Let Us Just Ask People What They Think: Community Perceptions and Recommendations about Coronavirus Vaccination.

Introduction: Despite widespread efforts to promote coronavirus disease 2019 vaccination in the United States, a significant segment of the population is still unvaccinated or incompletely vaccinated. Objective: The objective of this study was to understand attitudes toward the vaccine in patients presenting to an urban emergency department. Methods: We used a qualitative analysis and semistructured interviews with a convenience sample of patients presenting to an urban emergency department from January 18, 2021, to March 14, 2021. Our final sample consisted of 32 people. Results: We found that people trusted their own medical providers rather than popular or political figures. Critiques of the vaccination program highlighted difficulties in navigation and perceptions of inequity. Conclusions: Equitable distribution strategies and honest messaging may facilitate acceptance of the coronavirus disease 2019 vaccine. Trustworthy sources for vaccine knowledge should be used to target populations in which vaccine hesitancy is a persistent concern.

Coming to Grips With Benign Prostate Enlargement or Prostate Cancer in Contemporary Japan: Readings From a Cancer-Self.

This article explores how a group of 35 Japanese men comprehend and verbalize the somatic experience embedded in dealing with benign prostate enlargement, or disquiet/discomfort of developing prostate cancer. Grounded in an adaptation of the sexual scripts theorizing, a set of in-depth, semistructured individual interviews were conducted through a LINE-app videocall from 2021 to 2023. Outcomes of interview were analyzed through a conversational approach, and presented by using three axes: the body, gender, and sexuality. An understanding of the Japanese-civilized-self has rendered somatic knowing problematic and pretended ignorance a strategy to deal with conversations about a condition involving the genitals and body waste. The body refers to a cancer-self who copes with ignorance of the prostate's anatomy and physiology, the-mechanics-of-urine, and medication/treatment side-effects. Gender is concerned with a cancer-self who grapples with an ailment that "emasculates the self," and the feminization of care as well as infantilization at medical facilities. Sexuality implies a cancer-self who bears scripts related to asexuality, medication/treatments that affect libido and penile erections, and a tarnished sexual reputation as a "heterosexual man" because prostate stimulation has been associate with homosexuality.

Women living with infertility in Iran: A qualitative content analysis of perception of dignity.

BACKGROUND: Globally, infertility is known as a major problem which can ruin a couple's relationship. In recent years, many studies have addressed the causes of infertility, the outcomes of treatments for infertility, and the effects of infertility on couples' mental health; however, the concept of dignity of women living with infertility has never been examined in depth. OBJECTIVE: This study aimed to explore the dignity of women living with infertility in Iran. DESIGN: This qualitative research was conducted via conventional content analysis approach. METHODS: This qualitative study was conducted in Iran from February to December 2022. In this research, the data were collected through face-to-face semi-structured in-depth interviews with 23 women living with infertility selected via purposive sampling. The interviews were continued until reaching the data saturation point. Data analysis was performed simultaneously with data collection. The interviews were recorded, transcribed, and analyzed through Graneheim and Lundman style content analysis, with data management done using the MAXQDA software. To achieve the accuracy and validity of the study, the four-dimension criteria by Lincoln and Guba, namely credibility, dependability, conformability, and transformability, were considered and used. RESULTS: Analysis of the qualitative data yielded three themes and eight subthemes. The three main themes were (1) overcoming identity crises (overcoming dysthymia, coping with unaccomplished motherhood), (2) respect for personal identity (respect for confidentiality; respect for beliefs, values, and attitudes; avoidance of stigma and pity), and (3) compassion-focused therapy (sympathizing, mental and spiritual support, and enhancement of life skills). CONCLUSION: Dignity of women living with infertility encompasses overcoming identity crises, respect for personal identity, and compassion therapy. The policymakers and administrators in the healthcare system can use the findings of this study to create a proper clinical environment toward preserving the dignity of women living with infertility.

The Lived Experience of Informal Caregivers of People Who Have Severe Mental Illness and Coexisting Long-Term Conditions: A Qualitative Study.

