Provision and use of assistive products in patients after stroke and spinal cord injury in Germany: a qualitative interview study.

PURPOSE: Mobility impairments are a common consequence of stroke and spinal cord injury (SCI). Assistive products (APs) such as wheelchairs are often needed for activities and participation. The aim of the study was to explore the provision and use of APs in Germany and to identify associated factors underlying this practice. MATERIALS AND METHODS: Semi-structured interviews were conducted with 19 professionals from outpatient neurorehabilitation services (three general practitioners, five physical therapists, five occupational therapists, one speech therapist, one neuropsychologist, two outpatient nurses, one rehab technician and one social worker), two patient advocates (long-term survivors, each stroke and SCI) and 20 patients (10 each after stroke and SCI with mobility impairment, and first-ever affected). Analysis was performed by qualitative content analysis. RESULTS: Reported experiences were mixed, varying from high satisfaction to unusable APs and unmet needs. Identified factors associated with these experiences were related to care pathways, care coordination, inter-professional collaboration, professionals' knowledge and patient information, cost coverage, and approval procedures. CONCLUSION: Overall, patients seem satisfied with the APs they receive, but patients with more severe mobility impairments in particular experience deficits in the provision and use of APs. Further research is needed to develop and test strategies for the provision and use of APs.

Interprofessional collaboration between the multiple stakeholders and the involvement of end users is needed to realise the full potential of specific assistive products (APs).A care pathway should be implemented for the provision of appropriate APs.Professionals' expertise in both APs and end user empowerment needs to be improved.The approval process of the public health insurance should be accelerated and geared more towards the individual needs of patients.

[Opportunities and Challenges Of The Ethics Review Of Qualitative Health Services Research: A Survey Of Qualitative Researchers]. / Chancen und Herausforderungen der Ethikbegutachtung qualitativer Versorgungsforschung ­ eine Befragung qualitativ Forschender.

Ethics committees ensure compliance with ethical principles in medical research. They are oriented towards clinical studies, but also review e. g., qualitative research. Using a semi-structured online survey, we collected data on experiences of qualitative researchers with the review by ethics committees and analysed them via content analysis. In July 2019, 73 researchers took part in the survey. Five main topics were derived from their statements regarding the ethics review of qualitative research: 1. relevance of qualitative research expertise; 2. cooperation between researchers and ethics committees; 3. transparency of review criteria; 4. dealing with formal review requirements; 5. evaluation of the review's significance for qualitative research. The results show the potential of ethics review for reflection on ethical questions in qualitative research. Prerequisites for this are the fit with the characteristics and quality criteria of qualitative research, the presence of qualitative research expertise in ethics committees, the transparency of the ethics review process as well as openness to different professional cultures and a constructive communication culture.

Core values of employed general practitioners in Germany - a qualitative study.

BACKGROUND: "Core values" help to guide practice of health care delivery. The core values of general practice are described in the European definition of general practice by WONCA, e.g. a holistic, comprehensive and continuous care. They may be associated with the idea that the general practitioner is the owner of the practice rather than an employee. OBJECTIVES: The objective was to examine the core values of employed GPs in their professional setting and their practical manifestation. METHODS: From April to May 2021, we conducted 17 semi-structured telephone-interviews with employed GPs in two districts in Baden-Wuerttemberg, Germany. The data were analysed using qualitative content analysis. RESULTS: We identified twelve core values, including values relevant to patient care and values relevant to the lives of employed GPs. Values with high relevance were job satisfaction, the professional distance from patients, collaboration and collegial exchange, comprehensive care, adequate consultation time and availability to patients. Values with heterogeneous relevance were continuity of care, waiting times and medical autonomy. The value "availability" of employed GPs to patients was associated with both patient care and personal life. The limited availability of employed GPs was accompanied by tensions between these two trends and other values. CONCLUSION: The values of employed GPs are partly consistent with the current WONCA definition of general practice. There were also indications of new values. The increase in the proportion of employed GPs implies a need to reflect on the core values of general practice, taking into account factors on the part of employed GPs, patients, and practice organisation.

Development of individual competencies and team performance in interprofessional ward rounds: results of a study with multimodal observations at the Heidelberg Interprofessional Training Ward.

