Kidney Transplant Clinicians' Perceptions of Palliative Care for Patients With Failing Allografts in the US: A Mixed Methods Study.

RATIONALE & OBJECTIVE: Kidney transplant patients with failing allografts have a physical and psychological symptom burden as well as high morbidity and mortality. Palliative care is underutilized in this vulnerable population. We described kidney transplant clinicians' perceptions of palliative care to delineate their perceived barriers to and facilitators of providing palliative care to this population. STUDY DESIGN: National explanatory sequential mixed methods study including an online survey and semistructured interviews. SETTING & PARTICIPANTS: Kidney transplant clinicians in the United States surveyed and interviewed from October 2021 to March 2022. ANALYTICAL APPROACH: Descriptive summary of survey responses, thematic analysis of qualitative interviews, and mixed methods integration of data. RESULTS: A total of 149 clinicians completed the survey, and 19 completed the subsequent interviews. Over 90% of respondents agreed that palliative care can be helpful for patients with a failing kidney allograft. However, 46% of respondents disagreed that all patients with failing allografts benefit from palliative care, and two-thirds thought that patients would not want serious illness conversations. More than 90% of clinicians expressed concern that transplant patients and caregivers would feel scared or anxious if offered palliative care. The interviews identified three main themes: (1) transplant clinicians' unique sense of personal and professional responsibility was a barrier to palliative care engagement, (2) clinicians' uncertainty regarding the timing of palliative care collaboration would lead to delayed referral, and (3) clinicians felt challenged by factors related to patients' cultural backgrounds and identities, such as language differences. Many comments reflected an unfamiliarity with the broad scope of palliative care beyond end-of-life care. LIMITATIONS: Potential selection bias. CONCLUSIONS: Our study suggests that multiple barriers related to patients, clinicians, health systems, and health policies may pose challenges to the delivery of palliative care for patients with failing kidney transplants. This study illustrates the urgent need for ongoing efforts to optimize palliative care delivery models dedicated to kidney transplant patients, their families, and the clinicians who serve them. PLAIN-LANGUAGE SUMMARY: Kidney transplant patients experience physical and psychological suffering in the context of their illnesses that may be amenable to palliative care. However, palliative care is often underutilized in this population. In this mixed-methods study, we surveyed 149 clinicians across the United States, and 19 of them completed semistructured interviews. Our study results demonstrate that several patient, clinician, system, and policy factors need to be addressed to improve palliative care delivery to this vulnerable population.

Shared decision-making needs, barriers, and facilitators of patients with newly diagnosed advanced cancer in the hospital: a multi-level, mixed-methods study.

PURPOSE: Little is known about the shared decision-making (SDM) needs, barriers, and facilitators of patients with newly diagnosed advanced cancer in the hospital. Understanding this may improve SDM and cancer care quality in this vulnerable population. METHODS: A single-site, mixed-methods study of hospitalized patients with newly diagnosed advanced cancer, caregivers, and oncologists was conducted. After discharge, patient ± caregiver semi-structured interviews exploring SDM needs, barriers, and facilitators regarding their most important upcoming cancer-related decision were conducted. Oncologists were surveyed about patient knowledge and SDM needs using closed- and open-ended questions, respectively. Thematic analysis was performed for qualitative data with a focus on themes unique to or amplified by hospitalization. Descriptive statistics and the Chi-squared test were performed for quantitative data. RESULTS: Patients and caregivers reported high SDM needs surrounding treatment and prognostic information, leading to decisional conflict. Eight themes emerged: anticipated cancer treatment decisions, variable control preferences in decision-making, high cancer-related information needs and uncertainty, barriers and facilitators to information gathering during and post hospitalization, and decision-making facilitators. Among 32 oncologists, most (56%) reported patients were poorly informed about treatment and prognosis. Oncologists reported variable expectations about patient knowledge after hospitalization, facilitators to patient decision-making, and patient uncertainty while awaiting an outpatient oncologist appointment. CONCLUSION: Patients newly diagnosed with advanced cancer in the hospital have high SDM needs and experience decisional conflict. This may be due to barriers unique to or exacerbated by hospitalization. Further research is needed to develop strategies to address these barriers and enhance the facilitators identified in this study.

Experts' perceptions on motivators and barriers of healthy and sustainable dietary behaviors among adolescents: The SWITCH project.

