Barriers and facilitators of adherence to the use of ASICA, a digital app designed to support people previously treated for melanoma: concise report of a qualitative study.

We developed the Achieving Self-directed Integrated Cancer Aftercare (ASICA) in melanoma app to support monthly total-skin self-examinations (TSSE) by people previously treated for melanoma. A randomized 12-month trial demonstrated ASICA supported optimal monthly TSSE adherence in a third of participants (ClinicalTrials.gov NCT03328247). However, a further third of participants adhered well initially but subsequently dropped off, and a final third did not adhere at all. This follow-up qualitative study investigated trial participants' perceptions of barriers and facilitators to TSSE adherence using the app. Three former trial participants participated in a single focus group and 11 participated in new semistructured telephone interviews. These were analysed thematically alongside secondary analysis of 13 qualitative interviews conducted during the trial. All transcripts were recorded, transcribed and analysed thematically. Five themes encompassing barriers and facilitators to ASICA adherence emerged. These were: technology, role of others, tailoring, disease journey and competing priorities. These data will inform further development of ASICA to increase user adherence.

A qualitative process evaluation within a clinical trial that used healthcare technologies for children with asthma-insights and implications.

BACKGROUND: Healthcare technologies are becoming more commonplace, however clinical and patient perspectives regarding the use of technology in the management of childhood asthma have yet to be investigated. Within a clinical trial of asthma management in children, we conducted a qualitative process evaluation that provided insights into the experiences and perspectives of healthcare staff and families on (i) the use of smart inhalers to monitor medication adherence and (ii) the use of algorithm generated treatment recommendations. METHODS: We interviewed trial staff (n = 15) and families (n = 6) who were involved in the trial to gauge perspectives around the use of smart inhalers to monitor adherence and the algorithm to guide clinical decision making. FINDINGS: Staff and families indicated that there were technical issues associated with the smart inhalers. While staff suggested that the smart inhalers were good for monitoring adherence and enabling communication regarding medication use, parents and children indicated that smart inhaler use increased motivation to adhere to medication and provided the patient (child) with a sense of responsibility for the management of their asthma. Staff were open-minded about the use of the algorithm to guide treatment recommendations, but some were not familiar with its' use in clinical care. There were some concerns expressed regarding treatment step-down decisions generated by the algorithm, and some staff highlighted the importance of using clinical judgement. Families perceived the algorithm to be a useful technology, but indicated that they felt comforted by the clinicians' own judgements. CONCLUSION: The use of technology and individual data within appointments was considered useful to both staff and families: closer monitoring and the educational impacts were especially highlighted. Utilising an algorithm was broadly acceptable, with caveats around clinicians using the recommendations as a guide only and wariness around extreme step-ups/downs considering contextual factors not taken into account.

The Baby Box scheme in Scotland: A study of public attitudes and social value.

BACKGROUND: The Scottish Government introduced a free Baby Box scheme for all new parents in 2017, modelled on the Finnish scheme, to give every baby 'an equal start in life'. There is little evidence that it results in better health outcomes, but there has been limited research into different perspectives and discourses on such schemes. METHODS: Four focus groups were conducted with 21 parents in North-East Scotland. Recordings were transcribed verbatim, anonymized and analysed thematically with NVivo 12 software. Our thematic analysis was both inductive and deductive-remaining open to themes identified by participants themselves but also informed by the social policy literature on universalism and social cohesion. RESULTS: Across all the focus groups, we found a high degree of positivity about the principle of the Baby Box scheme, and for the most part the practical value of the contents. This was remarkably consistent across different communities and backgrounds. There was little evidence of the strongly polarized views present in media reporting. Parents seemed considerably less focused than the media on safety and health outcomes, and more focused on practical, material and social impacts. They reported little in the way of feeling patronized or monitored by the government. CONCLUSION: Our findings have important implications for future economic evaluations of the baby box. Such evaluations should broaden the valuation space beyond health outcomes to allow for the value of feelings of inclusion, solidarity and being part of a community. PATIENT OR PUBLIC CONTRIBUTION: This small project was designed in response to parent views already collected in the early roll-out of the Baby Box scheme in Scotland, about their priorities and responses to the scheme. Additional views were sought on the topic guide for the focus groups, and local community groups advised us on recruitment and the best timing and location for the focus groups to be held. The focus groups themselves were conducted as research, but with the intent of ensuring parent views featured more prominently in a debate that has been largely dominated by clinical and public health perspectives.

Women's perspectives on smartphone apps for fertility tracking and predicting conception: a mixed methods study.

BACKGROUND: Women use fertility tracking apps (FTAs) for conception purposes, but user perspectives on FTA use for conception are largely unknown. In collaboration with SPD Clearblue, this study explored: how women trying to conceive use FTAs; women's knowledge of their conception chances; and women's feelings towards a potential natural conception prediction app (NCPA). METHODS: A mixed methods design was used (online survey and phone interviews). Participants were women 18-40 years old actively trying to conceive. RESULTS: The survey received 154 responses and 24 interviews were conducted. Thematic analysis of interviews found that women consider several factors before trying to conceive (ex. age, financial and job security, stability of relationship, etc.) and may adopt lifestyle and behaviour changes when trying (ex. increasing exercise, smoking cessation, diet changes, etc.). Survey results indicated that nearly all respondents were aware of FTAs (n = 146, 94.8%), however, several other fertility and conception information sources were also used (ex. health care providers, online sources, family and friends, etc.). Nearly all respondents reported they would use an NCPA (n = 153, 99.4%). During interviews women had positive feelings towards such an app due to it offering new and individualised information, but worried the app could provide upsetting information. CONCLUSION: This research elaborates on women's uses of and interest in FTAs. Stakeholders should use this research to reflect on current conception experiences and possibilities for improvement through development of an NCPA. Future research should seek opinions from a more diverse sample of women to inform the development of an inclusive NCPA.