BACKGROUND: People with severe mental illness (SMI) experience higher rates and poorer outcomes of physical long-term conditions (LTCs). The management of SMI and LTCs is highly complex and many people with SMI rely on informal carers for support, which may lead to high levels of caregiver burden, and caregiver burnout. Caregiver burnout can result in poor health outcomes for informal carers and a reduction in the quality of care they are able to provide. Therefore, it is important to understand the caring experience to identify and address factors that contribute to burden and burnout. METHODS: This paper reports a secondary qualitative analysis of semistructured interviews and focus groups conducted with informal carers of people who have coexisting SMI and LTCs. We recruited 12 informal carers in England between December 2018 and April 2019. The transcripts were coded and analysed thematically. RESULTS: We identified two overarching themes and five subthemes. The themes included 'Fighting on all fronts: Mounting strain between demands and resources', which described the challenge of providing care in the context of coexisting SMI and LTCs, and 'Safekeeping: The necessity of chronic hypervigilance', which captured how informal carers' roles were defined by managing high-risk situations, leading to hypervigilance and paternalistic approaches to care. CONCLUSION: The experience of informal carers for people with SMI and coexisting LTCs is marked by limited access to support and the management of significant risk, which could contribute to high caregiver burden. Further primary research is needed to understand how the experiences of the caregiver role for people with SMI and LTCs influence caregiver burden. PATIENT OR PUBLIC CONTRIBUTION: Our PPI panel DIAMONDS Voice provided guidance on this study from conception, design and development of interview guides and recruitment materials to final write-up. DIAMONDS Voice consists of service users and carers who have experience of SMI and LTCs. Three carer members reviewed the final manuscript, and two are credited as authors.

Qualitative Exploration of Speech Pathologists' Experiences and Priorities for Aphasia Service Design: Initial Stage of an Experience-Based Co-Design Project to Improve Aphasia Services.

INTRODUCTION AND AIMS: Stroke survivors with aphasia (impaired language/communication) have poor outcomes and gaps in the clinical implementation of best practice contribute to this. Little is known, however, about speech pathologist perspectives on the touchpoints (key moments shaping experiences) in the clinical care pathway that have the greatest impact on service delivery nor how this varies by geographical location. We explored the experiences of speech pathologists who provide aphasia services to establish priorities for improvement and design. METHODS AND ANALYSIS: This is the initial experience gathering and priority identification stage of an experience-based co-design (EBCD) project. Speech pathologists were recruited from 21 geographically diverse Hospital and Health Services in Queensland, Australia. Speech pathologists working in acute, rehabilitation and community services shared positive and negative experiences of delivering aphasia care in interviews and focus groups. Experiential data were analysed using qualitative thematic analysis to determine touchpoints. Priorities for service design were identified using an adapted nominal group technique. RESULTS: Speech pathologists (n = 62) participated in 16 focus groups and nine interviews and shared 132 experiences of delivering aphasia care. Providing care in teams with poor awareness of the impacts of aphasia was identified as a key challenge, as poor patient-provider communication was perceived to increase risk of adverse outcomes for patients. Speech pathologists identified areas for improvement related to their own professional needs (e.g., greater access to clinical supervision); collaborative health care (e.g., better coordination and interdisciplinary care to increase therapy time); and the service context and environment (e.g., psychological services able to support diverse communication needs). CONCLUSIONS: Speech pathologist delivery of aphasia services could be improved through increased access to clinical supervision, opportunities for peer debriefing and interdisciplinary care. Priorities for service design varied by geographical location and included: education to support care transitions (remote areas), improved referral pathways and service linkage (regional areas) and dedicated aphasia staffing (metropolitan areas). PATIENT OR PUBLIC CONTRIBUTION: A consumer advisory committee comprising people with aphasia (n = 3, authors K.M., K.D. and B.A.), their significant others (n = 2, authors J.D. and P.M.), and a Cultural Capability Officer (author G.B.) guided this research. The team: (1) reviewed participant information; (2) co-designed surveys and workshop resources; (3) copresented research outcomes and contributed to publications. Research questions and study design (e.g., analysis methods and assessment measures) were developed by the research team (authors L.A., V.J.P., D.A.C. and S.J.W.).

Health Care Utilization and Care-seeking Behavior Among Vulnerabilized Sexual Minority Women: A Social-ecological Approach.

Sexual minority women (SMW) experience worse health than their heterosexual counterparts but have largely been omitted from health services research. To address this gap, we conducted 25 semi-structured, in-depth interviews with SMW. Transcripts were analyzed using thematic analysis, and findings were organized using a modified socioecological framework. Key themes at each socioecological level include (1) structural: stigma, sociocultural norms, health infrastructure; (2) organizational: stigma, patient-provider relationship, hours and location, linkage to care and co-location of services; (3) interpersonal: stigma and social support; (4) individual: internalized stigma, self-efficacy, socioeconomic status, health literacy, and intersecting identities. Stigma is the central theme affecting vulnerabilized SMW's experiences accessing care. Anti-stigma initiatives and factors that lead to personal resilience and can mitigate care access barriers were identified at each level. Interventions should focus on building inclusive policies/infrastructure and using SMW's unique social networks to empower and improve care access and health outcomes among vulnerabilized SMW.