The interplay of influences shaping dietary behaviors of adolescents needs to be well-understood to develop effective strategies stimulating healthy and sustainable behaviors. This study aimed to identify the most relevant, urgent, changeable and effective motivators and barriers of healthy and sustainable dietary behaviors among adolescents (10-19 years), as perceived by an inter- and transdisciplinary expert panel. Experts working in practice (N = 19) and academia (N = 13) - in the field of sustainability, health, nutrition and/or education - participated in this exploratory mixed-methods study. Five online semi-structured focus groups were conducted (6-7 participants). Data was thematically analyzed by two coders independently, using the socioecological framework. Subsequently, the same experts individually selected the five most relevant determinants and rated those on their urgency, changeability and effectiveness through an online questionnaire (N = 21). Participants revealed a wide system of 31 main determinants including 173 sub-determinants that motivate or hinder healthy and sustainable eating among adolescents. This system of determinants was mapped on the different layers of the socioecological model: individual factors (25 motivators; 30 barriers), social environments (15 motivators; 13 barriers), physical environments (18 motivators; 15 barriers), macro-level environments (19 motivators; 38 barriers). 'Role of peers' (social environment) was selected most as a determinant to be targeted in interventions (N = 13; urgency (M = 6.38) changeability (M = 3.85), effectiveness (M = 5.62)), followed by 'food environment around school' (N = 9; urgency (M = 5.78) changeability (M = 3.44), effectiveness (M = 5.44)), 'social influences' (N = 7; urgency (M = 5.43) changeability (M = 4.00), effectiveness (M = 5.71)), 'autonomy in development' (N = 7; urgency (M = 6.00) changeability (M = 4.29), effectiveness (M = 5.86)) and 'food availability' (N = 7; urgency (M = 6.29) changeability (M = 3.29), effectiveness (M = 6.29)). The prioritized determinants indicate that adolescents should be provided more supportive social and physical environments that promote healthy and sustainable dietary behaviors, taking into account their growing autonomy.

A comprehensive interventional program to improve the sexual function of women with endometriosis: a mixed-methods protocol study.

BACKGROUND: Endometriosis is a chronic disease affecting 6-10% of women worldwide. Sexual dysfunction has been reported in a significant percentage of these patients. Thus, the present study will be conducted to design, implement, and determine the effectiveness of an interventional program to improve the sexual function of women with endometriosis. MATERIALS AND METHODS: This mixed-methods study will be carried out in three phases with a sequential exploratory approach. In the first phase (qualitative study) participants will be selected by purposive sampling in Isfahan, Iran. The data will be collected through in-depth interviews and field notes and analyzed using conventional content analysis. The interventional program will be designed in the second phase based on the results of the qualitative study and literature review and using the Delphi method and panel of experts. The interventional program will be implemented at the individual level in the third phase to investigate its effect on improving women's sexual function. This phase includes quasi-experimental research, in which the pre- and post-intervention data will be collected from the intervention and control groups using the FSFI questionnaire and analyzed by descriptive and inferential statistical methods. Ultimately, a suitable interventional program will be presented by combining the data obtained in the qualitative and quantitative phases of the research. CONCLUSION: Conducting the present study, along with the design and implementation of an appropriate, native, and culturally sensitive interventional program, can contribute to improving the sexual function of women with endometriosis and enhancing the quality of sexual relations between couples.

Endometriosis is a chronic disease in women of reproductive age. The negative impact of endometriosis on intimate relationships and sexual function has been reported in a significant number of women with this disease. The results of this study offer a rich source of information for the required interventions to promote the sexual and reproductive health of women with endometriosis. This study is a sequential exploratory (qualitative­quantitative) mixed methods design that consists of three consecutive phases. In this study, following a qualitative approach, the researchers will explain the experiences of women with endometriosis of sexual function and the appropriate strategies to improve the sexual function of these women. In the second phase, the researcher will design an appropriate interventional program for to improving the sexual function of women with endometriosis by using the results of the qualitative phase and literature reviews. The purposed interventional program is designed using the Delphi method and panel of experts and will be finalized for execution. In the third stage, the effectiveness of interventional program on the sexual function of women with endometriosis will be investigated in a quasi-experimental study. Therefore, it is expected that conducting a mixed method study by presenting an interventional culturally sensitive program can contribute to improving the sexual function of women with endometriosis and enhancing the quality of sexual relations between couples.

eHealth Literacy and Web-Based Health Information-Seeking Behaviors on COVID-19 in Japan: Internet-Based Mixed Methods Study.

