing policy. Conclusion: It is paramount to seek student-feedback at forefront of university re-opening strategy. Clear communication channels are as important as an administrative response system's robustness. Bidirectional communication channels are fundamental and requisite during ever-changing policies and regulations. Engaging student representatives in decision making or implementation processes (such as "pilot" before "roll-out") would allow any potential issues to be managed early on. Gather real-time anonymous feedback and identify key areas that need further promulgation and those that need to be replaced with more effective ones.


Subject(s)
COVID-19 , Students, Nursing , COVID-19/epidemiology , COVID-19/prevention & control , Environment, Controlled , Female , Focus Groups , Humans , Male , Universities
8.
PLoS One ; 17(10): e0275627, 2022.
Article in English | MEDLINE | ID: covidwho-2065141

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic created unprecedented pressures on healthcare systems and led to the widespread adoption of telepharmacy services, a practice that was not previously established in the state of Qatar. OBJECTIVE: The -study aimed to explore clinical pharmacists' (CPs) perspectives and experiences in utilizing telepharmacy for the provision of pharmaceutical care during the COVID-19 pandemic. METHODS: A descriptive, qualitative approach using face-to-face focus group (FG) discussions was used. CPs across Hamad Medical Corporation (HMC) were purposively invited to participate in the study. FG discussions were audio-recorded, transcribed verbatim, and validated. Transcripts were analyzed using inductive thematic analysis. Recruitment continued until a saturation point was achieved. RESULTS: We conducted five focus groups that included 23 CPs and led to seven themes. Overall, CPs reported inadequate preparedness for the practice of telepharmacy, which they perceived as challenging. The primary perceived benefits of telepharmacy were decreased infection exposure risk, improved quality of care, improved patients' satisfaction, and enhanced workplace efficiency and productivity. The main highlighted risks of telepharmacy were related to threatened patient confidentiality, missed pharmaceutical care opportunities, and negatively impacted professional rapport with other healthcare providers; and the major perceived challenges were low digital health literacy, complex illnesses and medication regimens, lack of standardized protocols, and inadequacy of resources and cultural resistance for virtual care. Participants recommended standardization and training, resource allocation, and proper service promotion as potential facilitators of telepharmacy practice. CONCLUSION: The current study revealed that despite perceived barriers, pharmacists identified several benefits of telepharmacy and recommended potential facilitators that should be used to integrate and sustain the practice of telepharmacy in the future. Future studies should investigate the impact of telepharmacy on clinical pharmacy interventions and patient outcomes.


Subject(s)
COVID-19 , Community Pharmacy Services , Pharmacy Service, Hospital , Attitude of Health Personnel , COVID-19/epidemiology , Focus Groups , Humans , Pandemics , Pharmacists , Professional Role , Qatar/epidemiology
9.
Int J Med Inform ; 166: 104838, 2022 10.
Article in English | MEDLINE | ID: covidwho-2061272

ABSTRACT

BACKGROUND: Reporting individual clinical and patient-reported outcomes to patients during consultations may add to patients' disease knowledge and activation and stimulate Shared Decision Making (SDM). These outcomes can be presented over time in a clear way by the means of dashboarding. We aimed to systematically develop a Chronic Kidney Disease (CKD) dashboard designed to support consultations, test its usability and explore conditions for optimal use in practice. METHODS: For development a participatory approach with patients and healthcare professionals (HCPs) from three hospitals was used. Working groups and patient focus groups were conducted to identify needs and inform the dashboard's design. Usability was tested in patient interviews. A focus group with HCPs was held to identify conditions for optimal use of the dashboard in daily practice. RESULTS: A dashboard was developed for CKD patients stage 3b-4 visualizing both clinical and patient-reported outcomes over time for use during consultations and accessible for patients at home. Both HCPs and patients indicated that the dashboard can: motivate patients in their treatment by providing feedback on outcomes over time; improve consultation conversations by enhanced preparation of both HCPs and patients; better inform patients, thereby facilitating shared decision making. HCPs and patients both stated that setting a topic agenda for the consultation together is important in effectively discussing the dashboard during consultations. Moreover, the dashboard should not dominate the conversation. Lastly, findings of the usability tests provided design requirements for optimal user-friendliness and clarity. CONCLUSIONS: Dashboarding can be a valuable way of reporting individual outcome information to patients and their clinicians as findings suggest it may stimulate patient activation and facilitate decision making. Co-creation with patients and HCPs was essential for successful development of the dashboard. Gained knowledge from the co-creation process can inform others wishing to develop similar digital tools for use in clinical practice.