Digital competence among pre-service teachers: A global perspective on curriculum change as viewed by experts from 33 countries.

In the intensely developing information society, the education of pre-service teachers presents an organisational, methodological, and conceptual challenge. Recent years have necessitated reflection on the content and modalities of the formation of digital competence in pre-service teachers. This article - considers which components the digital competences of the new generations of teachers should contain and how this area can be effectively developed within academic education. The article is the result of interviews conducted with 35 experts (recognized scholars in the field of media pedagogy) from North and South America, Africa, Australia and Oceania, Asia, and Europe. Qualitative interviews using the Delphi methodology were conducted between June and September 2022. Using grounded theory principles, it was noted that there is a need to modify pre-service teachers' curricula in the following areas: creating, retrieving and managing digital content; integrating ICT into subject content; developing soft skills; enhancing interactivity in the classroom; social aspects of ICT; distance learning; new socio-technical processes; advanced digital competencies; predictive learning; analysing the impact of ICT on human life; data protection; e-risks; low digital competencies; understanding media messaging; and supporting people with disabilities.

Challenges and opportunities for competency-based health professional education in Bangladesh: an interview, observation and mapping study.

BACKGROUND: Bangladesh has a shortfall of health professionals. The World Health Organization states that improving education will increase recruitment and retention of health workers. Traditional learning approaches, in medical education particularly, focus on didactic teaching, teaching of subjects and knowledge testing. These approaches have been superseded in some programmes, with a greater focus on active learning, integrated teaching and learning of knowledge, application, skills and attitudes or values and associated testing of competencies as educational outcomes. In addition, some regions do not have continuous professional development or clinical placements for health worker students, contributing to difficulties in retention of health workers. This study aims to explore the experiences of health professional education in Bangladesh, focusing on what is through observation of health professional education sessions and experiences of educators. METHODS: This mixed method study included 22 observations of teaching sessions in clinical and educational settings, detailed analysis of 8 national curricula documents mapped to Global Competency and Outcomes Framework for Universal Health Coverage and 15 interviews of professionals responsible for health education. An observational checklist was created based on previous literature which assessed training of within dimensions of basic clinical skills; diagnosis and management; professionalism; professional development; and effective communication. Interviews explored current practices within health education in Bangladesh, as well as barriers and facilitators to incorporating different approaches to learning. RESULTS: Observations revealed a variety of approaches and frameworks followed across institutions. Only one observation included all sub-competencies of the checklist. National curricula documents varied in their coverage of the Global Competency and Outcomes Framework domains. Three key themes were generated from a thematic analysis of interview transcripts: (1) education across the career span; (2) challenges for health professional education; (3) contextual factors and health professional education. Opportunities for progression and development post qualification are limited and certain professions are favoured over others. CONCLUSION: Traditional approaches seem to predominate but there is some enthusiasm for a more clinical focus to education and for more competency based approaches to teaching, learning and assessment.

"The genie is out of the bottle": a qualitative study on the impact of COVID-19 on continuing professional development.

BACKGROUND: The onset of the COVID-19 pandemic catalysed a monumental shift in the field of continuing professional development (CPD). Prior to this, the majority of CPD group-learning activities were offered in-person. However, the pandemic forced the field to quickly pivot towards more novel methods of learning and teaching in view of social distancing regulations. The purpose of this study was to obtain the perspectives of CPD leaders on the impact of the pandemic to elucidate trends, innovations, and potential future directions in the field. METHODS: Semi-structured interviews were conducted between April-September 2022 with 23 CPD leaders from Canada and the USA. Interviews were audio-recorded, transcribed, and de-identified. A thematic analysis approach was used to analyse the data and generate themes. RESULTS: Participants characterised COVID-19 as compelling widespread change in the field of CPD. From the interviews, researchers generated six themes pertaining to the impact of the pandemic on CPD: (1) necessity is the mother of innovation, (2) the paradox of flexibility and accessibility, (3) we're not going to unring the bell, (4) reimagining design and delivery, (5) creating an evaluative culture, and (6) a lifeline in times of turmoil. CONCLUSION: This qualitative study discusses the impact of the pandemic on the field of CPD and leaders' vision for the future. Despite innumerable challenges, the pandemic created opportunities to reform design and delivery. Our findings indicate a necessity to maintain an innovative culture to best support learners, to improve the healthcare system, and to prepare for future emergencies.