Introduction: Interprofessional training wards (IPTW) aim to improve undergraduates' interprofessional collaborative practice of care. Little is known about the effects of the different team tasks on IPTW as measured by external assessment. In Heidelberg, Germany, four nursing and four medical undergraduates (= one cohort) care for up to six patients undergoing general surgery during a four-week placement. They learn both professionally and interprofessionally, working largely on their own responsibility under the supervision of the medical and nursing learning facilitators. Interprofessional ward rounds are a central component of developing individual competencies and team performance. The aim of this study was to evaluate individual competencies and team performance shown in ward rounds. Methods: Observations took place in four cohorts of four nursing and four medical undergraduates each. Undergraduates in one cohort were divided into two teams, which rotated in morning and afternoon shifts. Team 1 was on morning shift during the first (t0) and third (t1) weeks of the IPTW placement, and Team 2 was on morning shift during the second (t0) and fourth (t1) weeks. Within each team, a tandem of one nursing and one medical undergraduate cared for a patient room with three patients. Ward round observations took place with each team and tandem at t0 and t1 using the IP-VITA instrument for individual competencies (16 items) and team performance (11 items). Four hypotheses were formulated for statistical testing with linear mixed models and correlations. Results: A total of 16 nursing and medical undergraduates each were included. There were significant changes in mean values between t0 and t1 in individual competencies (Hypothesis 1). They were statistically significant for all three sum scores: "Roles and Responsibilities", Patient-Centeredness", and "Leadership". In terms of team performance (Hypothesis 2), there was a statistically significant change in mean values in the sum score "Roles and Responsibilities" and positive trends in the sum scores "Patient-Centeredness" and "Decision-Making/Collaborative Clinical Reasoning". Analysis of differences in the development of individual competencies in the groups of nursing and medical undergraduates (Hypothesis 3) showed more significant differences in the mean values of the two groups in t0 than in t1. There were significant correlations between individual competencies and team performance at both t0 and t1 (Hypothesis 4). Discussion: The study has limitations due to the small sample and some sources of bias related to the external assessment by means of observation. Nevertheless, this study offers insights into interprofessional tasks on the IPTW from an external assessment. Results from quantitative and qualitative analysis of learners self-assessment are confirmed in terms of roles and responsibilities and patient-centeredness. It has been observed that medical undergraduates acquired and applied skills in collaborative clinic reasoning and decision-making, whereas nursing undergraduates acquired leadership skills. Within the study sample, only a small group of tandems remained constant over time. In team performance, the group of constant tandems tended to perform better than the group of random tandems. The aim of IPTW should be to prepare healthcare team members for the challenge of changing teams. Therefore, implications for IPTW implementation could be to develop learning support approaches that allow medical and nursing undergraduates to bring interprofessional competencies to team performance, independent of the tandem partner or team.

[Between New Responsibility and Daily Routines - The Role of the VERAH in GP Care: A Qualitative Secondary Data Case Study of the Introduction of Software-Based Case Management]. / Zwischen neuer Verantwortung und Routinetätigkeit: Die Rolle der VERAH in der hausärztlichen Versorgung ­ Eine qualitative Sekundärdatenanalyse am Beispiel des softwaregestützten Case Management.

BACKGROUND: The concept of Care Assistant in General Practice (VERAH) was developed in order to integrate non-medical staff more strongly into primary care and thus to meet the increasing demand for care and the simultaneous shortage of medical staff. VERAHs are increasingly responsible for software-supported case management and are thus confronted with new tasks. The aim of this study was therefore to explore the role of the VERAH in primary care practices. METHODS: The present study is a qualitative secondary data analysis; the data collection took place within the projects VESPEERA and TelePraCMan. Twenty individual interviews and two focus group meetings were conducted with a total of 30 physicians, VERAHs and medical assistants from primary care. The data were analysed qualitatively according to Emerson. Contextual and socio-demographic data were collected with an accompanying questionnaire. RESULTS: The VERAHs of all primary care practices from which interview partners participated performed tasks within software-supported case management. Concerning the role of the VERAH, three themes were identified in the interviews: a) concrete tasks of the VERAH in software-supported case management within the practice team, b) relevance of software-supported case management within the activities of the VERAHS and c) relationship between VERAHs and patients. CONCLUSION: Taking over tasks in software-supported case management can contribute to strengthening and expanding the role of the VERAH. In the future, more attention should be paid to a clear description of the new role, and the conditions of the VERAHs' task fulfilment should be considered.

Current practice of outpatient rehabilitation services in patients with mobility-impaired paralysis due to stroke or spinal cord injury: a qualitative interview study in Germany.