Subject(s)
Patient Participation , Renal Insufficiency, Chronic , Focus Groups , Health Personnel , Humans , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/therapy
10.
Tidsskr Nor Laegeforen ; 142(12)2022 09 06.
Article in English, Norwegian | MEDLINE | ID: covidwho-2055631

ABSTRACT

BACKGROUND: The working day of Norwegian GPs was turned on its head during the COVID-19 pandemic due to the extreme, ongoing pressure the GP service was under. We conducted a qualitative study of the GPs' perceptions of the challenges they faced and of how they coped during the pandemic. MATERIAL AND METHOD: Focus group interviews were conducted with 19 GPs from four medical practices in the county of Innlandet. The interviews were analysed using the systematic text condensation method. RESULTS: The GPs described how they have coped with the extremely challenging demands on them. They expressed an expectation of rapid adaptability, and considered this a fundamental characteristic of the role of the GP. They felt an enormous responsibility for their own patients and that in a time of crisis this responsibility was extended to include the entire population. They saw themselves as an important part of the local authority's public health preparedness, even though they had not reflected on this to any great extent prior to the pandemic. INTERPRETATION: The GP service's adaptability during times of crisis depends on the GPs' strong individual and collective sense of responsibility and their ability to cope. The latter is the GP service's great strength, but it also represents a vulnerability due to the camouflaging of the overburdening of the service. This can lead to local authorities failing to take responsibility for their statutory duties.


Subject(s)
COVID-19 , General Practitioners , Attitude of Health Personnel , Focus Groups , Humans , Pandemics , Public Health , Qualitative Research
11.
BMC Health Serv Res ; 22(1): 1219, 2022 Sep 30.
Article in English | MEDLINE | ID: covidwho-2053902

ABSTRACT

BACKGROUND: Uganda has low levels of death registration, estimated at two per cent by the National Identification and Registration Authority (NIRA). There are 56 tribes and over 5 religious denominations with so many social norms and religious practices that could have contributed to low death registration in Uganda. Previous studies on the factors affecting death registration have not assessed the contribution of social norms and religious practices toward low death registration in developing countries. METHODS: A qualitative study design was adopted to examine the contribution of social norms and religious practices toward low death registration in the 3 Health and Demographic Surveillance systems (HDSS) sites of Uganda. The methods of data collection included: focus group discussions, key informant interviews, and a document review of the death registration booklet. 6 FGDs, 2 from each HDSS site were conducted comprising 1 female FGD of 10 participants and 1 male FGD of 10 participants. In addition, 26 key informant interviews were conducted with the district leaders, local council leaders, health care workers, cultural leaders, elderly, HDSS scouts and religious leaders in the 3 HDSS sites. RESULTS: In the 4 sub-counties and 1 town council where the study was conducted, only 32 deaths were registered with NIRA, the Civil Registration authority in Uganda for the entire year from 1st January to 31st December 2020. The study shows that social norms and religious practices have contributed to the low death registration in the 3 HDSS sites in Uganda. Social norms and religious practices either hinder or discourage death registration initiatives by the government of Uganda. It was found out that burials that take place on the same day of death discourage death registration. Cultural taboo to announcing the death of infants, neonates, twins and suicides in the community hinder death registration. The burying of a woman at her parent's house after bride price payment default by the family of a husband discourages death registration. The religious institutions have their own set of rules, practices, and norms, which in most cases discourage death registration. For example, religious leaders refuse to lead funeral prayers for non-active members in religious activities. Results also showed that mixed religions in families bring about conflicts that undermine death registration. Lastly, results showed that traditionalists do not seek medical treatment in hospitals and this hinders death registration at the health facilities. CONCLUSION: The study shows that death registration is very low in the 3 HDSS sites in Uganda and that social norms and religious practices contribute greatly to the low death registration. To overcome the negative effects of social norms and religious practices, a social behaviour campaign is proposed. In addition, community dialogue should be conducted to identify all negative social norms and religious practices, how they are perpetuated, their effects, and how they can be renegotiated or eliminated to bring about high death registration in the 3 HDSS sites of Uganda. Lastly, there is a need for partnerships with cultural and religious leaders to sensitize community members on the effect of social norms and religious practices on low death registration in the 3 HDSS sites in Uganda.