"Trying to write a story together": general practitioners' perspectives on culturally sensitive care.

BACKGROUND: Culturally sensitive care is integral to effective and equitable healthcare delivery, necessitating an understanding and acknowledgment of patients' cultural needs, preferences, and expectations. This study investigates the perceptions of cultural sensitivity among general practitioners (GPs), focusing on their intentions, willingness and perceived responsibilities in providing care tailored to cultural needs. METHODS: In-depth interviews were conducted with 21 Flemish GPs to explore their perspectives on culturally sensitive care. Data analysis followed a conventional qualitative content analysis approach within a constructivist framework. A coding scheme was developed to identify recurring themes and patterns in the GPs' responses. RESULTS: Findings reveal that culturally sensitive care provision is perceived as a multifaceted process, initiated by an exploration phase where GPs inquire about patients' cultural needs and preferences. Two pivotal factors shaping culturally sensitive care emerged: patients' specific cultural expectations and GPs' perceived responsibilities. These factors guided the process of culturally sensitive care towards three distinct outcomes, ranging from complete adaptation to patients' cultural requirements driven by a high sense of responsibility, through negotiation and compromise, to a paternalistic approach where GPs expect patients to conform to GPs' values and expectations. Three typologies of GPs in providing culturally sensitive care were identified: genuinely culturally sensitive, surface-level culturally sensitive, and those perceiving diversity as a threat. Stereotyping and othering persist in healthcare, underscoring the importance of critical consciousness and cultural reflexivity in providing patient-centered and equitable care. CONCLUSIONS: This study emphasizes the significance of empathy and underscores the necessity for GPs to embrace the exploration and acknowledgement of patients' preferences and cultural needs as integral aspects of their professional role. It highlights the importance of shared decision-making, critical consciousness, cultural desire and empathy. Understanding these nuances is essential for enhancing culturally sensitive care and mitigating healthcare disparities.

The Ottawa clinical fear of recurrence instruments: A screener, self-report, and clinical interview.

OBJECTIVE: Clinical fear of cancer recurrence (FCR) was recently defined by a group of experts during a Delphi study. Five criteria were agreed upon, namely: (a) high levels of preoccupation, (b) high levels of worry, (c) that are persistent, (d) hypervigilance and hypersensitivity to physical sensations that e) may result in functional impairment. No existing instruments comprehensively capture all these criteria for clinical FCR. METHODS: To remedy this gap, a set of three patient-reported outcome instruments including a one-item screener, self-report questionnaire, and semi-structured clinical interview, named the Ottawa Clinical Fear of Recurrence instruments, were developed. To do so, the research team first conducted a literature review of potential items. Additional FCR experts discussed the content of the screener and interview. The self-report's items were assessed for content validity by the same expert panel using Likert ratings and the Content Validity Index to narrow down the number of items. The three instruments were piloted with a group of cancer survivors to assess face validity following the European Organization for Research and Treatment of Cancer recommendations. RESULTS: The literature review and content validity assessment led to a final draft pre-pilot of 23 potential items for the self-report questionnaire. The instruments were piloted. Pilot study participants suggested changing wording and response options (particularly for the self-report) for greater clarity. CONCLUSIONS: Based on the feedback received, minor modifications were made, mostly for the self-report. In general, content and face validity for the three instruments were good for both experts and cancer survivors.

Equity in HIV/AIDS services requires optimization of mainstreaming sectors in Ethiopia.