PURPOSE: When mobility deficits persist after stroke or spinal cord injury (SCI), outpatient neurorehabilitation services are required. This study aimed to explore the current practice of German outpatient neurorehabilitation services and identify factors associated to this practice. METHODS: This was a qualitative observational study in which semi-structured interviews were conducted with professionals from outpatient neurorehabilitation services and mobility-impaired patients. A qualitative content analysis with a data-driven coding process was used. RESULTS: Three general practitioners, five physical, five occupational, and one speech therapist, one neuropsychologist, two outpatient nurses, one rehabilitation technician, one social worker, two patient advocates (long-term survivors, each stroke and SCI), and 20 patients (10 after stroke, 10 after SCI, all first-ever affected since approximately one year) participated. The reported experiences ranged from high satisfaction to perceived deficits in participation-oriented, evidence-based, and coordinated care. Identified associated factors were: (a) availability of specialised therapists and professional education, (b) outpatient service catalogue, (c) cost coverage, (d) setting rehabilitation goals, and (e) physician as care coordinator. CONCLUSION: Areas of improvement identified focused on: setting rehabilitation goals towards participation, training therapists on evidence-based treatments and shared decision-making, updating the outpatient service catalogue, and implementing coordination actions. Implementation of these recommendations should be evaluated.

Professionals need to be trained in setting rehabilitation goals and treatments. The continuing education should be based on current evidence and address interprofessionalism. Academization and continuing education in scientific work for therapists should be advanced.Professionals should educate patients about rehabilitation goals and set rehabilitation goals together, both interprofessional coordinated and with the patient (shared decision-making). Activity and participation should be the central aspects. Rehabilitation clinicians should give instructions to therapists on what to do if rehabilitation goals are not worked on.Rehabilitation clinicians should encourage interprofessional collaboration and information exchange where this is not the case. The exchange of information between outpatient professionals should be promoted through appropriate measures, that is, interprofessional meetings could be introduced.The outpatient service catalogue should be revised regarding evidence-based and participation-oriented treatments and enable appropriate cost coverage.

[Measuring individual competencies and team performance in clinical learning settings of interprofessional collaborative practice: Empirical development of the Interprofessional Ward Round Individual and Team Assessment Tool (IP-VITA)]. / Individuelle Kompetenzen und Team-Performance in klinischen Lernsettings der interprofessionellen Zusammenarbeit erfassen: Die empirische Entwicklung des Interprofessionelle Visiten Individual und Team Assessment Tools (IP-VITA).

BACKGROUND: Interprofessional training wards (IPTW) can contribute to the development of interprofessional competencies. In order to evaluate the acquisition of competencies, instruments are needed that record both team performance and individual competencies in the clinical teaching setting in third-party assessment. This paper describes the Interprofessional Ward Round Individual and Team Assessment-Tool, IP-VITA ("Interprofessionelle Visiten Individual und Team Assessment Tool") and its development. METHOD: Based on the empirical exploration of the three observation instruments "Teamwork Assessment Scale" (TAS), "McMaster-Ottawa Scale" and "Individual Teamwork Observation and Feedback Tool" (iTOFT) in at least four rounds each at the HIPSTA (with n=8 students and trainees each), a preliminary version of the IP-VITA was created. This preliminary version was then refined in subsequent empirical steps: a consensual validation in the research team was followed by a "member check" with the clinical colleagues of the HIPSTA, the input from external experts and an empirical test in an alternative setting. RESULTS: The IP-VITA is an empirically developed multimodal instrument to assess the interprofessional competencies of trainees and students as well as their team performance in clinical settings with patient interaction. It comprises three parts. In part A, structural data, the persons involved and the essential patient characteristics are recorded. Part B consists of 12 items and a free-text field for recording behaviour at the individual level. Part C also consists of 12 items and evaluates behaviour at team level. DISCUSSION: The IP-VITA instrument was developed specifically for the context of evaluating interprofessional ward rounds in a clinical educational setting. The instrument takes into account the ambiguous position of the assessment of interprofessional collaboration between individual competence and team performance. Beyond the HIPSTA, it can be used as a formative assessment instrument, and it may also be useful for summative assessments.

Keeping up with evidence-based recommendations - a qualitative interview study with general practitioners in Germany on information-seeking behaviour in cardiovascular care.

