Current status and influencing factors of fear disease progression in Chinese primary brain tumor patients: A mixed methods study.

OBJECTIVE: In this study, we investigated the fear of disease progression in Chinese PBT patients and examined the correlation between sociodemographic, clinical, and psychological variables of patients with the fear of progression (FoP). Additionally, the study also evaluated the subjective experience of FoP in patients with primary brain tumors (PBT). METHODS: A mixed-methods study was conducted between March 2022 and December 2023, consisting of two phases: a quantitative approach in phase I, and a qualitative approach in phase II. In phase I, 305 patients with PBT filled in several questionnaires. An analysis was performed to identify potential predictors associated with FoP. In phase II, semi-structured interviews were conducted with 16 participants whose FoP scores were ≥ 34 in phase I to obtain information on their personal experiences with FoP. RESULTS: The results of the quantitative study showed that 192 (63 %) patients experienced high levels of FoP. The mean score of fear of progression was (34.02±6.78). Young age, high disease uncertainty, low social support, high negative coping and low positive coping are important factors affecting FoP in PBT patients. Qualitative research focused on three themes: triggers, coping styles, and the help needed. CONCLUSION: Enhanced screening and assessment of FoP is essential to identify dysfunctionin PBT. Meanwhile, the implications of these predictors for enhanced healthcare professional education and patient self-management may help healthcare providers implement relevant interventions promptly and help patients reduce their FoP. However, due to limitations such as sample, reporting bias, and specific mechanisms between predictors and FOPs that have not yet been explored in depth, further exploration is needed in the future.

Understanding of head injury assessment and return to play processes and associated factors in United States Major League Rugby players.

OBJECTIVES: Evaluate professional rugby players' self-reported perceived understanding of the head injury assessment (HIA) and return to play (RTP) processes and determine factors related to understanding and trust pertaining to these processes. METHODS: An electronic survey measured concepts of interest. A thematic analysis of player understanding was performed, and player statements were coded. RESULTS: 207 U.S. Major League Rugby (MLR) players participated (26.7 ± 3.4 years). HIA and RTP protocol understanding was not correlated with concussion history (p = 0.41). International rugby experience and trust regarding MLR support of the following protocols and opposing team medical staff practices varied in their relationship to HIA understanding. Trust that all MLR teams follow the same protocols was positively correlated with all HIA questions (ps < 0.03). No HIA questions were correlated with trust in their own team's medical staff. All trust questions were significantly correlated with RTP process understanding. Qualitative analysis identified four HIA- and RTP-related themes: education needs, staffing needs, HIA criticisms, and importance of player safety. CONCLUSION: International playing experience and greater trust in the MLR and league stakeholders were associated with greater player understanding of the HIA and RTP protocols. These results provide insight into the importance of educating players on league-specific concussion protocols.

Cervical cancer screening delay and associated factors among women with HIV in Lesotho: a mixed-methods study.

BACKGROUND: Cervical cancer is the fourth most common cancer in women worldwide, and women with human immunodeficiency virus (HIV) are particularly at risk of developing it. Regular screening effectively prevents morbidity and mortality. This mixed-methods study quantitatively assessed cervical cancer screening uptake and qualitatively explored the process of undergoing cervical cancer screening to understand possible reasons for delayed screening among women with HIV in Lesotho. METHODS: Between October 2020 and March 2022, the Viral load Triggered ART care in Lesotho (VITAL) trial enrolled women aged 18 years and older with HIV who were taking antiretroviral therapy (ART). Cervical cancer screening delay was defined as reporting a screening that occurred more than two years ago or never having been screened. Cervical cancer screening uptake and the association between screening delay and sociodemographic variables were assessed using a multivariable mixed-effects logistic regression model accounting for clustering at clinic level. In-depth interviews were conducted with 16 women to obtain information on awareness, perceptions, and barriers to cervical cancer screening and were analyzed using thematic analysis. RESULTS: Quantitative data were available for 3790 women. Among them, cervical cancer screening was delayed in 1814 (47.9%), including 1533 (40.5%) who were never screened. Compared to women aged 25 to 39 years, women aged 18 to 24 years (adjusted odds ratio (aOR) 2.8; 95% confidence interval (CI) 2.1-3.7), women aged 40 to 59 years (aOR 1.3; CI 1.1-1.6), and women older than 60 years (aOR 3.9; CI 3.0-5.1) were at higher risk of screening delay. Furthermore, time on ART below 6 months (aOR 1.6; CI 1.1-2.3) compared to above 6 months was associated with screening delay. Qualitative data identified limited awareness of cervical cancer risks and screening guidelines, misconceptions and fears created by the influence of other women's narratives, and low internal motivation as the main barriers to screening uptake. CONCLUSIONS: Cervical cancer screening delay was common. Limited personal awareness and motivation as well as the negative influence of other women were the primary internal barriers to cervical cancer screening. Awareness and screening campaigns in Lesotho should consider these factors. TRIAL REGISTRATION: clinicaltrials.gov, NCT04527874, August 27, 2020.