Subject(s)
Social Norms , Suicide , Aged , Female , Focus Groups , Humans , Infant , Infant, Newborn , Male , Medical Assistance , Uganda
12.
Health Expect ; 25(6): 2807-2817, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2052472

ABSTRACT

BACKGROUND: In the management of epidemics, like COVID-19, trade-offs have to be made between reducing mortality and morbidity and minimizing socioeconomic and political consequences. Traditionally, epidemic management (EM) has been guided and executed attentively by experts and policymakers. It can, however, still be controversial in the public sphere. In the last decades, public engagement (PE) has been successfully applied in various aspects of healthcare. This leads to the question if PE could be implemented in EM decision-making. METHODS: From June to October 2020, seven deliberative discussion focus groups were executed with 35 Dutch citizens between 19 and 84 years old. Their views on PE in COVID-19 management were explored. The deliberative approach allows for the education of participants on the topic before the discussion. The benefits, barriers, timing and possible forms of PE in EM were discussed. RESULTS: Almost all participants supported PE in EM, as they thought that integrating their experiences and ideas would benefit the quality of EM, and increase awareness and acceptance of measures. A fitting mode for PE was consultation, as it was deemed important to provide the public with possibilities to share ideas and feedback; however, final authority remained with experts. The publics could particularly provide input about communication campaigns and control measures. PE could be executed after the first acute phase of the epidemic and during evaluations. CONCLUSIONS: This paper describes the construction of an empirically informed framework about the values and conditions for PE in EM from the perspective of the public. Participants expressed support to engage certain population groups and considered it valuable for the quality and effectiveness of EM; however, they expressed doubts about the feasibility of PE and the capabilities of citizens. In future studies, these results should be confirmed by a broader audience. PATIENT OR PUBLIC CONTRIBUTION: No patients or members of the public were involved in the construction and execution of this study. This study was very exploratory, to gain a first insight into the views of the public in the Netherlands, and will be used to develop engagement practices accordingly. At this stage, the involvement of the public was not yet appropriate.


Subject(s)
COVID-19 , Humans , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , COVID-19/epidemiology , Motivation , Focus Groups , Communication , Netherlands
13.
Nurse Educ Pract ; 64: 103459, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2042054

ABSTRACT

AIM: This study aimed to explore the thoughts and feelings of Asian American nursing students regarding Anti-Asian racism that they might anticipate or experience during their clinical training. BACKGROUND: Asian Americans have long been viewed as perpetual foreigners and coronavirus disease 2019 has reinforced that negative view. Asian American nursing students may anticipate and experience racial discrimination during their clinical training, which could negatively affect their mental health. DESIGN: This is a qualitative research study using focus group discussions. METHOD: Focus group discussions were conducted over Zoom and audiotaped. The audiotapes were transcribed and validated for accuracy. A thematic analysis was performed using NVivo10. Emerging themes and subthemes were compared and discussed until agreements were made. RESULTS: Nineteen students participated in four focus group meetings, of which, 13 (68 %) had clinical training and six (32 %) were preclinical students. Four major themes emerged: (a) looking forward to hands-on learning opportunities, (b) enduring racial microaggressions, (c) maintaining professionalism in the face of racial microaggressions and (d) standing up for oneself and other Asian American healthcare workers. Preclinical students were anxiously waiting for clinical training so that they could have hands-on learning experiences. They anticipated that anti-Asian racism in clinical settings would be similar to what they had experienced on the streets and therefore, they were not afraid of it. Students who had clinical training reported experiencing a variety of racial microaggressions that varied from "side-eyes" to "verbal assault" and occurred at three levels: patients, nurses and clinical instructors. They reported that most of the microaggressions were familiar to them, but some, especially coming from their clinical instructors, were unique to clinical settings. CONCLUSION: Asian American nursing students experienced racial microaggressions during their clinical training which came from patients, nurses on the unit and their clinical instructors. Nevertheless, the students strove to maintain professionalism and stand up for themselves and other Asian healthcare workers as they gained confidence in clinical knowledge and skills.