BACKGROUND: Due to the nature of their work, general practitioners (GPs) need to be up to date with evidence in various medical domains. While much synthesised research evidence is easily accessible nowadays, in practice, the time to search for and review this evidence proposes a challenge. In German primary care, the knowledge infrastructure is rather fragmented, leaving GPs with relatively few primary care specific resources of information and many resources from other medical fields. This study aimed to explore GPs information-seeking behaviour regarding evidence-based recommendations in cardiovascular care in Germany. METHODS: To explore views of GPs a qualitative research design was chosen. Data was collected through semi-structured interviews. In total, 27 telephone interviews with GPs were conducted between June and November 2021.Verbatim transcript interviews were then analysed using thematic analysis, deriving at themes inductively. RESULTS: Two broad strategies of information-seeking behaviour in GP could be distinguished: (a) generic information-seeking behaviour and (b) casuistic information-seeking. The first referring to strategies GPs apply to keep up with medical developments such as new medication and the second referring to purposeful information exchange regarding individual patients, such as referral letters. The second strategy was also used to keep up with medical developments in general. CONCLUSION: In a fragmented information landscape, GPs used information exchange on individual patients to remain informed about medical developments in general. Initiatives to implement recommended practices need to take this into account, either by using these sources of influence or by making GPs aware of possible bias and risks. The findings also emphasize the importance of systematic evidence-based sources of information for GPs. TRAIL REGISTRATION: We registered the study prospectively on 07/11/2019 at the German Clinical Trials Register (DRKS, www.drks.de ) under ID no. DRKS00019219.

[Acceptance of telemetric care for patients with sICD safety advice : Qualitative interview study in cardiological health services research]. / Akzeptanz einer telemetrischen Versorgung bei Patienten mit sICD-Sicherheitshinweis : Qualitative Interviewstudie der kardiologischen Versorgungsforschung.

BACKGROUND: Telemonitoring is used to monitor implantable cardioverter defibrillators (ICDs). Despite the scientifically proven effectiveness and safety of telemetric care, studies show that the offer is not used and accepted by all patients. OBJECTIVES: The aim of this study is to investigate the attitudes of ICD patients towards telemonitoring, including which aspects influence attitudes and decision-making. METHODS: Data were collected using semi-structured, guideline-based individual interviews. A total of 14 patients with a subcutaneous ICD (sICD) and both primary and secondary prophylactic indications were recruited. Data analysis followed a content-structuring qualitative approach. RESULTS: Patients with telemonitoring perceived a high benefit with low concerns about digital technology, while the opposite was observed for patients without telemonitoring. The patients' previous medical experience has a crucial impact on the acceptance of telemonitoring. All age groups reported the technical implementation and practical handling of telemonitoring to be simple and uncomplicated. CONCLUSION: The results suggest that the primary and secondary prophylactic indication for ICD implantation have an influence on the attitude towards telemonitoring and, thus, on acceptance. Further qualitative research regarding user acceptance of telemonitoring of other ICD systems is needed.

["This is Not at All Foreseeable from the Outset" - Research Ethics in Qualitative Health Services Research: A Survey of Researchers]. / "Das ist vorher gar nicht absehbar"? ­ Forschungsethische Fragen in der qualitativen Versorgungsforschung. Eine Befragungsstudie mit Forschenden.

BACKGROUND: Health services research is multidisciplinary and involves the use of a plurality of research methods. Medicine as a discipline serves as an important reference, also in terms of addressing ethics issues in research. At the same time, however, the highly formalized ethical reviews common in medicine, are controversial within the social sciences, especially among qualitative researchers. So far, little is known about which research ethics issues arise in qualitative health services research. METHODS: In summer 2019, an online survey was conducted among health services researchers on two main topics: a) research ethics issues in qualitative health services research and b) experiences with the ethics review procedures. The questionnaire contained ten open questions; the responses were analyzed for content. The first topic (ethical issues) is addressed within this article. RESULTS: A total of 73 researchers with heterogeneous professional background and an average of more than seven years of work experience in health services research participated in the survey. The following were reported as central research ethics issues: a) legitimacy and anticipation of ethical challenges in the planning of research, b) field access, consent and burdens during data collection, c) anonymization and data protection in data processing, d) data analysis, e) publication of results and data and f) general topics such as central principles and goals of research as well as the role of researchers. The main formats for dealing with these issues were exchange and consultation as well as referring to texts and regulations. CONCLUSIONS: On the one hand, the data documents typical central research ethics questions that researchers are confronted with in the context of qualitative health services research; on the other hand, they also point to gaps and less considered topics. A systematizing ethical reflection could take up these findings in order to develop health services research-specific principles and strategies for handling research ethics issues.