Investigation of Expectations and Satisfaction After Sinus Surgery for Chronic Rhinosinusitis.

OBJECTIVE: To perform the first mixed-methods analysis of patient expectations and satisfaction after endoscopic sinus surgery (ESS). METHODS: Semi-structured interviews of subjects undergoing ESS were performed to understand pre-operative expectations and 6-month post-operative satisfaction. Descriptive statistics, logistic regression, and mediation analyses were performed. Quantitative questions were followed by qualitative probes for subjects to expand on quantitative answers. Study sample size was determined by thematic saturation based on qualitative responses. Data visualization was used to triangulate quantitative and qualitative data wherein themes emerged. RESULTS: A total of 52 participants were included in the mixed-method analysis, and 110 were included in the mediation analysis. 56% of participants were male, with an average age of 55.7 (SD ± 2.18). Mean change in SNOT-22 was 20.8 (SD ± 3.74), and 25% of participants did not achieve a minimal clinically important difference (MCID). Of the participants who did not achieve MCID, 79% would still choose to have sinus surgery again. Qualitative interviews revealed multiple preliminary categories describing the patient experience with ESS. Regression analysis showed that the most important predictor of satisfaction was whether pre-operative expectations were met (OR = 3.8, p < 0.001). In mediation analysis, the effect of the clinical outcome on patient satisfaction was completely mediated by pre-operative expectations (indirect effect p = 0.009, direct effect p = 0.17). CONCLUSION: Patient expectations and satisfaction are important yet understudied measures in CRS and ESS. In ESS, satisfaction with outcome is driven by the fulfillment of pre-operative expectations. Aligning such expectations is the most important intervention a sinus surgeon can perform to maximize success. LEVEL OF EVIDENCE: 4 Laryngoscope, 2024.

Possibilities and power during early Head Start Home visits: Comparing family- and home visitor-opened decision-making.

Decision-making by families and professionals about how to support children's development is an integral aspect of home visits. This study investigated home visit decision-making in a US program for families experiencing poverty, Early Head Start (EHS), through the following questions: What types of decisions do home visitors and families make about children's development during EHS home visits? How and to what extent do home visitors and families participate during these decisions? A convergent mixed methods research design was implemented to investigate participation through frequency counts and discourse analysis of home visit transcripts. Home visitor participants were four women, three white and one Black. Twelve families participated (12 mothers, 2 fathers). Parents identified as white (n = 8), Black (n = 3), and multiracial (n = 3; Black and white). One parent was a bilingual Arabic and English speaker. A total of 66 decisions about children's development were identified, with 49 decisions initiated by home visitors and 17 initiated by families. Although families talked more and took on active roles when they initiated (i.e., opened) decisions, home visitors predominantly controlled decision-making. Quantitative and qualitative participation differed only in the beginning of family-opened decisions, and home visitors gradually took more control.

La toma de decisiones por parte de familias y profesionales acerca de cómo apoyar el desarrollo de los niños es un aspecto integral de las visitas a casa. Este estudio investigó la decisión de hacer visitas a casa en el programa de Estados Unidos para familias que viven en pobreza, "De un comienzo temprano" (Early Head Start), a través de las siguientes preguntas: ¿Qué tipo de decisiones toman las visitadoras a casa y las familias acerca del desarrollo de los niños durante las visitas a casa del programa "De un comienzo temprano?" ¿Cómo y hasta qué punto las visitadoras a casa y las familias participan durante la toma de estas decisiones? Se implementó un diseño convergente mixto de métodos de investigación para investigar la participación por medio de conteos frecuentes y análisis de las transcritas conversaciones de la visita a casa. Las visitadoras a casa que participaron fueron cuatro mujeres, tres blancas y una de raza negra. Doce familias participaron (12 mamás, 2 papás). Los progenitores se identificaron como blancos (n = 8), negros (n = 3) y multirraciales (n = 3, negros y blancos). Uno de los progenitores era hablante bilingüe de árabe e inglés. Se identificó un total de 66 decisiones acerca del desarrollo de los niños, de las cuales 49 fueron iniciadas por las visitadoras a casa y 17 por las familias. Aunque las familias hablaron más y asumieron un papel activo cuando hablaban primero sobre las decisiones (v.g., cuando abrían la conversación), las visitadoras a casa predominantemente controlaron la toma de decisiones. La participación cuantitativa y cualitativa difirió sólo al principio de las decisiones iniciadas por las familias y las visitadoras a casa gradualmente asumieron mayor control.