Subject(s)
COVID-19 , Racism , Students, Nursing , Aggression/psychology , Asian Americans/psychology , Focus Groups , Humans , Microaggression , Pandemics , Racism/psychology
14.
J Korean Acad Nurs ; 52(4): 391-406, 2022 Aug.
Article in Korean | MEDLINE | ID: covidwho-2040073

ABSTRACT

PURPOSE: The purpose of this study was to provide foundational knowledge on nursing tasks performed on patients with COVID-19 in a nationally-designated inpatient treatment unit. METHODS: This study employs both quantitative and qualitative approaches. The quantitative method investigated the content and frequency of nursing tasks for 460 patients (age ≥ 18 y, 57.4% men) from January 20, 2020, to September 30, 2021, by analyzing hospital information system records. Qualitative data were collected via focus group interviews. The study involved interviews with three focus groups comprising 18 nurses overall to assess their experiences and perspectives on nursing care during the pandemic from February 3, 2022, to February 15, 2022. The data were examined with thematic analysis. RESULTS: Overall, 49 different areas of nursing tasks (n = 130,687) were identified based on the Korean Patient Classification System for nurses during the study period. Among the performed tasks, monitoring of oxygen saturation and measuring of vital signs were considered high-priority. From the focus group interview, three main themes and eleven sub-themes were generated. The three main themes are "Experiencing eventfulness in isolated settings," "All-around player," and "Reflections for solutions." CONCLUSION: During the COVID-19 pandemic, it is imperative to ensure adequate staffing levels, compensation, and educational support for nurses. The study further propose improving guidelines for emerging infectious diseases and patient classification systems to improve the overall quality of patient care.


Subject(s)
COVID-19 , COVID-19/epidemiology , Female , Focus Groups , Hospitalization , Humans , Inpatients , Male , Pandemics
15.
BMC Health Serv Res ; 22(1): 253, 2022 Feb 24.
Article in English | MEDLINE | ID: covidwho-2038734

ABSTRACT

BACKGROUND: Older adults in Colombia have seen a number of stressful life events - including the Colombian armed conflict, forced misplacement and recently COVID-19. These events likely have had and are having a substantial impact on people's mental health and well-being, whilst mental health care provision in Colombia is not sufficient and often access is limited and unaffordable. Therefore, the aim of this study is to understand the impact of stressful life events on the mental health of older adults living in Colombia, and co-produce, pilot, and evaluate a community-based mental health intervention in Turbo. METHODS: This 3-year international mixed-methods study comprises of three phases: Phase I will explore the impact of stressful life events on the mental health of older adults living in Colombia, and their mental health needs, via quantitative needs assessments and qualitative interviews and focus groups; Phase II will involve synthesising the findings from Phase I as well as conducting a systematic review and qualitative interviews with experts into implementing mental health interventions in LMICs to co-produce a community-based mental health intervention with older adults and local community group leaders and care providers; Phase III will involve the piloting and evaluation of the mental health intervention via quantitative and qualitative assessments. Co-production and public involvement underpin each element of this project. DISCUSSION: Appropriate mental health care is as important as physical health care, but this study also looks at how we might integrate these findings into community-level public health initiatives for application both within Colombia and more widely in both LMICs and more developed countries. This study protocol will act as a guide for the development and adaptation of psychosocial mental health interventions in different cultures and contexts.


Subject(s)
Health Services Needs and Demand , Mental Health Services , Mental Health , Stress, Psychological , Aged , Armed Conflicts/psychology , COVID-19/psychology , Colombia/epidemiology , Focus Groups , Humans , Systematic Reviews as Topic
16.
J Health Organ Manag ; ahead-of-print(ahead-of-print)2022 Aug 19.
Article in English | MEDLINE | ID: covidwho-2029187