BACKGROUND: During the COVID-19 pandemic, much misinformation and disinformation emerged and spread rapidly via the internet, posing a severe public health challenge. While the need for eHealth literacy (eHL) has been emphasized, few studies have compared the difficulties involved in seeking and using COVID-19 information between adult internet users with low or high eHL. OBJECTIVE: This study examines the association between eHL and web-based health information-seeking behaviors among adult Japanese internet users. Moreover, this study qualitatively shed light on the difficulties encountered in seeking and using this information and examined its relationship with eHL. METHODS: This cross-sectional internet-based survey (October 2021) collected data from 6000 adult internet users who were equally divided into sample groups by gender, age, and income. We used the Japanese version of the eHL Scale (eHEALS). We also used a Digital Health Literacy Instrument (DHLI) adapted to the COVID-19 pandemic to assess eHL after we translated it to Japanese. Web-based health information-seeking behaviors were assessed by using a 10-item list of web sources and evaluating 10 topics participants searched for regarding COVID-19. Sociodemographic and other factors (eg, health-related behavior) were selected as covariates. Furthermore, we qualitatively explored the difficulties in information seeking and using. The descriptive contents of the responses regarding difficulties in seeking and using COVID-19 information were analyzed using an inductive qualitative content analysis approach. RESULTS: Participants with high eHEALS and DHLI scores on information searching, adding self-generated information, evaluating reliability, determining relevance, and operational skills were more likely to use all web sources of information about COVID-19 than those with low scores. However, there were negative associations between navigation skills and privacy protection scores when using several information sources, such as YouTube (Google LLC), to search for COVID-19 information. While half of the participants reported no difficulty seeking and using COVID-19 information, participants who reported any difficulties, including information discernment, incomprehensible information, information overload, and disinformation, had lower DHLI score. Participants expressed significant concerns regarding "information quality and credibility," "abundance and shortage of relevant information," "public trust and skepticism," and "credibility of COVID-19-related information." Additionally, they disclosed more specific concerns, including "privacy and security concerns," "information retrieval challenges," "anxieties and panic," and "movement restriction." CONCLUSIONS: Although Japanese internet users with higher eHEALS and total DHLI scores were more actively using various web sources for COVID-19 information, those with high navigation skills and privacy protection used web-based information about COVID-19 cautiously compared with those with lower proficiency. The study also highlighted an increased need for information discernment when using social networking sites in the "Health 2.0" era. The identified categories and themes from the qualitative content analysis, such as "information quality and credibility," suggest a framework for addressing the myriad challenges anticipated in future infodemics.

Experts' perspectives on how to promote implicit and explicit motor learning in children: A mixed-methods study.

BACKGROUND: Little is known about how motor learning strategies (MLSs) can promote implicit and explicit motor learning processes. This study aimed to explore experts' perspectives on therapists' use of MLSs to promote specific learning processes in children with and without developmental coordination disorder (DCD). METHODS: In this mixed-methods study, two consecutive digital questionnaires were used to ascertain the opinions of international experts. Questionnaire 2 explored the findings of Questionnaire 1 in greater depth. In order to reach a certain level of agreement about the classification of MLSs as promoting either (more) implicit or (more) explicit motor learning, 5-point Likert scales were used in addition to open-ended questions. The open-ended questions were analysed with a conventional analysis approach. Open coding was performed by two reviewers independently. Categories and themes were discussed within the research team, taking both questionnaires as one dataset. RESULTS: Twenty-nine experts from nine different countries with different backgrounds in research, education and/or clinical care completed the questionnaires. The results of the Likert scales showed large variation. Two themes emerged from the qualitative analyses: (1) Experts found it difficult to classify MLSs as promoting either implicit or explicit motor learning, and (2) experts stressed the need for clinical decisionmaking when choosing MLSs. CONCLUSIONS: Insufficient insight was gained into how MLSs could promote (more) implicit or (more) explicit motor learning in children in general and in children with DCD specifically. But this study demonstrated the importance of clinical decisionmaking to model and adapt MLSs to child, task and environment, with therapists' knowledge of MLSs being an important prerequisite. Research is needed to better understand the various learning mechanisms of children and how MLSs can be used to manipulate these mechanisms.

Physiotherapists' moral distress: Mixed-method study reveals new insights.

BACKGROUND: Moral distress is a well-recognized term for emotional, cognitive, and physical reactions of  professionals, when facing conflicts between perceived obligations and institutional constraints. Though studied across medical roles, limited research exists among physiotherapists. RESEARCH QUESTION: What factors contribute to Moral distress among physiotherapists and how do they cope? OBJECTIVES: To develop and test a multifaceted model of Moral distress and gain an in-depth understanding of the phenomena. RESEARCH DESIGN: A 2017-2022 mixed-methods study: (1) Survey of 407 physiotherapists quantitatively testing a literature-based model analyzing relationships between Moral distress, Moral sensitivity, Locus of control, Self-efficacy, Ethical climate perceptions and demographics, analyzed by descriptive and inferential statistics, multiple comparisons and structural equation modelling (SPSS26, SAS, AMOS); (2) Semi-structured interviews with 21 physiotherapists examining Moral distress experiences using meticulous phenomenological analysis. PARTICIPANTS AND CONTEXT: Israeli physiotherapists from various occupational settings recruited via professional networks. ETHICAL CONSIDERATIONS: The Haifa University Ethics Committee authorized the study. Informed consent was obtained for the anonymous survey and before interviews regarding recording, and quote use. FINDINGS: Quantitative results showed moderately high average Moral distress, significantly higher among women and paediatric physiotherapists, positively correlating with Moral sensitivity. Qualitative findings revealed intense emotions around Moral distress experiences, inner conflicts between care ideals and constraints, and coping strategies like reflective skills. Senior therapists, despite higher self-efficacy and moral sensitivity, still reported persistent high distress. DISCUSSION: Moral distress has complex links with moral sensitivity, self-efficacy, perceived professional autonomy and organizational support. A renewed framework emerged explaining relations between moral distress and personal, professional and organizational factors. CONCLUSIONS: Multidimensional insights help identify Moral distress causes and coping strategies among physiotherapists, advancing theory. Conclusions can shape ethics training programs and competencies.