Top 10 research priorities in colorectal cancer: results from the Colorectal Cancer Priority-Setting Partnership.

BACKGROUND: Colorectal cancer (CRC) is the third most frequent cause of cancer death in the word. Which aspects of research into CRC should be accorded the highest priority remains unclear, because relevant stakeholders, such as patients, nurses, and physicians, played hardly any part in the development of research projects. The goal in forming the CRC Priority-Setting Partnership (PSP) was to bring all relevant stakeholders together to identify and prioritize unresolved research questions regarding the diagnosis, treatment, and follow-up of CRC. METHODS: The CRC PSP worked in cooperation with the British James Lind Alliance. An initial nationwide survey was conducted, and evidence uncertainties were collected, categorized, summarized, and compared with available evidence from the literature. The as-yet unresolved questions were (provisionally) ranked in a second national wide survey, and at a concluding consensus workshop all stakeholders came together to finalize the rankings in a nominal group process and compile a top 10 list. RESULTS: In the first survey (34% patients, 51% healthcare professionals, 15% unknown), 1102 submissions were made. After exclusion of duplicates and previously resolved questions, 66 topics were then ranked in the second survey (56% patients, 39% healthcare professionals, 5% unknown). This interim ranking process revealed distinct differences between relatives and healthcare professionals. The final top 10 list compiled at the consensus workshop covers a wide area of research topics. CONCLUSION: All relevant stakeholders in the CRC PSP worked together to identify and prioritize the top 10 evidence uncertainties. The results give researchers and funding bodies the opportunity to address the most patient-relevant research projects. It is the first detailed description of a PSP in Germany, and the first PSP on CRC care worldwide.

Interprofessional weaning boards for invasively ventilated patients in intensive care units: Qualitative interview study with healthcare professionals in Germany.

Numbers of mechanically ventilated patients are increasing worldwide. Weaning Boards could support weaning from the ventilator by facilitating interprofessional consultations between Weaning Centers and nonpneumological intensive care units. This study, which is linked to the project Prevention of invasive Ventilation, aimed to explore the design and implementation of future Weaning Boards. Semistructured interviews were conducted with physicians, nurses, respiratory therapists, and physiotherapists of intensive care units and Weaning Centers in Baden-Wuerttemberg, Germany. Participants were asked to share their views on (a) required characteristics of Weaning Boards and (b) the current care of weaning patients in their wards. Qualitative data analysis included inductive and deductive steps referring to the Template for Intervention Description and Replication checklist and the Consolidated Framework for Implementation Research. The 14 interviewed healthcare professionals addressed characteristics of future Weaning Boards including (a) preconditions, (b) procedure, (c) interprofessional participants, (d) type of performance, and (d) time frame. Identified determinants for successful implementation were related to (a) individual characteristics of healthcare professionals, (b) ward characteristics, and (c) healthcare system characteristics. Weaning Boards could be a useful tool to advance knowledge sharing between professionals, improve education about weaning protocols, and support patient-oriented care. The implementation of Weaning Boards can be influenced by individual characteristics of participating professionals, difficulties in the interaction between professional groups, the present workplace culture, and the current coronavirus disease 2019 (COVID-19) pandemic.

Health Education about Lifestyle-Related Risk Factors in Gynecological and Obstetric Care: A Qualitative Study of Healthcare Providers' Views in Germany.

OBJECTIVE: Lifestyle-related risk factors (LRRFs) during pregnancy and lactation are associated with a range of health problems. However, previous studies have shown a large knowledge gap among pregnant women regarding the effects of LRRFs. This study aimed to investigate the role of health education about LRRFs during pregnancy and lactation in gynecological and obstetric care from healthcare providers' (HCPs) point of view. METHODS: To explore the views of healthcare providers, a qualitative study was performed. In 2019, 22 in-depth interviews were conducted with a purposive sample of 9 gynecologists and 13 midwives. Participants came from different inpatient and outpatient care settings and from rural, urban, and socially deprived areas in southern Germany. All the interviews were tape-recorded and transcribed verbatim. A combined inductive and deductive approach was applied for data analysis. RESULTS: Interviews with HCPs showed that they were aware of the possible impacts of LRRFs during pregnancy and lactation. They noted the importance of action, specifically among women with low socioeconomic status (SES), migrants, and women with a concerning medical history or other specific needs. However, the interviews showed that, at present, there is no standardized practice of educating patients on LRRFs in routine care. This was attributed to a lack of guidelines and time, unfavorable regulations, and undefined responsibilities. The priority of health education is lower in inpatient healthcare settings as compared to outpatient healthcare settings. HCPs apply a demand-driven healthcare approach, focusing on a woman's medical history, needs, and personal circumstances. HCPs voiced the importance of implementing pre-conception education across different healthcare settings, garnering support from other health organizations, and setting out clearly defined responsibilities among HCPs. CONCLUSIONS: This qualitative study explored HCPs' perspectives on health education about LRRFs during pregnancy and lactation. The results from this study emphasize the need for a central strategy for health education about LRRFs during pregnancy and lactation in gynecological and obstetric care.