Auditory and Psychological Impacts of Tympanoplasty in Chronic Suppurative Otitis Media Patients: A Mixed-Methods Study.

Introduction: Chronic Suppurative Otitis Media (CSOM) significantly impacts auditory functions and overall quality of life. Although tympanoplasty is recognized for its auditory benefits, its broader psychological impacts in CSOM patients remain underexplored. Method: In this sequential explanatory mixed-methods study, 100 adult CSOM patients undergoing tympanoplasty were evaluated from January 2022 to December 2023. The study integrated quantitative assessments (Pure-Tone Audiometry, Speech Audiometry, COMOT-15, HADS) and qualitative data from semi-structured interviews. Results: Post-tympanoplasty, patients exhibited a notable improvement in auditory functions, with an average decrease in Pure-Tone Audiometry (PTA) thresholds by 30 dB and a 28% increase in speech recognition scores. Psychological assessments reflected a significant enhancement in quality of life, with an average decrease of 25 points in COMOT-15 scores, and reductions in HADS anxiety and depression scores by an average of 7 and 6 points, respectively. Qualitative interviews reinforced these results, emphasizing improved social interactions and emotional well-being. A strong correlation was observed between the auditory and psychological improvements. Conclusion: The study demonstrates that tympanoplasty in CSOM patients leads to significant auditory and psychological improvements, highlighting the necessity of a comprehensive treatment approach. This underscores the importance of considering both physical and mental health in CSOM management. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-024-04907-1.

A Technology-Based Intervention Impacts Quality of Life for Low-Income Older Adults by Reducing Loneliness and Improving Healthcare Self-Efficacy and Self-Rated Health.

This paper describes a technology program aimed at developing technical skills and confidence, reducing social isolation and loneliness, and increasing healthcare self-management and self-efficacy among older adults. We conducted a mixed-methods study using surveys collected at baseline and 12 months from 90 older adults. Focus group data (n = 7) collected at 12 months were examined for convergence with key quantitative outcomes, emergent value-related themes, and evaluation of program structure and staff. Outcome data showed improvements in loneliness (Cohen's d = -0.24, p = .004) (validated by qualitative data), self-rated health (d = 0.23, p = .011), and healthcare self-efficacy (d = 0.31, p = .004). Participants with higher healthcare self-efficacy (ß = 0.24, p = .03) and higher negative emotions (ß = 0.28, p = .01) had greater frequency of internet use to search for health information. Qualitative findings described program mechanisms supporting increases in self-efficacy, including increased technology use and confidence, and values statements demonstrating the meaningfulness of learning technology and its impact on multiple domains of quality of life.

Using interactive computer play in physical therapy and occupational therapy clinical practice: an explanatory sequential mixed methods study.

Introduction: This study explored the extent to which an interactive computer play system, Bootle Blast, supports motor learning in a clinical context and examined clinicians' perceptions of their therapeutic role in the system's use as an intervention tool. Methods: In this observational sequential explanatory mixed methods study, five children with cerebral palsy [mean age 9.4 years (SD, 0.5), Gross Motor Function Classification System Levels I-III] used Bootle Blast during a single video-recorded therapy session with their treating clinicians (physical therapists, occupational therapists, and therapy assistants). Children played one Bootle Blast mini game independently (without clinician involvement) before clinicians carried out therapy sessions with the game as per usual care. The type and extent of motor learning strategies (MLS) delivered by Bootle Blast and clinicians were rated from video recordings by a trained assessor using the 22-item Motor Learning Strategies Rating Instrument. Semi-structured interviews with clinicians were conducted to gain insights into MLS use and clinicians' perceived role during Bootle Blast use. Interviews were audio recorded, transcribed verbatim, and analyzed independently by two researchers using thematic analysis. Quantitative and qualitative data were merged and reported using narrative and joint display approaches. Results: Bootle Blast provided eight MLS, with clinicians adding or enhancing another eight. Four themes reflected clinicians' perspectives: (1) Bootle Blast disguises therapy as play, (2) clinicians give Bootle Blast the human touch; (3) home use of Bootle Blast is promising; and (4) Bootle Blast is not always the right fit but some shortcomings could be addressed. Agreement was found for nine MLS and disagreement for four MLS when quantitative and qualitative findings were merged. Discussion: Bootle Blast delivers several MLS as part of game play and clinicians can enhance and provide additional MLS to suit the child's needs/abilities. Further game refinements that were identified in this study may optimize its clinical use.

Protocol for the SELECT study: a sequential mixed methods study of the selection of UK medical students into clinical academic training.