Evaluation of Respiratory Therapist Extender Comfort With Mechanical Ventilation During COVID-19 Pandemic.

BACKGROUND: Staffing strategies used to meet the needs of respiratory care departments during the COVID-19 pandemic included the deployment of respiratory therapist extenders. The purpose of this study was to evaluate respiratory therapist extenders' comfort level with critical care ventilators while caring for patients with COVID-19. To our knowledge, this is the first study to evaluate the deployment of certified registered nurse anesthetists (CRNAs) in a critical care setting. METHODS: A qualitative survey method was used to assess CRNA experience with critical care ventilators. Prior to deployment in the ICU, CRNAs were trained by clinical lead respiratory therapists. Education included respiratory clinical practices and ventilator management. Sixty-minute sessions were held with demonstration stations set up in ICUs for hands-on experience. RESULTS: Fifty-six CRNAs responded to our survey (63%). A mean ± SD of 9.48 ± 12.27 h was spent training prior to deployment in the ICU. CRNAs were at the bedside a mean ± SD of 73.0 ± 40.6 h during the pandemic. While CRNA comfort level with critical care ventilators increased significantly (P < .001) from the beginning to the end of their work experience, no statistically significant differences were found between CRNA comfort based on years of experience. Differences in comfort level were not found after training (chi-squared test 23.82, P = .09) or after ICU experience was completed (chi-squared test = 15.99, P = .45). Similarly, mean comfort level did not increase based on the number of hours spent working in the ICU (chi-squared test = 13.67, P = .55). CONCLUSIONS: Comfort level with mechanical ventilation increased for CRNAs working alongside respiratory therapists during the COVID-19 pandemic.

Using the Onitor® Track for weight loss: A mixed methods study among overweight and obese women.

Non-communicable disease rates associated with being overweight or obese are rising. Technologies warrant consideration as weight loss interventions. Cloudtag's® Onitor® Track, a dual-position wearable plus smartphone application, monitors energy expenditure and provides tailored exercise programmes. This research aimed to undertake an experimental study of 20 overweight and obese women using the technology; explore its feasibility and acceptability through interviews; and investigate its behaviour change techniques. The primary outcome was decreased body weight (kg) at 4 weeks. Secondary outcomes were body mass index (kg/m2) and waist circumference (cm) changes. 15 overweight and obese women took part. Results indicated weight loss (median 2.7 kg, p < 0.05) and waist circumference decrease (median 4 cm, p < 0.05), but attrition was high (60%). Users reported dietary changes but few activity adjustments. They valued feedback. 27 behaviour change techniques were identified. The Onitor® Track shows potential for weight loss in overweight and obese women, but further work is needed.

A mixed methods exploratory study of women's relationships with and uses of fertility tracking apps.

Digital self-tracking is rising, including tracking of menstrual cycles by women using fertility tracking apps (FTAs). However, little is known about users' experiences of FTAs and their relationships with them. The aim of this study was to explore women's uses of and relationships with FTAs. This exploratory study employed a mixed methods approach, involving the collection and analysis of an online survey and follow-up interviews. Qualitative analysis of survey and interview data informed hypothesis development. Online surveys yielded 241 responses and 11 follow-up interviews were conducted. Just over a third of women surveyed had experience of using FTAs (89/241) and follow-up interviews were conducted with a proportion of respondents (11/241). Four main motivations to use FTAs were identified: (a) to observe cycle (72%); (b) to conceive (34%); (c) to inform fertility treatment (12%); and (d) as contraception (4%). Analysis of the free-text survey questions and interviews using grounded theory methodology highlighted four themes underpinning women's relationships with FTAs: (a) medical grounding; (b) health trackers versus non-trackers; (c) design; and (d) social and ethical aspects. Participants who used other health apps were more likely to use FTAs (p = 0.001). Respondents who used contraception were less likely to use FTAs compared with respondents who did not use contraception (p = 0.002). FTA usage also decreases (p = 0.001) as age increases. There was no association between FTA usage and menstrual status (p = 0.259). This research emphasises the differing motivations for FTA use. Future research should further explore the diverse relationships between different subgroups of women and FTAs.

"The more you know, the more you realise it is really challenging to do": Tensions and uncertainties in person-centred support for people with long-term conditions.

OBJECTIVE: To identify and examine tensions and uncertainties in person-centred approaches to self-management support - approaches that take patients seriously as moral agents and orient support to enable them to live (and die) well on their own terms. METHODS: Interviews with 26 UK clinicians about working with people with diabetes or Parkinson's disease, conducted within a broader interdisciplinary project on self-management support. The analysis reported here was informed by philosophical reasoning and discussions with stakeholders. RESULTS: Person-centred approaches require clinicians to balance tensions between the many things that can matter in life, and their own and each patient's perspectives on these. Clinicians must ensure that their supportive efforts do not inadvertently disempower people. When attending to someone's particular circumstances and perspectives, they sometimes face intractable uncertainties, including about what is most important to the person and what, realistically, the person can or could do and achieve. The kinds of professional judgement that person-centred working necessitates are not always acknowledged and supported. CONCLUSION: Practical and ethical tensions are inherent in person-centred support and need to be better understood and addressed. PRACTICE IMPLICATIONS: Professional development and service improvement initiatives should recognise these tensions and uncertainties and support clinicians to navigate them well.