ABSTRACT

PURPOSE: The article aims to argue that the concept of "distributed leadership" lacks the specificity required to allow a full understanding of how change happens. The authors therefore utilise the "Strategic Action Field Framework" (SAF) (Moulton and Sandfort, 2017) as a more sensitive framework for understanding leadership in complex systems. The authors use the New Care Models (Vanguard) Programme as an exemplar. DESIGN/METHODOLOGY/APPROACH: Using the SAF framework, the authors explored factors affecting whether and how local Vanguard initiatives were implemented in response to national policy, using a qualitative case study approach. The authors apply this to data from the focus groups and interviews with a variety of respondents in six case study sites, covering different Vanguard types between October 2018 and July 2019. FINDINGS: While literature already acknowledges that leadership is not simply about individual leaders, but about leading together, this paper emphasises that a further interdependence exists between leaders and their organisational/system context. This requires actors to use their skills and knowledge within the fixed and changing attributes of their local context, to perform the roles (boundary spanning, interpretation and mobilisation) necessary to allow the practical implementation of complex change across a healthcare setting. ORIGINALITY/VALUE: The SAF framework was a useful framework within which to interrogate the data, but the authors found that the category of "social skills" required further elucidation. By recognising the importance of an intersection between position, personal characteristics/behaviours, fixed personal attributes and local context, the work is novel.


Subject(s)
Delivery of Health Care , Leadership , England , Focus Groups , Qualitative Research
17.
Int J Environ Res Public Health ; 19(16)2022 08 14.
Article in English | MEDLINE | ID: covidwho-2023644

ABSTRACT

A healthy diet in early childhood is an important contributor to ensuring lifelong health and in reducing risk for obesity. The child care environment is critical to supporting nutrition as a majority of young children less than 5 years of age are enrolled in out-of-home care. In order to better understand barriers to implementing and integrating nutrition best practices, we conduced focus groups with child care providers (n = 25) in Illinois. Providers from low-income communities, rural communities, and communities of color were prioritized. Focus group participants reported several challenges including the high cost of nutritious food, picky eating, and their perception that parents did not set good examples at home. Many providers identified the Child and Adult Care Food Program (CACFP) as a critical resource in helping them implement best practices. Providers discussed needing and wanting more training, more money for food, and more parental support. These results indicate support for additional resources and sustained training and technical assistance to address perceived challenges. The evidence of the importance of CACFP in helping providers engage in nutrition best practices indicates support for expansion and strengthening of the program.


Subject(s)
Child Care , Child Day Care Centers , Adult , Child , Child, Preschool , Diet, Healthy , Focus Groups , Humans , Nutritional Status
18.
Health Expect ; 25(6): 2851-2861, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2019284

ABSTRACT

BACKGROUND: As digital tools are increasingly used to support COVID-19 contact tracing, the equity implications must be considered. As part of a study to understand the public's views of digital contact tracing tools developed for the national 'Test and Protect' programme in Scotland, we aimed to explore the views of groups often excluded from such discussions. This paper reports on their views about the potential for contact tracing to exacerbate inequalities. METHODS: A qualitative study was carried out; interviews were conducted with key informants from organizations supporting people in marginalized situations, followed by interviews and focus groups with people recruited from these groups. Participants included, or represented, minority ethnic groups, asylum seekers and refugees and those experiencing multiple disadvantage including severe and enduring poverty. RESULTS: A total of 42 people participated: 13 key informants and 29 members of the public. While public participants were supportive of contact tracing, key informants raised concerns. Both sets of participants spoke about how contact tracing, and its associated digital tools, might increase inequalities. Barriers included finances (inability to afford smartphones or the data to ensure access to the internet); language (digital tools were available only in English and required a degree of literacy, even for English speakers); and trust (many marginalized groups distrusted statutory organizations and there were concerns that data may be passed to other organizations). One strength was that NHS Scotland, the data guardian, is seen as a generally trustworthy organization. Poverty was recognized as a barrier to people's ability to self-isolate. Some participants were concerned about giving contact details of individuals who might struggle to self-isolate for financial reasons. CONCLUSIONS: The impact of contact tracing and associated digital tools on marginalized populations needs careful monitoring. This should include the contact tracing process and the ability of people to self-isolate. Regular clear messaging from trusted groups and community members could help maintain trust and participation in the programme. PATIENT AND PUBLIC CONTRIBUTION: Our patient and public involvement coapplicant, L. L., was involved in all aspects of the study including coauthorship. Interim results were presented to our local Public and Patient Involvement and Engagement Group, who commented on interpretation and made suggestions about further recruitment.