The Sexual Grooming Behaviors of Youth Who Engage in Harmful Sexual Behaviors.

Little is known about the extent to which youths who commit harmful sexual behaviors (HSBs) against another minor utilize sexual grooming during the offense process. This study examined sexual grooming behaviors reported by adults (n = 250) who experienced HSBs by another minor during their childhood. Participants completed a self-report survey which included the Sexual Grooming Scale - Victim Version (SGS-V). The results showed that most participants (n = 242; 96.9%) reported at least one sexual grooming behavior, with an average of 11.3 behaviors reported. These findings will be discussed as they pertain to the identification and prevention of HSBs among youth.

Identifying meaningful subpopulation segments among older public assistance recipients: a mixed methods study to develop tailor-made health and welfare interventions.

BACKGROUND: Public assistance recipients have diverse and complex needs for health and social support in addition to financial support. Segmentation, which means dividing the population into subgroups (segments) with similar sociodemographic characteristics, is a useful approach for allocating support resources to the targeted segments. Clustering is a commonly used statistical method of segmentation in a data-driven marketing approach. This explanatory sequential mixed methods study applied a clustering technique, aiming to identify segments among older public assistance recipients quantitatively, and assess the meaningfulness of the identified segments in consultation and support activities for older recipients qualitatively. METHODS: We identified the segments of older recipients in two municipalities using probabilistic latent semantic analysis, a machine learning-based soft clustering method. Semi-structured interviews were subsequently conducted with caseworkers to ask whether the identified segments could be meaningful for them in practice and to provide a reason if they could not think of any older recipients from the segment. RESULTS: A total of 3,165 older people on public assistance were included in the analysis. Five distinct segments of older recipients were identified for each sex from 1,483 men and 1,682 women. The qualitative findings suggested most of identified segments reflected older recipients in practice, especially two of them: female Cluster 1 (facility residents aged over 85 years with disability/psychiatric disorder), and female Cluster 2 (workers). Some caseworkers, however, did not recall older recipients in practice when working with certain segments. CONCLUSIONS: A clustering technique can be useful to identify the meaningful segments among older recipients and can potentially discover previously unrecognized segments that may not emerge through regular consultation practices followed by caseworkers. Future research should investigate whether tailored support interventions for these identified segments are effective.

Barriers to early diagnosis of cervical cancer: a mixed-method study in Côte d'Ivoire, West Africa.

BACKGROUND: Cervical cancer, a major public health problem in many developing countries, is usually associated with a poor survival related to an advanced disease at diagnosis. In Côte d'Ivoire and other developing countries with high cervical cancer prevalence, little is known about factors associated with advanced cervical cancer stages in a context of limited access to screening services. METHODS: From May to July 2019, we conducted a cross-sectional study using a mixed, quantitative and qualitative method. Information on socio-demographic and history of the disease was extracted from a rapid case ascertainement study performed by the cancer registry of Côte d'Ivoire that enrolled all women diagnosed with cervical cancer between July 2018 and June 2019. In-depth semi-structured interviews were conducted among a subset of these women (12 women) and six healthcare providers to further capture barriers to early cervical cancer diagnosis. Factors associated with an advanced stage III, IV (according to FIGO classification) were estimated by a logistic regression model. Qualitative data were analyzed using a thematic analysis technique guided by the treatment pathway model and triangulated with quantitative data. RESULTS: In total, 95 women with cervical cancer [median age = 51 (IQR 42-59)] years, were included. Among them, 18.9% were living with HIV and only 9.5% were covered by a health insurance. The majority (71.5%) were diagnosed with advanced cervical cancer. Being HIV-uninfected (aOR = 5.4; [1.6-17.8], p = 0.006) and being uninsured (aOR = 13.1; [2.0-85.5], p = 0.007) were independently associated with advanced cervical cancer in multivariable analysis. Qualitative data raised additional factors potentially related to advanced cervical cancer stages at diagnosis, including the lack of patient information on cervical cancer by healthcare providers and inadequate national awareness and screening campaigns. CONCLUSION: In a context of challenges in access to systematic cervical cancer screening in Côte d'Ivoire, access to health insurance or integrated healthcare program appear to be key determinants of early diagnosis of cervical cancer.