Resilience of the primary health care system - German primary care practitioners' perspectives during the early COVID-19 pandemic.

BACKGROUND: Primary care is a relevant pillar in managing not only individual, but also societal medical crises. The COVID-19 pandemic has demanded a rapid response from primary care with interventions in the health care system. The aim of this paper was to explore the responses of primary care practitioners (PCP) during the early COVID-19 pandemic and to analyze these with a view on the resilience of the primary health care system from the PCPs perspective. METHODS: Shortly after the first COVID-19 wave (July-October 2020) n = 39, semi-structured telephone interviews were conducted with PCP in practices and at Corona contact points (CCP) in Baden-Wuerttemberg (Germany). Qualitative content analysis was applied, and the evolved categories were related to in a framework for resilience. RESULTS: Primary care had an overall strong ability to adapt and show resilience, albeit with wide variance in speed and scope of the responses. When coping with uncertainty, the reasons given by PCPs in favor of opening a CCP mainly involved intrinsic motivation and self-initiative; the reasons against doing so were i.e. the lack of personal protective equipment, problems with space, and worries about organizational burden. A strong association existed between the establishment of a CCP and the use of resources (i.e. existing networks, personal protective equipment, exercising an office of professional political function). Our study predominantly found adaptive aspects for measures taken at medical practices and transformative aspects for setting up outpatient infection centers. PCPs played an important role in the coordination process (i.e. actively transferring knowledge, integration in crisis management teams, inclusion in regional strategic efforts) reaching a high level in the dimensions knowledge and legitimacy. The dimension interdependence repeatedly came into focus (i.e. working with stakeholders to open CCP, interacting among different types of primary care facilities, intersectoral interfaces). A need for regional capacity planning was visible at the time of the interviews. CONCLUSIONS: The results can be used for practical and research-based institutional and capacity planning, for developing resilience in primary care and for augmentation by perspectives from other stakeholders in the primary health care system.

[Utilization and reporting of qualitative research methods in health services research in Germany: A scoping review on original research publications (2010-2019)]. / Anwendung und Darstellung qualitativer Methoden in der Versorgungsforschung in Deutschland: ein Scoping Review zu Primärstudien (2010­2019).

BACKGROUND: Qualitative research methods offer a unique perspective on health care services. However, little is known about the actual application of qualitative methods in health services research. Therefore, the aim of this study was to gain an overview of volume and variety of the use of qualitative research methods in health services research in Germany. METHODS: By means of a scoping review, a systematic literature search of the database PubMed was conducted in September 2020. We included (1) qualitative studies in (2) a health services setting (3) in Germany, (4) published in either German or English as (5) original research in a journal (6) between 2010 and 2019. After removing duplicates, tandem teams of researchers first performed a title and abstract screening, followed by a full text screening. Data was extracted by using a category grid considering research focus, study design and reporting. RESULTS: In total, 759 articles were included in the title and abstract screening. After applying the exclusion criteria, 97 articles were included in the data extraction. The studies investigating mainly subjective perspectives of different stakeholders, especially physicians and patients, covered 13 areas of health care. Interviews were the dominant form of data collection (n=64). Data analysis was mainly conducted using content analysis (n=65). CONCLUSION: A clear absolute increase in publications since the mid-2010s can be observed. At the same time, there has been a strong tendency towards certain methods being used for data collection and analysis. Compared to reporting standards and guidelines (e.g., COREQ), incomplete reporting of research methods has been noted. The results show that both an extension of the range of methods and the quality of reporting need to be discussed.

Media use in gynecological and obstetric care and women's perceived level of education received of lifestyle-related risks: A cross-sectional study.