Subject(s)
COVID-19 , Contact Tracing , Humans , Contact Tracing/methods , COVID-19/epidemiology , COVID-19/prevention & control , Qualitative Research , Focus Groups , Trust
19.
J Int AIDS Soc ; 25(8): e25944, 2022 08.
Article in English | MEDLINE | ID: covidwho-2013582

ABSTRACT

INTRODUCTION: Zimbabwe adopted differentiated HIV care policies in 2015 to promote client-centred care and relieve strain on health facilities. We examined the availability, experiences and perceptions of differentiated antiretroviral therapy (ART) delivery in rural Zimbabwe following the policy adoption. METHODS: We undertook a cross-sectional mixed methods study in all the 26 facilities providing HIV care in a rural district in Zimbabwe. We collected quantitative data about ART delivery and visit durations from 31 healthcare providers and a purposive stratified sample of 378 clients obtaining ART either through routine care or differentiated ART delivery models. We performed 26 semi-structured interviews among healthcare providers and seven focus group discussions (FGDs) among clients to elicit their perceptions and experiences of ART delivery. Data were collected in 2019, with one follow-up FGD in 2021. We analysed the transcripts thematically, with inductive coding, to identify emerging themes. RESULTS: Twenty facilities (77%) offered at least one differentiated ART delivery models, including community ART refill groups (CARGs; 13 facilities, 50%), fast-track refill (8, 31%), family refill (6, 23%) or club refill (1, 4%). Thirteen facilities (50%) offered only one model. The median visit duration was 28 minutes (interquartile range [IQR]: 16-62). Participants in fast-track had the shortest visit durations (18 minutes, IQR: 11-24). Confidentiality and disclosure of HIV status, travelling long distances, travel costs and waiting times were the main issues influencing clients' views on differentiated ART delivery. Fast-track refill was perceived as the preferred model of clients for its limited involuntary disclosure and efficiency. In contrast, group- and community-based refill models reduced travel costs but were felt to be associated with involuntary disclosure of HIV status, which could discourage clients. Healthcare providers also experienced an additional workload when offering facility-based group models, such as CARGs. CONCLUSIONS: Differentiated ART delivery models were widely available in this rural setting, but most facilities did not offer a choice of models to address clients' diverse preferences. A minority offered fast-track refills, although this model was often mentioned as desirable. Confidentiality, travel expenses and client waiting times are key elements to consider when planning and rolling out differentiated HIV care.


Subject(s)
Anti-HIV Agents , HIV Infections , Anti-HIV Agents/therapeutic use , Cross-Sectional Studies , Focus Groups , HIV Infections/drug therapy , Humans , Zimbabwe
20.
J Prim Care Community Health ; 13: 21501319221119692, 2022.
Article in English | MEDLINE | ID: covidwho-2009334

ABSTRACT

BACKGROUND: Deployment of telehealth has been touted as a means of reducing health disparities in underserved groups. However, efforts to reduce regulatory barriers have not been associated with greater telehealth uptake. The goal of this study was to examine engagement with technology among low-income people of color living in Newark, New Jersey. METHODS: Using surveys and focus groups, we examined study participants' daily use of technology (eg, Internet) and comfort with telehealth services (eg, use of teleconferencing for medication refills) before and after COVID-related social distancing mandates went into effect. RESULTS: Use of technology was significantly lower in the pre-COVID period. However, prior months' use of technology had a weak but significant correlation with comfort with telehealth (r = .243, P = .005) in bivariate analyses and was the only significant predictor in multivariate analyses. Analyses of focus group discussions confirmed that lack of experience with technology and distrust of the security and privacy of digital systems were the most important barriers to comfort with telehealth in our sample. CONCLUSION: Our study found that approximately 20% of people in this under-resourced community lacked access to basic technologies necessary for successful deployment of telehealth services. The study's timing provided an unexpected opportunity to compare experiences and attitudes relating to telehealth in 2 regulatory environments. Although uptake of telehealth services increased with the Federal governments' relaxation of regulatory barriers, there was not a similar increase in comfort with telehealth use. Investments in broadband access and equipment should be accompanied by educational programs to increase day-to-day use of and comfort with associated technologies which would improve consumer confidence in telehealth.


Subject(s)
COVID-19 , Telemedicine , Focus Groups , Humans , Poverty , Surveys and Questionnaires
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