BACKGROUND: Internationally, there has been a move towards fostering diverse healthcare workforces that are representative of the patient populations they serve. Selection criteria for academic-clinicians often aim to capture skills and attributes that demonstrate both clinical and academic excellence. Currently, it is not known whether the selection criteria for early academic-clinical careers advantage or disadvantage certain ethnic or socioeconomic groups. The UK has a structured route of integrated clinical academic training with entry level training for newly qualified doctors administered through the 'Specialised Foundation Programme' which provides protected time for research within the first two years of postgraduate clinical training. In this study, we aim to identify what selection criteria are used within the UK Specialised Foundation Programme, and how these relate to demographic factors. METHODS: We will perform a mixed methods study consisting of a document analysis of person specifications and selection criteria used in the 2024 UK Specialised Foundation Programme, and a national cross-sectional survey of current medical students in the UK. We will obtain the person specifications, selection criteria, white space (open ended questions used during shortlisting) and interview questions and mark schemes from each Specialised Unit of Applications via information available on their websites or through Freedom of Information requests. Our survey will collect information relating to demographic data, selection criteria, and perceptions of specialised foundation programme selection. DISCUSSION: International literature has demonstrated inequity in academic markers used in selection of post-graduate clinicians and that disadvantages caused by selection can compound over time. As such it is important to understand what inequity exists within the selection of early academic-clinicians, as this can help inform more equitable selection practices and help nurture a more diverse academic-clinical workforce.

Are nurses and patients willing to work with service robots in healthcare? A mixed-methods study.

INTRODUCTION: Scholars have become increasingly interested in incorporating robots into healthcare. While there is a growing body of research examining nurses' and patients' attitudes towards using robots in healthcare, no prior research has specifically explored their willingness to integrate service robots within the Egyptian healthcare context. AIM: The aim of this study was twofold: (a) to explore the behavioral intentions of nurses to accept robots in their workplace, and (b) to examine the willingness of patients to use service robots in healthcare settings. METHODS: A mixed-methods study was conducted. Quantitative data were collected from 301 nurses using the Behavioral Intention to Accept Robots in the Workplace Scale and from 467 patients using the Service Robot Integration Willingness Scale through convenience sampling at three tertiary public hospitals in Port Said, Egypt. Qualitative data were obtained through in-depth, semi-structured interviews with 16 nurses, focusing on their perspectives and concerns regarding robot integration. Descriptive analyses were used to analyze quantitative data, and thematic analysis was used to analyze qualitative data. RESULTS: Quantitative results indicated a moderate level of behavioral intention to use robots among nurses. Patients demonstrated low willingness to use service robots. In the qualitative analysis of the data obtained from the interviews with nurses, three categories (Concerns about Robots, Roles and Competencies, and Potential Benefits) and eight themes (interaction and emotions, maintenance and reliability, job insecurity, role clarity, competence in critical care, trustworthiness, reducing physical strain, and specialized applications) were identified. CONCLUSION: The results of this study indicate that nurses' behavioral intention to accept service robots in healthcare settings is moderate and their acceptance is influenced by various factors related to their concerns about robots, roles and competencies, and potential benefits they could gain. Patients showed a low level of willingness to use service robots in healthcare settings. IMPLICATION: Providing targeted educational programs to nurses and patients, assuring them with the provision of robust maintenance protocols, enhancing their confidence in the capabilities of robots, and defining clear roles for robots are crucial for the successful integration of robots into healthcare settings.

A protocol for identifying the needs related to drug use, health and social (re)integration of people living in prison within five European countries.

BACKGROUND: Compared to the general population, people living in prison are at an increased risk to experience negative (mental) health outcomes. Moreover, delinquency and drug use have many risk factors in common. A need exists for increasing the knowledge about health needs, drug use patterns and the coverage of drug-related interventions in prison within Europe. The current protocol describes the design of a study about wellbeing, drug use and related care in prison. METHODS/DESIGN: A multicentre mixed method design is implemented in five European countries (Belgium, Cyprus, Greece, Lithuania and Luxembourg). Qualitative and quantitative data collection tools are combined in order to generate complementary and comprehensive results. First, a cross-sectional survey among people living in prison is conducted. This survey is based on a model questionnaire, the European Questionnaire on Drug use among people living in Prison, developed by the European Monitoring Centre for Drug and Drugs Addiction. Second, people living in prison and people who have been recently released from prison are involved in qualitative semi-structured face-to-face interviews. The main topics of interest are the use of drugs and other health related topics such as loneliness, anxiety, depression, infectious diseases, suicide and treatment. Third, data regarding health and social reintegration measures in prison is collected through a quantitative survey addressed to the prison authorities. DISCUSSION: This study protocol presentes a European study which aims to assess drug use among people living in prison and recently released people who use drugs as well as the existing care services in prisons. Hereby, factors related to the prison environment and their needs, both inside and outside prison are taken into account. Importantly, this study protocol describes a methodology which is developed to be executed in different prison settings within different countries simultaneously. Accordingly, for each country the protocol is adjustable to specific national legal requirements, regional differences and distinct local regulations of prison administrations. However, extensive modularity inevitably comes with significant limitations of comparability and generalizability of the results.