Prolonged facemask wearing among hospital workers and dry eye - a mixed-methods study.

BACKGROUND: Prolonged facemask wearing may have negatively affected essential workers with dry eye. We conducted a mixed-methods study to examine and understand the associations of the ocular surface, periocular environment, and dry eye-related symptoms among hospital workers across the job spectrum with prolonged facemask use. METHODS: We recruited clinical and non-clinical hospital workers with self-reported symptoms of dry eye and prolonged facemask use. We measured symptoms using the 5-item Dry Eye Questionnaire and the Ocular Surface Disease Index (OSDI). Objective ocular signs included corneal and conjunctival staining, fluorescein tear break up time (TBUT), meibography, tear film interferometry, and periocular humidity. We compared symptoms and signs across levels of periocular humidity, dry eye severity, facemask type, and job type. Participants with moderate or severe dry eye symptoms (OSDI > = 23) were invited for a semi-structured, one-on-one interview. RESULTS: We enrolled 20 clinical and 21 non-clinical hospital workers: 27% were 40 years or older, 76% were female, 29% reported a race other than White, and 20% were Hispanic. Seventeen individuals participated in the semi-structured interviews. From the quantitative analyses, we found that 90% of participants reported worsened severity of dry eye at work due to facemasks. Although wearing facemasks resulted in higher periocular humidity levels compared with not wearing facemasks, 66% participants reported increased airflow over their eyes. Findings from the qualitative interviews supported the finding that use of facemasks worsened dry eye symptoms, especially when facemasks were not fitted around the nose. The data did not suggest that non-clinical hospital workers experienced a greater impact of dry eye than clinical workers. CONCLUSIONS: Healthcare providers and patients with dry eye should be educated about the discomfort and the ocular surface health risks associated with inadequately fitted facemasks. Wearing a fitted facemask with a pliable nose wire appears to mitigate the upward airflow.

Effect of Artificial Intelligence-based Health Education Accurately Linking System (AI-HEALS) for Type 2 diabetes self-management: protocol for a mixed-methods study.

BACKGROUND: Patients with type 2 diabetes (T2DM) have an increasing need for personalized and Precise management as medical technology advances. Artificial intelligence (AI) technologies on mobile devices are being developed gradually in a variety of healthcare fields. As an AI field, knowledge graph (KG) is being developed to extract and store structured knowledge from massive data sets. It has great prospects for T2DM medical information retrieval, clinical decision-making, and individual intelligent question and answering (QA), but has yet to be thoroughly researched in T2DM intervention. Therefore, we designed an artificial intelligence-based health education accurately linking system (AI-HEALS) to evaluate if the AI-HEALS-based intervention could help patients with T2DM improve their self-management abilities and blood glucose control in primary healthcare. METHODS: This is a nested mixed-method study that includes a community-based cluster-randomized control trial and personal in-depth interviews. Individuals with T2DM between the ages of 18 and 75 will be recruited from 40-45 community health centers in Beijing, China. Participants will either receive standard diabetes primary care (SDPC) (control, 3 months) or SDPC plus AI-HEALS online health education program (intervention, 3 months). The AI-HEALS runs in the WeChat service platform, which includes a KBQA, a system of physiological indicators and lifestyle recording and monitoring, medication and blood glucose monitoring reminders, and automated, personalized message sending. Data on sociodemography, medical examination, blood glucose, and self-management behavior will be collected at baseline, as well as 1,3,6,12, and 18 months later. The primary outcome is to reduce HbA1c levels. Secondary outcomes include changes in self-management behavior, social cognition, psychology, T2DM skills, and health literacy. Furthermore, the cost-effectiveness of the AI-HEALS-based intervention will be evaluated. DISCUSSION: KBQA system is an innovative and cost-effective technology for health education and promotion for T2DM patients, but it is not yet widely used in the T2DM interventions. This trial will provide evidence on the efficacy of AI and mHealth-based personalized interventions in primary care for improving T2DM outcomes and self-management behaviors. TRIAL REGISTRATION: Biomedical Ethics Committee of Peking University: IRB00001052-22,058, 2022/06/06; Clinical Trials: ChiCTR2300068952, 02/03/2023.

Health literacy in individuals with knee pain-a mixed methods study.