BACKGROUND: Mainstreaming HIV and AIDS across sectors is crucial to close the disparities in service provision and coverage. However, evidence has shown that certain social groups are left behind in receiving HIV/AIDS services. The objective of this study was twofold: to understand the reasons behind the existing inequities and to explore challenges of equity in HIV/AIDS services in the Amhara region of Ethiopia. METHODS: Twenty-two adults (aged 26-57 years) from eighteen sectors that are mainstreaming HIV and AIDS were purposefully selected until the point of saturation and participated in a semi-structured in-depth interview conducted between January 20 and February 17, 2023. Interviewees were asked to describe their mainstreaming experiences in equitable HIV/AIDS services, reflect on the challenges and barriers that impede equitable service provision, or explain the reasons behind the existence of inequity in HIV/AIDS services. The interviews were audio recorded, transcribed, translated, and iteratively analysed, with early analysis informing subsequent interviews. An inductive-reflexive thematic analysis was conducted, whereby themes and subthemes were identified, and the relationships between subthemes and patterns were critically reviewed. RESULTS: The challenges to equitable HIV/AIDS service provision were grouped into eight thematic areas: (1) changing contexts that shifts public and government attention to emerging diseases, war and political instability, and poverty; (2) leadership-related, such as the lack of supervision and monitoring, not politicising HIV/AIDS (not providing political attention to HIV/AIDS) and weak intersectoral collaboration; (3) financial constraints due to a random budgeting and contract interruption with non-governmental organisations (NGOs); (4) lack of resources due to scarcity and unfair distribution; (5) inadequate skilled personnel due to inadequate numbers and lack of continuous professional and career development; (6) lack of equity-related evidence-based tools and guidelines; (7) inadequate understanding of equity due to lack of training and misunderstanding, and lack of access to equity-oriented tools and guidelines; and (8) cultural norms, values, and perceptions. CONCLUSIONS: This study identified critical challenges faced in the equitable HIV/AIDS services provision. To achieve equity in HIV/AIDS services, mainstreaming sectors need to invest in mechanisms to sustain services in emergency situations; identify effective leaders to maintain collaboration, monitoring, and evaluation; institutionalise responsive budgeting and establish alternative funds to maintain non-governmental organisations initiatives; provide continuous up-to-date training and create a common evidence-sharing platform; implement proper recruitment, education, and professional development of HIV/AIDS focal persons; and promote and practice culturally safe care. It is, therefore, essential to optimise sectors that are mainstreaming HIV/AIDS and incorporate equity considerations in their strategic plans and working guidelines.

What aspects of health and wellbeing are most important to parent carers of children with disabilities?

INTRODUCTION: Parent carers of children with special educational needs or disabilities are at risk of poorer health and wellbeing outcomes because of the distinct and challenging circumstances they face. Evaluations of interventions promoting the health of parent carers should focus on measuring the aspects of health and wellbeing which are most relevant to this group. As part of a programme of research on parent carer-focused interventions, this study aimed to understand which aspects of health and wellbeing are perceived by parent carers as most meaningful and important. METHODS: A qualitative study using semistructured online interviews was conducted. A purposive sample of parent carers was interviewed about relevant health and wellbeing outcomes. Transcripts were analysed thematically. RESULTS: Thirty parent carers were interviewed, 19 of whom had experienced a health-promoting intervention, either as participants (n = 14) or facilitators (n = 5). Three main themes were identified: 'self, identity and beliefs'; 'social connections and support' and 'health-promoting practices and outcomes.' Each theme encompassed the challenges participants faced, and the changes that helped them overcome these challenges. 'Self-identity' challenges focused on the overwhelming nature of the parental care role and the emotional impact of this. Changes were brought about by developing a positive mindset, increasing confidence, and reconnecting with aspects of their identity which were important to them before they became parent carers. Challenges related to 'social connections' reflected parent carers' isolation. Change was brought about through increased peer support and peer interactions. Parent carers experienced challenges in terms of 'health-promoting activities' because they lacked free time and experienced poor physical health. Changes were brought about by engagement in health-promoting activities of various kinds. CONCLUSION: Parent carers view health and wellbeing in terms of overcoming the common challenges they face as a group. These challenges reflect the ways in which their physiological and psychological needs are often unmet. Researchers interested in measuring parent carer health and wellbeing should consider the specific challenges this group face, as well as theoretical frameworks which can make sense of these challenges, such as self-determination theory. PATIENT OR PUBLIC CONTRIBUTION: Our team carries out patient and public involvement (PPI) through a Family Faculty group facilitated by a Family Involvement Co-ordinator (A. McD.) who is herself a parent carer. A study-specific PPI working group was established which included members of the Family Faculty. The PPI group advised on various aspects of the research as reported in the paper. The manuscript was co-authored by the team's Family Involvement Co-ordinator (A. McD.).

Treatment trajectories of individuals diagnosed with rectal cancer: an interpretative phenomenological study.