Optimizing EFL learning: exploring the role of learner background factors and the nuances of their effects on intrinsic and extrinsic motivation among university students in a mixed-methods study.

INTRODUCTION: Motivation is a driving force behind man's behavior which has led to many psychological studies throughout the world. Moreover, it is the fuel for successful learning. While intrinsic motives provide the internal rewards, extrinsic motivation supplies the required external rewards to keep the engine of learning running. Knowing the factors which impact intrinsic/extrinsic motivation helps educators target their efforts at a higher level and make more informed decisions. METHOD: This study intends to examine how intrinsic vs. extrinsic motivation may be influenced by demographics including learners' background factors of major, age, and occupation and to determine the relationships that may exist between intrinsic and extrinsic motivation. To this end, an explanatory sequential mixed-methods research was conducted at one of the public universities in Shiraz on the majors of Elementary Education, Educational Affairs, Social Studies and Theology, and the Arabic language which were selected through cluster sampling. These students were having their English courses at the university. Based on Krejcie and Morgan's formula for sample size, a questionnaire was administered to 100 participants to collect quantitative data. Moreover, semi-structured interview sessions were conducted with one fourth of the participants. RESULTS: Using Multiple Analysis of Variance (MANOVA) and Pearson correlation, we found that learners' background factors of age, field of study and professional status did not affect intrinsic nor extrinsic motivation. However, significant and positive relationships were found between intrinsic motivation and total motivation index, and between extrinsic motivation and total motivation index. Qualitative data obtained from the interviews were analyzed using a thematic analysis. The results of the interviews showed some new illuminating trends as revealed from the participants' responses and it was found that most interviewees followed intrinsic motives and considered motivation as a factor of great significance. CONCLUSION: In the English as a Foreign Language (EFL) context in which our study was conducted, instructors can follow more similar classroom motivational techniques and strategies since neither type of motivation was influenced by the variables of different major, age and occupation. Though many studies have shown that EFL learners are more extrinsically motivated in comparison with ESL ones, our study revealed that participants were more intrinsically motivated. Thus, this study may be replicated in other educational contexts such as an ESL context. The study can also be repeated in some universities in which other educational systems such as coed education is used to see the possible similarities and differences. Motivation is the important stimulant to impel the learners to achieve their learning goals; thus, it should receive sufficient attention in various educational settings.

"I'm Trying to Reach Out, I'm Trying to Find My People": A Mixed-Methods Investigation of the Link Between Sensory Differences, Loneliness, and Mental Health in Autistic and Nonautistic Adults.

Background: Rates of loneliness are substantially higher among autistic compared with nonautistic individuals. This observation refutes the persistent stereotype that autistic individuals are not motivated to seek meaningful social relationships. More plausibly, social environments systematically exclude people with higher levels of sensory differences, impeding on opportunities for autistic individuals to form meaningful relationships. In this study, we sought to quantify the level of distress associated with loneliness (Study A) and provide complementary qualitative insight into experiences of loneliness in relationship to sensory differences in autistic adults (Study B). Methods: In Study A, N = 209 participants completed a range of self-report questionnaires. In Study B, nine autistic adults took part in 10-minute unstructured dyadic conversations around the topic of loneliness. We derived a qualitative understanding of autistic individuals' experience of loneliness, enriched by inductive and deductive analyses. Results: In Study A, the autistic group showed significantly higher levels of loneliness, loneliness distress, anxiety, depression, and sensory reactivity. We found significant positive correlations between variables, but no group differences in differential relationships. The effect of sensory reactivity on anxiety and depression was mediated by levels of loneliness in both groups. In Study B, autistic participants described the pain of feeling lonely and socially disconnected, while simultaneously experiencing a need for restorative solitude after social overstimulation. Discussion: Our results indicate that sensory differences are related with higher loneliness and associated poor mental health in both autistic and nonautistic adults. This effect was exacerbated in autistic adults due to higher levels of sensory reactivity. First-hand reports from autistic adults on intense loneliness and the obstructive role of sensory environments refute stereotypes about a lack of social motivation in autistic adults. We conclude that to enable meaningful and inclusive social interaction, a societal effort is needed to create spaces that consider the sensory needs of all neurotypes.