BACKGROUND: Low health literacy is associated with worse pain and poorer self-management. This study (1) examined the level of health literacy and associations with lifestyle habits, health status, chronic pain, and radiographic knee osteoarthritis; and (2) explored experiences illuminating health literacy among individuals with knee pain. METHODS: A convergent parallel mixed-methods design was used, including 221 individuals. Health literacy was assessed by HLS-EU-Q16 and eHEALS. The questionnaire included questions on lifestyle habits, health status, and pain distribution. Radiographic knee osteoarthritis was assessed with x-rays. Associations were analysed using logistic regression analyses. Individual semi-structured interviews were conducted (n = 19) and analysed with qualitative content analysis. RESULTS: The result showed that 71% reported sufficient health literacy. Higher education, healthy lifestyle habits, better general health, and absence of widespread pain were associated with sufficient health literacy. Experiences regarding health literacy influencing the decision-making process toward a decision on action comprised: (1) searching for information actively or passively; (2) processing of the information included being informed, critical, and interpretive; and (3) taking a stand on the information based on trustfulness and motivation. CONCLUSION: Seven out of 10 reported sufficient health literacy. Despite this, unhealthy lifestyles were common, suggesting that having sufficient HL is not enough for a behavioural change and the decision-making process, including different phases such as searching, processing, and taking a stand on health information is important to consider. More research on health literacy is needed to gain knowledge of how best to develop health promotion in individuals with knee pain.

Uptake of pediatric patient-reported outcome and experience measures and challenges associated with their implementation in Alberta: a mixed-methods study.

BACKGROUND: Implementing Patient-reported Outcome Measures (PROMs) and Patient-reported Experience Measures (PREMs) is an effective way to deliver patient- and family-centered care (PFCC). Although Alberta Health Services (AHS) is Canada's largest and fully integrated health system, PROMs and PREMs are yet to be routinely integrated into the pediatric healthcare system. This study addresses this gap by investigating the current uptake, barriers, and enablers for integrating PROMs and PREMs in Alberta's pediatric healthcare system. METHODS: Pediatric clinicians and academic researchers with experience using PROMs and PREMs were invited to complete a quantitative survey. Additionally, key stakeholders were qualitatively interviewed to understand current challenges in implementing pediatric PROMs and PREMs within AHS. Quantitative data gathered from 22 participants were descriptively analyzed, and qualitative data from 14 participants were thematically analyzed. RESULTS: Participants identified 33 PROMs and 6 PREMs showing diversity in the types of pediatric PROMs and PREMs currently being used in Alberta and their mode of administration. The qualitatively identified challenges were associated with patients, family caregivers, and clinicians. The absence of system-level support, such as integration within electronic medical records, is considered a significant system-level challenge. CONCLUSIONS: The significant variation in the types of PROMs and PREMs used, the rationale for their use, and their mode of administration demonstrate the diverse and sporadic use of these measures in Alberta. These findings highlight the need for province-wide uniform implementation of pediatric PROMs and PREMs in Alberta. Our results could benefit healthcare organizations in developing evidence-based PROM and PREM implementation strategies in pediatrics.

Evaluating an addiction medicine unit in Sudbury, Ontario Canada: a mixed-methods study protocol.

BACKGROUND: In response to the escalating global prevalence of substance use and the specific challenges faced in Northern Ontario, Canada, an Addiction Medicine Unit (AMU) was established at Health Sciences North (HSN) in Sudbury. This protocol outlines the approach for a comprehensive evaluation of the AMU, with the aim of assessing its impact on patient outcomes, healthcare utilization, and staff perspectives. METHODS: We conducted a parallel mixed-method study that encompassed the analysis of single-center-level administrative health data and primary data collection, including a longitudinal observational study (target n = 1,200), pre- and post-admission quantitative interviews (target n = 100), and qualitative interviews (target n = 25 patients and n = 15 staff). We implemented a participatory approach to this evaluation, collaborating with individuals who possess lived or living expertise in drug use, frontline staff, and decision-makers across the hospital. Data analysis methods encompass a range of statistical techniques, including logistic regression models, Cox proportional hazards models, Kaplan-Meier curves, Generalized Estimating Equations (GEE), and thematic qualitative analysis, ensuring a robust evaluation of patient outcomes and healthcare utilization. DISCUSSION: This protocol serves as the foundation for a comprehensive assessment designed to provide insights into the AMU's effectiveness in addressing substance use-related challenges, reducing healthcare disparities, and improving patient outcomes. All study procedures have been meticulously designed to align with the ethical principles outlined in the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. The findings will be disseminated progressively through committees and working groups established for this research, and subsequently published in peer-reviewed journals. Anticipated outcomes include informing evidence-based healthcare decision-making and driving improvements in addiction treatment practices within healthcare settings.

Association Between Online Health Information-Seeking Behaviors by Caregivers and Delays in Pediatric Cancer: Mixed Methods Study in China.