Rectal cancer affects almost every aspect of an individual's daily life. However, there are gaps in understanding the complete spectrum of experiences spanning from diagnosis to recovery. Therefore, the aim of this study was to explore the treatment trajectories of individuals diagnosed with rectal cancer. Adopting an interpretative phenomenological approach, seven participants were recruited using purposive sampling. Data were collected using semi-structured, in-depth interviews that were digitally recorded, transcribed and analysed using thematic analysis. Study rigour was established following the four-dimension criteria of credibility, dependability, transferability and confirmability. Four prominent themes emerged from the participants' experiences of undergoing rectal cancer treatment: uncovering the inner battles; navigating the physical challenges; anchors of support and conquering the summit. These findings contribute to knowledge and practice by highlighting the importance of providing a comprehensive and individualised treatment plan for individuals that takes account of the physical and psycho-emotional implications of rectal cancer treatment.

Sources of stress and coping strategies among Chinese medical graduate students: a qualitative study.

BACKGROUND: The incidence of mental health problems among medical graduate students is much higher than among students of other disciplines. This can have adverse consequences for the medical students themselves as well as their future patients. This study aims to understand the pressures faced by Chinese medical students and the current status of mental health education. It also propose recommendations for the current situation and prospects for the future. METHOD: The authors conducted in-depth semi-structured interviews with 22 master's students from five medical schools during November 2023. All interview sessions were recorded and transcribed verbatim. The transcriptions were analyzed using the Colaizzi's seven-step method. RESULT: Three main themes were extracted from the students' statements: sources of psychological stress, ways to cope with stress, and perspectives on mental health education. The study showed that current mental health education in China is mostly in the form of printed mental health education manuals and mental health lectures, and there is no active tiered intervention for students at different levels. It is suggested that reforms should be made to shift to a model where the school proactively identifies problems and intervenes based on feedback. CONCLUSION: This study reveals the widespread psychological stress and shortcomings in current education methods. To address these challenges, institutions should develop tailored interventions, including tiered support systems, open dialogue promotion, and resilience training. Future research should focus on evaluating innovative interventions' effectiveness, ultimately fostering a supportive environment that enhances students' success and contributes to a healthier healthcare workforce.

Voices of care: unveiling patient journeys in primary care for hypertension and diabetes management in Kerala, India.

Background: Diabetes and hypertension are leading public health problems, particularly affecting low- and middle-income countries, with considerable variations in the care continuum between different age, socio-economic, and rural and urban groups. In this qualitative study, examining the factors affecting access to healthcare in Kerala, we aim to explore the healthcare-seeking pathways of people living with diabetes and hypertension. Methods: We conducted 20 semi-structured interviews and one focus group discussion (FGD) on a purposive sample of people living with diabetes and hypertension. Participants were recruited at four primary care facilities in Malappuram district of Kerala. Interviews were transcribed and analyzed deductively and inductively using thematic analysis underpinned by Levesque et al.'s framework. Results: The patient journey in managing diabetes and hypertension is complex, involving multiple entry and exit points within the healthcare system. Patients did not perceive Primary Health Centres (PHCs) as their initial points of access to healthcare, despite recognizing their value for specific services. Numerous social, cultural, economic, and health system determinants underpinned access to healthcare. These included limited patient knowledge of their condition, self-medication practices, lack of trust/support, high out-of-pocket expenditure, unavailability of medicines, physical distance to health facilities, and attitude of healthcare providers. Conclusion: The study underscores the need to improve access to timely diagnosis, treatment, and ongoing care for diabetes and hypertension at the lower level of the healthcare system. Currently, primary healthcare services do not align with the "felt needs" of the community. Practical recommendations to address the social, cultural, economic, and health system determinants include enabling and empowering people with diabetes and hypertension and their families to engage in self-management, improving existing health information systems, ensuring the availability of diagnostics and first-line drug therapy for diabetes and hypertension, and encouraging the use of single-pill combination (SPC) medications to reduce pill burden. Ensuring equitable access to drugs may improve hypertension and diabetes control in most disadvantaged groups. Furthermore, a more comprehensive approach to healthcare policy that recognizes the interconnectedness of non-communicable diseases (NCDs) and their social determinants is essential.

Vaccine communication strategies among healthcare workers as a reflection of the Israeli Ministry of Health's communication strategies before and after the COVID-19 pandemic.