Why is this an important issue? Research shows that autistic people experience loneliness more often than nonautistic adults. It also shows that sensory differences contribute to higher loneliness, and that both sensory differences and loneliness are related to poor mental health, such as anxiety and depression. However, we do not know if this is unique to autistic adults, or something that also occurs in nonautistic adults. There are also not many studies where autistic people themselves describe loneliness, and how they link their loneliness to sensory differences. Finding out about whether there are differences in autistic and nonautistic people regarding loneliness, and letting autistic people put their thoughts about loneliness into their own words is important to learn more about how we can start to tackle the high rates of loneliness in autistic adults. What was the purpose of this study? Our goal was to ask autistic people how they experience loneliness, and to empirically test whether the links between sensory differences, loneliness, and anxiety and depression are present in autistic people only, or also in nonautistic people. What did the researchers do? We conducted two separate studies. In Study A, we asked autistic and nonautistic adults to fill out questionnaires about their loneliness, how distressed they are by loneliness, anxiety, depression, and how they experience the sensory environment. In Study B, we asked eight autistic adults to speak with each other and nonautistic participants about their experiences with loneliness. We gave them some conversation starters and then looked for common themes that came up in the conversations. What were the results of the study? In Study A, we found that autistic people were more distressed about being lonely, and had higher levels of loneliness, depression, anxiety, and sensory differences than nonautistic participants. However, in both groups, sensory differences were related to higher anxiety and depression, and loneliness was an important influence on this relationship. This finding was supplrted by Study B, where autistic participants described that they often struggle to make meaningful connections because their sensory sensitivities keep them from going out. What do these findings add to what was already known? Our findings show in a scientific way that loneliness is just as bad for autistic as nonautistic people. We also find that sensory sensitivities might play a role in making autistic people lonelier. What are potential weaknesses in the study? Our study sample does not represent the entire autism spectrum. All our participants were able to speak and travel to the study venues with little support. Our study participants were also mostly White, and our study can, therefore, not speak about the experiences of autistic people across different ethnic groups. How will these findings help autistic adults now or in the future? We hope that our findings will support the idea that loneliness is indeed a distressing experience for autistic people, and that society as a whole recognizes the need to create welcoming sensory environments that help to overcome the disconnect that many autistic adults experience.

Perceived Impact of COVID-19 in an Underserved Community: A Natural Language Processing Approach.

AIM: To utilise natural language processing (NLP) to analyse interviews about the impact of COVID-19 in underserved communities and to compare it to traditional thematic analysis in a small subset of interviews. DESIGN: NLP and thematic analysis were used together to comprehensively examine the interview data. METHODS: Fifty transcribed interviews with purposively sampled adults living in underserved communities in the United States, conducted from June 2021 to May 2022, were analysed to explore the impact of the COVID-19 pandemic on social activities, mental and emotional stress and physical and spiritual well-being. NLP includes several stages: data extraction, preprocessing, processing using word embeddings and topic modelling and visualisation. This was compared to thematic analysis in a random sample of 10 interviews. RESULTS: Six themes emerged from thematic analysis: The New Normal, Juxtaposition of Emotions, Ripple Effects on Health, Brutal yet Elusive Reality, Evolving Connections and Journey of Spirituality and Self-Realisation. With NLP, four clusters of similar context words for each approach were analysed visually and numerically. The frequency-based word embedding approach was most interpretable and well aligned with the thematic analysis. CONCLUSION: The NLP results complemented the thematic analysis and offered new insights regarding the passage of time, the interconnectedness of impacts and the semantic connections among words. This research highlights the interdependence of pandemic impacts, simultaneously positive and negative effects and deeply individual COVID-19 experiences in underserved communities. IMPLICATIONS: The iterative integration of NLP and thematic analysis was efficient and effective, facilitating the analysis of many transcripts and expanding nursing research methodology. IMPACT: While thematic analysis provided richer, more detailed themes, NLP captured new elements and combinations of words, making it a promising tool in qualitative analysis. REPORTING METHOD: Not applicable. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

How to optimize the CAR-T Cell therapy process? A group concept mapping analysis of preconditions for a frictionless process from a German multistakeholder perspective.