BACKGROUND: Pediatric cancer patients in China often present at an advanced stage of disease resulting in lower survival and poorer health outcomes. One factor hypothesized to contribute to delays in pediatric cancer has been the online health information-seeking (OHIS) behaviors by caregivers. OBJECTIVE: This study aims to examine the association between OHIS behaviors by caregivers and delays for Chinese pediatric cancer patients using a mixed methods approach. METHODS: This study used a mixed methods approach, specifically a sequential explanatory design. OHIS behavior by the caregiver was defined as the way caregivers access information relevant to their children's health via the Internet. Delays in pediatric cancer were defined as any one of the following 3 types of delay: patient delay, diagnosis delay, or treatment delay. The quantitative analysis methods included descriptive analyses, Student t tests, Pearson chi-square test, and binary logistic regression analysis, all performed using Stata. The qualitative analysis methods included conceptual content analysis and the Colaizzi method. RESULTS: A total of 303 pediatric cancer patient-caregiver dyads was included in the quantitative survey, and 29 caregivers completed the qualitative interview. Quantitative analysis results revealed that nearly one-half (151/303, 49.8%) of patients experienced delays in pediatric cancer, and the primary type of delay was diagnosis delay (113/303, 37.3%), followed by patient delay (50/303, 16.5%) and treatment delay (24/303, 7.9%). In this study, 232 of the 303 (76.6%) caregiver participants demonstrated OHIS behaviors. When those engaged in OHIS behaviors were compared with their counterparts, the likelihood of patient delay more than doubled (odds ratio=2.21; 95% CI 1.03-4.75). Qualitative analysis results showed that caregivers' OHIS behaviors impacted the cancer care pathway by influencing caregivers' symptom appraisal before the first medical contact and caregivers' acceptance of health care providers' diagnostic and treatment decisions. CONCLUSIONS: Our findings suggest that OHIS among Chinese pediatric caregivers may be a risk factor for increasing the likelihood of patient delay. Our government and society should make a concerted effort to regulate online health information and improve its quality. Specialized freemium consultations provided by health care providers via online health informatic platforms are needed to shorten the time for caregivers' cancer symptom appraisal before the first medical contact.

Adaptation and Implementation of a Shared Decision-Making Tool From One Health Context to Another: Partnership Approach Using Mixed Methods.

BACKGROUND: Osteoarthritis is a leading cause of pain and disability. Knee osteoarthritis accounts for nearly four-fifths of the burden of osteoarthritis internationally, and 10% of adults in the United Kingdom have the condition. Shared decision-making (SDM) supports patients to make more informed choices about treatment and care while reducing inequities in access to treatment. We evaluated the experience of a team adapting an SDM tool for knee osteoarthritis and the tool's implementation potential within a local clinical commissioning group (CCG) area in southwest England. The tool aims to prepare patients and clinicians for SDM by providing evidence-based information about treatment options relevant to disease stage. OBJECTIVE: This study aimed to explore the experiences of a team adapting an SDM tool from one health context to another and the implementation potential of the tool in the local CCG area. METHODS: A partnership approach using mixed methods was used to respond to recruitment challenges and ensure that study aims could be addressed within time restrictions. A web-based survey was used to obtain clinicians' feedback on experiences of using the SDM tool. Qualitative interviews were conducted by telephone or video call with a sample of stakeholders involved in adapting and implementing the tool in the local CCG area. Survey findings were summarized as frequencies and percentages. Content analysis was conducted on qualitative data using framework analysis, and data were mapped directly to the Theoretical Domains Framework (TDF). RESULTS: Overall, 23 clinicians completed the survey, including first-contact physiotherapists (11/23, 48%), physiotherapists (7/23, 30%), specialist physiotherapists (4/23, 17%), and a general practitioner (1/23, 4%). Eight stakeholders involved in commissioning, adapting, and implementing the SDM tool were interviewed. Participants described barriers and facilitators to the adaptation, implementation, and use of the tool. Barriers included a lack of organizational culture that supported and resourced SDM, lack of clinician buy-in and awareness of the tool, challenges with accessibility and usability, and lack of adaptation for underserved communities. Facilitators included the influence of clinical leaders' belief that SDM tools can improve patient outcomes and National Health Service resource use, clinicians' positive experiences of using the tool, and improving awareness of the tool. Themes were mapped to 13 of the 14 TDF domains. Usability issues were described, which did not map to the TDF domains. CONCLUSIONS: This study highlights barriers and facilitators to adapting and implementing tools from one health context to another. We recommend that tools selected for adaptation should have a strong evidence base, including evidence of effectiveness and acceptability in the original context. Legal advice should be sought regarding intellectual property early in the project. Existing guidance for developing and adapting interventions should be used. Co-design methods should be applied to improve adapted tools' accessibility and acceptability.

Examining clinician choice to follow-up (or not) on automated notifications of medication non-adherence by clinical decision support systems.