OBJECTIVE: The application of media on lifestyle-related risk factors (LRRFs) by healthcare providers to educate women may improve women's adherence, health literacy, and awareness of LRRFs, as well as offspring's health outcomes. This study investigated whether exposure to media-based education in gynecological and obstetric care is associated with LRRFs perceived levels of education received during pregnancy and lactation. METHODS: We conducted a cross-sectional, observational study across 14 randomly generated sample points in the 12 most populated cities in Baden-Württemberg, southwest Germany. Women were recruited from gynecological and obstetric institutions. Participants were 219 women who met our inclusion criteria and completed the quantitative questionnaire. We applied ordinal logistic regression analyses to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of women's perceived level of education received related to healthcare providers' exposure to media-based education. RESULTS: Media-based education on LRRFs during pregnancy through gynecologists and/or midwives were significantly associated with women's perceived level of education received (gynecologists: OR = 4.26 (95% CI: 2.04, 8.90; p < .001); midwives: OR = 3.86 (95% CI: 1.66, 8.98; p = .002)). Similar results were found for media-based education through gynecologists and/or midwives on LRRFs during lactation and its association with women's self-assessed level of perceived level of education received (gynecologists: OR = 4.76 (95% CI: 2.15, 10.56; p < .001); midwives: OR = 7.61 (95% CI: 3.13, 18.53; p < .001)). CONCLUSIONS: This study suggests that the exposure to media-based education in gynecological and obstetric care increases women's perceived level of education received of LRRFs during pregnancy and lactation. Therefore, it is recommendable to apply media in gynecological and obstetric care settings.

Assessment of shared decision making in pediatrics: Developing German scales for patients aged 7-18 years, parents and parent-proxy reports (CollaboRATEpediatric).

OBJECTIVE: To develop parsimonious German scales (CollaboRATEpediatric) to assess shared decision making (SDM) with patients aged 7-18 years, parents and parents on behalf of their children (parent-proxy reports), and to establish comprehensibility and preliminary face validity. METHODS: Based on an existing SDM scale for adults (CollaboRATE) we developed CollaboRATEpediatric in a two-step approach: (1) team-based translation of the English CollaboRATE scale into German and adaptation for pediatric patients, parents and parent-proxy reports, followed by (2) iterative revisions of the CollaboRATEpediatric scales based on cognitive interviews with patients and parents until comprehensibility and preliminary face validity were established. RESULTS: Taking into account seven problem areas identified in four rounds of cognitive interviews (e.g., item complexity) we developed CollaboRATEpediatric scales for patients, parents and parent-proxy reports. By iteratively revising items we were able to resolve all problem areas and achieved full comprehensibility and intended interpretation of all items. CONCLUSION: The scales enable the parsimonious assessment of SDM with pediatric patients and parents as well as comparisons between the two groups. Future empirical work will establish the psychometric performance of CollaboRATEpediatric. PRACTICE IMPLICATIONS: CollaboRATEpediatric can be used in quality improvement initiatives to foster the comprehensive implementation of SDM in pediatrics.

[Safety culture in orthopedics and trauma surgery : A qualitative study of the physicians' perspective]. / Sicherheitskultur in der Orthopädie und Unfallchirurgie : Eine qualitative Untersuchung der ärztlichen Perspektive.

BACKGROUND: Hospitals in Germany operate risk management, which can support the prevention of adverse events and to systematically process them. Safety culture is one aspect of this. In German-speaking countries, however, surveying the safety culture is still limited and almost exclusively carried out using quantitative instruments. In Germany, the discipline of orthopedics and trauma surgery is characterized by a high number of confirmed treatment errors and lack of risk clarification, Therefore, this study investigated the safety culture in this discipline. OBJECTIVE: (I) How do orthopedic and trauma surgeons perceive the handling of adverse events in trauma centers and (II) what are relevant components of the safety culture from a medical perspective? MATERIAL AND METHODS: A qualitative study using 14 semi-structured one-to-one interviews was carried out with physicians in orthopedics and trauma surgery. The interviews were audiotaped, transcribed, and analyzed using the thematic analysis by Braun and Clarke and the Yorkshire contribution factors framework. The MAXQDA software was used to organize data. RESULTS: A strong influence of senior staff on the handling of adverse events in the medical team could be determined. It was expected that senior staff members have a strong model role function. They were expected to exemplify a high safety culture, because their behavior influences the team's behavior in patient safety-related situations. CONCLUSION: The involvement of senior staff in the development of interventions to improve the safety culture in orthopedics and trauma surgery should be considered due to the importance of hierarchical structures.