Background: Healthcare workers play a central role in communicating information to the public regarding vaccines. Most of the literature has focused on healthcare workers' hesitancy and doubts about getting the flu vaccine themselves. However, few studies have dealt with how they perceive their role in communicating information regarding vaccines, especially following the COVID-19 pandemic. Objectives: (1) To identify the communication strategies used by the Israeli Ministry of Health regarding vaccines during epidemic crises (before and after the COVID-19 pandemic); (2) To identify the communication strategies used by healthcare workers regarding vaccines before and after the COVID-19 pandemic. Methods: A qualitative study based on in-depth interviews was conducted among healthcare workers and used a semi-structured protocol as a research tool. A total of 18 healthcare workers were sampled using purposeful and snowball sampling. Results: Despite healthcare workers' perception that there has been a decrease in trust in the Israeli Ministry of Health among the public following the COVID-19 outbreak, they still rely on the Israeli Ministry of Health as their primary source of information and use the same communication strategies (such as fear appeals and correcting information) as of the Israeli Ministry of Health to communicate with the public, healthcare providers, and other relevant stakeholders. Conclusion: Healthcare workers have been shaped by the professional socialization processes within the health system, leading to a predominant reliance on established communication strategies and informational channels. This reliance underscores the importance of evolving these methods to better engage with the public. To address this, there is a compelling need to innovate and adopt new communication techniques that emphasize effective dialogue and transparent interactions. By doing so, healthcare professionals can ensure that their outreach is not only informative but also responsive to the diverse needs and preferences of the community.

Yoga and meditation for menopausal symptoms in breast cancer survivors: a qualitative study exploring participants' experiences.

PURPOSE: Breast cancer survivors commonly experience menopausal symptoms, specifically when undergoing antihormonal therapy. Unfortunately, they often have a restricted range of treatment options available to alleviate menopausal symptoms. The objective of this qualitative study was to explore breast cancer survivors' experiences and effects of a yoga and meditation intervention supplementing previously reported RCT outcomes. METHODS: The qualitative data included in this study were part of a larger randomized controlled trial which evaluated the efficacy and safety of a 12-week yoga and meditation intervention on menopausal symptoms in breast cancer survivors. All participants who underwent the yoga intervention (n = 19) were invited to take part in semi-structured interviews after all quantitative data collection had been completed. Interviews (n = 9) were recorded, transcribed, and then coded into superordinate themes using thematic analysis. RESULTS: Nine female participants were interviewed, and the following themes emerged: (1) representations and expectations from the yoga intervention; (2) course structure and implementation; (3) perceptions and effects of the intervention (at emotional, physical, behavioral, and spiritual level); (4) differences between the study yoga intervention and other physical activities. CONCLUSIONS: In accordance with the accounts of participants, yoga might offer a promising intervention for breast cancer survivors. All those interviewed either currently attended a yoga class or expressed a desire to continue practicing yoga. Additionally, our findings inform future studies regarding aspects such as the importance of extending outcome measures beyond specific cancer-related complains, the advantages of addressing homogenous groups (i.e., breast cancer specific), or considering that different intervention components might need different assistance to encourage long-term use.

How early clinical experiences in rural communities influence student learning about rural generalism considered through the lens of educational theory.

Introduction: Rural communities have poorer health compared to urban populations due partly to having lesser healthcare access. Rural placements during medical education can equip students with the knowledge and skills to work in rural communities, and, it is hoped, increase the supply of rural physicians. It is unclear how students gain knowledge of rural generalism during placements, and how this can be understood in terms of place-based and/or sociocultural educational theories. To gain insight into these questions we considered the experiences of pre-clerkship medical students who completed two mandatory four-week rural placements during their second year of medical school. Methods: Data was collected using semi-structured interviews or focus groups, followed by thematic analysis of the interview transcripts. Results: Rural placements allowed students to learn about rural generalism such as breadth of practice, and boundary issues. This occurred mainly by students interacting with rural physician faculty, with the effectiveness of precepting being key to students acquiring knowledge and skills and reporting a positive regard for the placement experience. Discussion: Our data show the central role of generalist physician preceptors in how and what students learn while participating in rural placements. Sociocultural learning theory best explains student learning, while place-based education theory helps inform the curriculum. Effective training and preparation of preceptors is likely key to positive student placement experiences.