BACKGROUND: Maintaining medication adherence can be challenging for people living with mental ill-health. Clinical decision support systems (CDSS) based on automated detection of problematic patterns in Electronic Health Records (EHRs) have the potential to enable early intervention into non-adherence events ("flags") through suggesting evidence-based courses of action. However, extant literature shows multiple barriers-perceived lack of benefit in following up low-risk cases, veracity of data, human-centric design concerns, etc.-to clinician follow-up in real-world settings. This study examined patterns in clinician decision making behaviour related to follow-up of non-adherence prompts within a community mental health clinic. METHODS: The prompts for follow-up, and the recording of clinician responses, were enabled by CDSS software (AI2). De-identified clinician notes recorded after reviewing a prompt were analysed using a thematic synthesis approach-starting with descriptions of clinician comments, then sorting into analytical themes related to design and, in parallel, a priori categories describing follow-up behaviours. Hypotheses derived from the literature about the follow-up categories' relationships with client and medication-subtype characteristics were tested. RESULTS: The majority of clients were Not Followed-up (n = 260; 78%; Followed-up: n = 71; 22%). The analytical themes emerging from the decision notes suggested contextual factors-the clients' environment, their clinical relationships, and medical needs-mediated how clinicians interacted with the CDSS flags. Significant differences were found between medication subtypes and follow-up, with Anti-depressants less likely to be followed up than Anti-Psychotics and Anxiolytics (χ2 = 35.196, 44.825; p < 0.001; v = 0.389, 0.499); and between the time taken to action Followed-up0 and Not-followed up1 flags (M0 = 31.78; M1 = 45.55; U = 12,119; p < 0.001; η2 = .05). CONCLUSION: These analyses encourage actively incorporating the input of consumers and carers, non-EHR data streams, and better incorporation of data from parallel health systems and other clinicians into CDSS designs to encourage follow-up.

Effectiveness of transition programs on new graduate nurses' clinical competence, job satisfaction and perceptions of support: A mixed-methods study.

AIM: To assess the effectiveness of two graduate nurse programs on new graduate nurses' overall competence at 3, 6, 9 and 12 months. Secondary aims were to assess new nurses' job satisfaction at 12 months and explore their experiences of support. BACKGROUND: Most clinical settings have implemented transition programs to help new nurses to adapt to their new environments and expand their competences. To this day, very few studies have assessed the effectiveness of these programs. DESIGN: Longitudinal mixed-methods study. METHODS: The study was conducted at two teaching hospitals in Australia. New nurses were recruited during orientation. Data were collected at baseline (T0; n = 88), 3 (T1; n = 29), 6 (T2; n = 15), 9 (T3; n = 11) and 12 months (T4; n = 9). At each time point, the questionnaire included demographic and the Nurse Competence Scale. At T4, the questionnaire also included the Nurse Satisfaction Scale. Semi-structured interviews were conducted from T1 to T4. This study conforms to the STROBE guidelines. RESULTS: Competence increased significantly at T1, with participants stating that they learned by "getting out" of student mode. At T2, despite no significant difference in competence, participants expressed they were more confident and in control, because they felt supported. Again, at T3, there was no significant increase in competence. Finally, at T4, competence increased significantly, with participants acknowledging that they still had a lot to learn. CONCLUSION: This study supports that 12-month transition programs are necessary for NGNs to expand their competence. One major factor influencing NGNs during their first year was how well they felt supported and encouraged to seek help when they needed it. RELEVANCE: There is a need to understand how new NGNs enrolled in transition programs expand their competences. Their professional development depends on a supportive environment where NGNs feel confident in asking questions or for help.

Self-efficacy, uncertainty and anxiety among nursing graduates in response to licensing test postponement due to the COVID-19 pandemic: A mixed-methods study.

AIM: To examine the relationships between self-efficacy, uncertainty and anxiety among nursing graduates waiting for a mandatory nursing licensing test that was postponed due to the COVID-19 pandemic. METHODS: A total of 352 graduates of nursing education programs participated in this mixed-methods study. The data were collected using an online questionnaire in June 2020. RESULTS: The participants demonstrated high uncertainty and anxiety and low self-efficacy towards the ability to succeed in the licensing exam. Graduates, who started working, reported lower uncertainty. Self-efficacy, uncertainty, gender and family status contributed significantly to the explanation of 24% of the variance of the anxiety. The qualitative analysis revealed three themes: (a) emotional distress, cognitive challenge and social implications, (b) consequences for significant others and (c) strengthening of professional values and norms. CONCLUSIONS: A significant crisis like a pandemic is accompanied by acute cognitive burden and stressful emotional experiences and creates an unconventional situation that requires unusual solutions. Granting a temporary permit for employment as a nurse following the postponement of a licensing test contributed to the ability of nursing graduates to cope with the situation. Policies to deal with similar situations in the future emergencies should be developed and implemented.