Introduction: Treatment with chimeric antigen receptor T (CAR-T) cells involves a large number of interdisciplinary stakeholders and is associated with complex processes ranging from patient-specific production to follow-up care. Due to the complexity, maximum process optimization is required in order to avoid efficiency losses. This study aimed at systematically determining the preconditions for a frictionless flow of the CAR-T process by surveying the stakeholders involved. Methods: A Group Concept Mapping (GCM) analysis, a mixed-methods participatory research, was conducted. CAR-T experts from different professional backgrounds went through three steps: 1) Brainstorming relevant aspects (statements) for a frictionless process, 2) Sorting the collected statements based on their similarity, and 3) Rating the importance and feasibility of each statement. A cluster map reflecting the overarching topics was derived, and mean ratings per statement and cluster were calculated. Results: Overall, 20 CAR-T experts participated. A total of 80 statements were collected, resulting in a map of the following 10 clusters (mean importance/feasibility): Information for patients and physicians (4.16/3.77), Supportive network (4.03/3.53), Eligibility of patients (4.41/3.63), Evidence, transparency and communication (4.01/3.33), Paperwork (4.1/2.52), Interface with pharmaceutical manufacturer (4.03/2.85), Reimbursement (4.29/2.31), Quality Management (4.17/3.18), Infrastructure of CAR-T clinics (4.1/2.93), and Patient-oriented processes (4.46/3.32). Discussion: The 80 statements underlined the complex and manifold nature of the CAR-T treatment process. Our results reflect the first step in overcoming hurdles: identifying potential hurdles and required preconditions. Decision-makers and stakeholders can use the results to derive strategies and measures to further promote a frictionless process.

Voluntarily stopping eating and drinking (VSED): A systematic mixed-methods review focusing on the carers' experiences.

BACKGROUND: Voluntary stopping of eating and drinking (VSED) is a way to end one's life prematurely. We synthesized the empirical data on VSED. METHODS: In this systematic mixed-methods review, we searched MEDLINE, CINAHL, PsycINFO, Google Scholar, and BELIT for English and German articles published between January 1, 2013 and November 12, 2021. We included quantitative and qualitative research examining the experiences, attitudes, and knowledge of people confronted with VSED. We inductively analyzed the data after quantitative data transformation. We assessed quality and confidence using the Mixed-Methods Appraisal Tool and GRADE-CERQual approach, respectively. This study was registered in PROSPERO (CRD42022283743). FINDINGS: We identified 22 eligible articles, comprising 16 studies. The participants were healthcare professionals and relatives, but not individuals undertaking VSED. We present here our findings on the challenges of accompanying VSED, positive experiences with VSED, and the identified needs. Support during VSED is needed at multiple levels (medical care, family relief, course planning), and the willingness to accompany VSED is very high among healthcare professionals. However, there are several problems, the most obvious being the lack of knowledge and expertise regarding VSED, placing a great burden on families and professionals. The confidence in the review findings ranged from moderate to low. INTERPRETATION: Evidence-based guidance, in-depth knowledge, and training of healthcare professionals can greatly reduce the burden and fear among individuals accompanying VSED.

Prenatal maternal mental health and resilience in the United Kingdom during the SARS-CoV-2 pandemic: a cross- national comparison.

Introduction: Prenatal mental health problems are associated with morbidity for the pregnant person, and their infants are at long-term risk for poor health outcomes. We aim to explore how the SARS-CoV-2 pandemic affected the mental health of pregnant people in the United Kingdom (UK), and to further identify resilience factors which may have contributed to varying mental health outcomes. We also aim to examine the quality of antenatal care provided during the pandemic in the UK and to identify potential inadequacies to enhance preparedness for future events. Methods: During June-November 2020, we recruited 3666 individuals in the UK for the EPPOCH pregnancy cohort (Maternal mental health during the COVID-19 pandemic: Effect of the Pandemic on Pregnancy Outcomes and Childhood Health). Participants were assessed for depression, anxiety, anger and pregnancy-related anxiety using validated scales. Additionally, physical activity, social support, individualized support and personal coping ability of the respondents were assessed as potential resilience factors. Results: Participants reported high levels of depression (57.05%), anxiety (58.04%) and anger (58.05%). Higher levels of social and individualized support and personal coping ability were associated with lower mental health challenges. Additionally, pregnant individuals in the UK experienced higher depression during the pandemic than that reported in Canada. Finally, qualitative analysis revealed that restrictions for partners and support persons during medical appointments as well as poor public health communication led to increased mental health adversities and hindered ability to make medical decisions. Discussion: This study revealed increased mental health challenges among pregnant individuals in the UK during the SARS-CoV-2 pandemic. These results highlight the need for reassessing the mental health support measures available to pregnant people in the UK, both during times of crisis and in general.

What do employers need when supporting stroke survivors to return to work?: a mixed-methods study.