Qualitative research methods in medical dissertations: an observational methodological study on prevalence and reporting quality of dissertation abstracts in a German university.

BACKGROUND: Qualitative methods offer a unique contribution to health research. Academic dissertations in the medical field provide an opportunity to explore research practice. Our aim was to assess the use of qualitative methods in dissertations in the medical field. METHODS: By means of a methodological observational study, an analysis of all academic medical dissertations' abstracts between 1998 and 2018 in a repository databank of a large medical university faculty in Germany was performed. This included MD dissertations (Dr. med. (dent.)) and medical science dissertations (Dr. sc. hum.). All abstracts including "qualitativ*" were screened for studies using qualitative research methods. Data were extracted from abstracts using a category grid considering a) general characteristics (year, language, degree type), b) discipline, c) study design (mixed methods/qualitative only, data conduction, data analysis), d) sample (size and participants) and e) technologies used (data analysis software and recording technology). Thereby reporting quality was assessed. RESULTS: In total, 103 abstracts of medical dissertations between 1998 and 2018 (1.4% of N = 7619) were included, 60 of MD dissertations and 43 of medical sciences dissertations. Half of the abstracts (n = 51) referred to dissertations submitted since 2014. Most abstracts related to public health/hygiene (n = 27) and general practice (n = 26), followed by medical psychology (n = 19). About half of the studies (n = 47) used qualitative research methods exclusively, the other half (n = 56) used mixed methods. For data collection, primarily individual interviews were used (n = 80), followed by group interviews (n = 33) and direct observation (n = 11). Patients (n = 36), physicians (n = 36) and healthcare professionals (n = 17) were the most frequent research participants. Incomplete reporting of participants and data analysis was common (n = 67). Nearly half of the abstracts (n = 46) lacked information on how data was analysed, most of the remaining (n = 43) used some form of content analysis. In summary, 36 abstracts provided all crucial data (participants, sample size,; data collection and analysis method). CONCLUSION: A small number of academic dissertations used qualitative research methods. About a third of these reported all key aspects of the methods used in the abstracts. Further research on the quality of choice and reporting of methods for qualitative research in dissertations is recommended.

Beyond Known Barriers-Assessing Physician Perspectives and Attitudes Toward Introducing Open Health Records in Germany: Qualitative Study.

BACKGROUND: Giving patients access to their medical records (ie, open health records) can support doctor-patient communication and patient-centered care and can improve quality of care, patients' health literacy, self-care, and treatment adherence. In Germany, patients are entitled by law to have access to their medical records. However, in practice doing so remains an exception in Germany. So far, research has been focused on organizational implementation barriers. Little is known about physicians' attitudes and perspectives toward opening records in German primary care. OBJECTIVE: This qualitative study aims to provide a better understanding of physicians' attitudes toward opening records in primary care in Germany. To expand the knowledge base that future implementation programs could draw from, this study focuses on professional self-conception as an influencing factor regarding the approval for open health records. Perspectives of practicing primary care physicians and advanced medical students were explored. METHODS: Data were collected through semistructured guide-based interviews with general practitioners (GPs) and advanced medical students. Participants were asked to share their perspectives on open health records in German general practices, as well as perceived implications, their expectations for future medical records, and the conditions for a potential implementation. Data were pseudonymized, audiotaped, and transcribed verbatim. Themes and subthemes were identified through thematic analysis. RESULTS: Barriers and potential advantages were reported by 7 GPs and 7 medical students (N=14). The following barriers were identified: (1) data security, (2) increased workload, (3) costs, (4) the patients' limited capabilities, and (5) the physicians' concerns. The following advantages were reported: (1) patient education and empowerment, (2) positive impact on the practice, and (3) improved quality of care. GPs' professional self-conception influenced their approval for open records: GPs considered their aspiration for professional autonomy and freedom from external control to be threatened and their knowledge-based support of patients to be obstructed by open records. Medical students emphasized the chance to achieve shared decision making through open records and expected the implementation to be realistic in the near future. GPs were more hesitant and voiced a strong resistance toward sharing notes on perceptions that go beyond clinical data. Reliable technical conditions, the participants' consent, and a joint development of the implementation project to meet the GPs' interests were requested. CONCLUSIONS: Open health record concepts can be seen as a chance to increase transparency in health care. For a potential future implementation in Germany, thorough consideration regarding the compatibility of GPs' professional values would be warranted. However, the medical students' positive attitude provides an optimistic perspective. Further research and a broad support from decision makers would be crucial to establish open records in Germany.