Introduction: Les communautés rurales sont en moins bonne santé que les populations urbaines, en partie parce qu'elles ont moins accès aux soins de santé. Les stages de médecine en milieu rural peuvent permettre aux étudiants d'acquérir les connaissances et les compétences nécessaires pour travailler dans les communautés rurales et, on l'espère, augmenter le nombre de médecins y travaillent. On ne sait pas clairement comment les étudiants acquièrent des connaissances sur le généralisme rural au cours de leurs stages, et comment cela peut être compris en termes de théories éducatives socioculturelles et/ou basées sur le lieu de travail. Pour répondre à ces questions, nous avons étudié les expériences d'étudiants en médecine au pré-clinique qui ont effectué deux stages obligatoires de quatre semaines en milieu rural au cours de leur deuxième année d'études de médecine. Méthodes: Les données ont été recueillies au moyen d'entrevues semi-structurées ou de groupes de discussion, suivis d'une analyse thématique des transcriptions des entrevues. Résultats: Les stages en milieu rural ont permis aux étudiants de se familiariser avec le généralisme rural, notamment l'étendue de la pratique et les questions de limites. L'efficacité du préceptorat est essentielle pour que les étudiants acquièrent des connaissances et des compétences et qu'ils aient une expérience de stage positive. Discussion: Nos données témoignent du rôle central que jouent les médecins généralistes précepteurs quant au contenu et modes d'apprentissage des étudiants lorsqu'ils participent à des stages en milieu rural. La théorie de l'apprentissage socioculturel est celle qui explique le mieux l'apprentissage des étudiants, tandis que la théorie de la formation fondée sur le lieu contribue à orienter le programme d'études. Une formation et préparation efficace des précepteurs est probablement la clé d'une expérience de stage positive pour les étudiants.

Understanding the perspective of community co-educators on community-based service learning: a qualitative analysis.

Background: Community-based service learning (CBSL) is a core component of the Canadian medical education system. However, the unique role of community partner organizations (CPOs) in supporting CBSL remains unclear. This qualitative study evaluates the perspective of CPOs as co-educators in the undergraduate medical curriculum. Methods: We conducted eight semi-structured, one-on-one interviews with CPOs at a medical school in Toronto, Ontario between 2020-2021. Interviews were conducted following a pre-determined interview guide and then recorded, de-identified, and transcribed. Three reviewers independently performed an inductive thematic analysis of codes followed by a group review of discrepancies. Results: Five main findings were identified: 1) CPOs share a common interest in serving as co-educators; 2) considerable heterogeneity in the understanding of co-education exists; 3) there is an opportunity for increased partnerships between CPOs and faculty; 4) the role of co-educators is limited by curriculum structure; and 5) co-educators facilitate unique teachings of social determinants of health otherwise not available through traditional didactic teaching. Conclusions: There is an emerging, unique role for community co-educators in the undergraduate medical curriculum, supported by interest from CPOs. Its emphasis may contribute to future cohorts of medical students capable of understanding and addressing the needs of the populations they serve.

Contexte: L'apprentissage par le service communautaire (APSC) est une composante essentielle du système d'éducation médicale canadien. Cependant, le rôle unique des organismes communautaires partenaires (OCP) dans le soutien de l'APSC n'est toujours pas clair. Cette étude qualitative évalue le point de vue des OCP en tant que co-éducateurs dans le programme d'études médicales de premier cycle. Méthodes: Nous avons mené huit entrevues individuelles semi-structurées avec des OCP d'une faculté de médecine de Toronto, en Ontario, entre 2020 et 2021. Les entrevues ont été menées en suivant un guide d'entrevue prédéterminé, puis enregistrées, dépersonnalisées et transcrites. Trois examinateurs ont effectué indépendamment une analyse thématique inductive des codes, suivie d'un examen collectif des divergences. Résultats: Cinq conclusions principales ont été identifiées : 1) les OCP ont un intérêt commun à agir en tant que co-éducateurs; 2) il existe une grande hétérogénéité dans la compréhension de la co-éducation; 3) il est possible d'accroître les partenariats entre les OCP et le corps professoral; 4) le rôle des co-éducateurs est limité par la structure du curriculum médical et 5) les co-éducateurs facilitent des opportunités d'apprentissage uniques sur les déterminants sociaux de la santé qui ne sont pas disponibles dans le cadre de l'enseignement didactique traditionnel. Conclusions: Les co-éducateurs communautaires jouent un rôle novateur et unique dans le programme d'études médicales de premier cycle, soutenu par l'intérêt des OCP. L'accent mis sur ce rôle peut contribuer à former de futures cohortes d'étudiants en médecine capables de comprendre et de répondre aux besoins des populations qu'ils servent.