BACKGROUND: Employers are key in supporting stroke survivors to return to work (RTW) but do not always have knowledge/skills or guidance to do so. OBJECTIVES: To explore employers' needs for provision of post-stroke RTW support. METHODS: Mixed-methods study. Participants recruited through voluntary response/purposive sampling. Survey of employers investigated stroke knowledge (maximum score: 7), RTW process knowledge (maximum score: 8), and perceived competency for actions supporting RTW (maximum score: 100%). Regression analyses explored relationships between employers' demographic/contextual characteristics and knowledge and perceived competency scores. Interviews with employers explored factors influencing their post-stroke RTW support. Interview data were analyzed using a framework analysis. Survey/interview findings were synthesized with those from a qualitative systematic review. RESULTS: Across the survey (n = 50), interviews (n = 7), and review (25 studies), employers' support was influenced by stroke survivors' decisions to disclose stroke-related limitations, employers' knowledge regarding roles/responsibilities, employers' communication skills, and information provided by healthcare. Regression analyses: Human resources/occupational health support was positively associated with stroke knowledge (ß = 2.30, 95% CI 0.36-4.41, p = 0.013) and RTW process knowledge (ß = 5.12, 95% CI 1.80-6.87, p = 0.001). Post-stroke RTW experience was positively associated with stroke knowledge (ß = 1.36, 95% CI 0.46-2.26, p = 0.004) and perceived competency (ß = 31.13, 95% CI 18.40-44.76, p = 0.001). Organization size (i.e. working in a larger organization) was positively associated with RTW process knowledge (ß = 2.96, 95% CI 1.52-4.36, p = <.001). CONCLUSIONS: Employers' RTW support was influenced by personal and environmental factors; they may benefit from education and guidance on stroke and their roles/responsibilities during the RTW process.

Barriers and facilitators to routine revaccination among adult Hematopoietic Cell Transplant survivors in the United States: A convergent mixed methods analysis.

BACKGROUND: Hematopoietic cell transplant (HCT) survivorship care includes recommendations for post-HCT revaccination to restore immunity to vaccine-preventable diseases (VPDs). However, not all survivors agree to be vaccinated. No existing studies have comprehensively reported barriers and facilitators to adult HCT survivors completing revaccination. METHODS: A cross-sectional survey of 194 adult HCT survivors was analyzed using convergent mixed methods. The analysis used various statistical methods to determine the prevalence of barriers and facilitators and the association between revaccination and the number and specific type of barriers and facilitators. Content analysis was applied to open-ended item responses. Integrated analysis merged quantitative and qualitative findings. RESULTS: The most frequent barriers included the inability to receive live vaccines because of immunosuppression, identifying a suitable community location for administering childhood vaccines to adults, and delayed immune recovery. The most frequent facilitators were having healthcare insurance and a clear calendar of the revaccination schedule. Complete revaccination rates were lower with each additional reported barrier (OR = 0.58; 95% CI 0.459-0.722) and higher with each additional reported facilitator (OR = 1.31; 95% CI 1.05-1.63). Content analysis suggested that most barriers were practical issues. One significant facilitator highlighted by respondents was for the transplant center to coordinate and serve as the vaccination location for revaccination services. Merged analysis indicated convergence between quantitative and qualitative data. CONCLUSION: Practical barriers and facilitators played a consequential role in revaccination uptake, and survivors would like to be revaccinated at the transplant center.

The first AI-based Chatbot to promote HIV self-management: A mixed methods usability study.

BACKGROUND: We developed MARVIN, an artificial intelligence (AI)-based chatbot that provides 24/7 expert-validated information on self-management-related topics for people with HIV. This study assessed (1) the feasibility of using MARVIN, (2) its usability and acceptability, and (3) four usability subconstructs (perceived ease of use, perceived usefulness, attitude towards use, and behavioural intention to use). METHODS: In a mixed-methods study conducted at the McGill University Health Centre, enrolled participants were asked to have 20 conversations within 3 weeks with MARVIN on predetermined topics and to complete a usability questionnaire. Feasibility, usability, acceptability, and usability subconstructs were examined against predetermined success thresholds. Qualitatively, randomly selected participants were invited to semi-structured focus groups/interviews to discuss their experiences with MARVIN. Barriers and facilitators were identified according to the four usability subconstructs. RESULTS: From March 2021 to April 2022, 28 participants were surveyed after a 3-week testing period, and nine were interviewed. Study retention was 70% (28/40). Mean usability exceeded the threshold (69.9/68), whereas mean acceptability was very close to target (23.8/24). Ratings of attitude towards MARVIN's use were positive (+14%), with the remaining subconstructs exceeding the target (5/7). Facilitators included MARVIN's reliable and useful real-time information support, its easy accessibility, provision of convivial conversations, confidentiality, and perception as being emotionally safe. However, MARVIN's limited comprehension and the use of Facebook as an implementation platform were identified as barriers, along with the need for more conversation topics and new features (e.g., memorization). CONCLUSIONS: The study demonstrated MARVIN's global usability. Our findings show its potential for HIV self-management and provide direction for further development.