Infant feeding choices among Panamanian mothers: A qualitative study.

Infant and child nutrition practices are among the most critical determinants of infant health and breastfeeding is considered the gold standard of infant feeding. Despite extensive public health interventions to promote breastfeeding, its prevalence has decreased in recent years in Panama, particularly in urban settings. There has been a nearly 20% drop in breastfeeding in the 10 years leading to 2020. Current literature often fails to elucidate the factors underpinning Panamanian mothers' decision making in relation to breastfeeding. This article explores the experiences, views, and decision making related to infant feeding choices of mothers in Panama City. The study used a qualitative approach, involving online semistructured interviews with seven participants. Utilizing the socioecological model enabled an understanding of the influence of the various, nested levels of a mother's social environment on behaviors and practices. Five themes were developed following analysis: "practical, bodily, and emotional challenges"; "workplace influences"; "family and friends' support"; "the role of health care and healthcare professionals"; "the influence of social and cultural norms on decisions and practices." The main barrier to breastfeeding was the lack of family support, especially from grandmothers. In contrast, private lactation consultation and partners' support were perceived as the best approaches for breastfeeding success, suggesting an urgent need for publicly available lactation support. This study demonstrates the importance of understanding the complexity of the social norms surrounding infant feeding, showing the challenges that mothers face in this process, and sheds light on the (public) interventions necessary to improve breastfeeding initiation and continuation.

Medical students' views about person-centred communication in dementia care.

Adopting principles of person-centred communication has been highlighted as one strategy to improve care of people living with dementia (PLWD) in health and social care settings. However, person-centred communication is interpreted and applied variably in different settings, and healthcare professionals' views about communicating with PLWD are under-explored. This study aimed to investigate medical students' views about the principles and applicability of a model of person centred communication - the Dementia Model of Effective Communication (DeMEC) - to clinical practice. Quantitative and qualitative data was collected using questionnaires ( n = 531), focus groups ( n = 21) and interviews ( n = 10). Students generally endorsed the person-centred approach to communication, but two aspects were highlighted as complex and divisive - the acceptability or otherwise of lying, and of communicating with family in advance of the PLWD. We discuss the nature of these communicative dilemmas, implications for the education and training of medical students, and future directions for research.

End of life care for people with dementia: The views of health professionals, social care service managers and frontline staff on key requirements for good practice.

BACKGROUND: Evidence consistently shows that people with advanced dementia experience suboptimal end of life care compared to those with cancer; with increased hospitalisation, inadequate pain control and fewer palliative care interventions. Understanding the views of those service managers and frontline staff who organise and provide care is crucial in order to develop better end of life care for people with dementia. METHODS AND FINDINGS: Qualitative interviews and focus groups were conducted from 2013 to 2015 with 33 service managers and 54 staff involved in frontline care, including doctors, nurses, nursing and care home managers, service development leads, senior managers/directors, care assistants and senior care assistants/team leads. All were audio recorded and transcribed verbatim. Participants represented a diverse range of service types and occupation. Transcripts were subject to coding and thematic analysis in data meetings. Analysis of the data led to the development of seven key themes: Recognising end of life (EOL) and tools to support end of life care (EOLC), Communicating with families about EOL, Collaborative working, Continuity of care, Ensuring comfort at EOL, Supporting families, Developing and supporting staff. Each is discussed in detail and comprise individual and collective views on approaches to good end of life care for people with dementia. CONCLUSIONS: The significant challenges of providing good end of life care for people with dementia requires that different forms of expertise should be recognised and used; including the skills and knowledge of care assistants. Successfully engaging with people with dementia and family members and helping them to recognise the dying trajectory requires a supportive integration of emotional and technical expertise. The study strengthens the existing evidence base in this area and will be used with a related set of studies (on the views of other stakeholders and observations and interviews conducted in four services) to develop an evidence-based intervention.

Talking About Looking: Three Approaches to Interviewing Carers of People With Rheumatoid Arthritis About Information Seeking.

Given the profusion of illness-related information, in this article, we consider how talking about information seeking-and in particular Internet use-is difficult, not because it is necessarily a highly sensitive topic (though it may be), but rather due to the unusual and unfamiliar situation of talking about information seeking. Drawing on interviews conducted as part of a study on the educational needs of carers of people with rheumatoid arthritis, we compare three types of interview for understanding online information seeking: interviews (recall), researcher-led observation (joining participant at the computer), and diaries. We discuss the strengths and weaknesses of each approach and discuss how changing interview questions and the form of interaction can help to produce different types of data, and potentially more meaningful insights. Of the three approaches, conducting interviews with participants while looking at a computer (talking while looking) offered the best opportunities to understand Internet-based information seeking.

Expert views on the factors enabling good end of life care for people with dementia: a qualitative study.

BACKGROUND: Dementia, of all long term illnesses, accounts for the greatest chronic disease burden, and the number of people with age-related diseases like dementia is predicted to double by 2040. People with advanced dementia experience similar symptoms to those dying with cancer yet professional carers find prognostication difficult and struggle to meet palliative care needs, with physical symptoms undetected and untreated. While elements of good practice in this area have been identified in theory, the factors which enable such good practice to be implemented in real world practice need to be better understood. The aim of this study was to determine expert views on the key factors influencing good practice in end of life care for people with dementia. METHODS: Semi-structured telephone and face-to-face interviews with topic guide, verbatim transcription and thematic analysis. Interviews were conducted with experts in dementia care and/or palliative care in England (n = 30). RESULTS: Four key factors influencing good practice in end of life care for people with dementia were identified from the expert interviews: leadership and management of care, integrating clinical expertise, continuity of care, and use of guidelines. CONCLUSIONS: The relationships between the four key factors are important. Leadership and management of care have implications for the successful implementation of guidelines, while the appropriate and timely use of clinical expertise could prevent hospitalisation and ensure continuity of care. A lack of integration across health and social care can undermine continuity of care. Further work is needed to understand how existing guidelines and tools contribute to good practice. DISCLAIMER: This article presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research programme (Grant Reference Number RP-PG-0611-20005). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Why is dementia different? Medical students' views about deceiving people with dementia.

OBJECTIVES: Care of patients with dementia raises challenging ethical issues, including the use of deception in clinical practice. This study aimed to determine the extent to which medical students agree that ethical arguments for and against deceiving patients in general apply to patients with dementia. METHOD: Qualitative study using six focus groups (n = 21) and 10 interviews (n = 10) with undergraduate students in years 1, 3 and 5 at a UK medical school. Analysis using initial coding followed by comparison of data with a pre-existing framework concerning deception in clinical practice. RESULTS: Arguments for and against deceiving patients with dementia overlapped with those previously described in relation to clinical practice in general. However, the majority of participants highlighted issues unique to dementia care that warranted additional consideration. Three key dementia-specific considerations identified were capacity (understanding, retaining and emotional processing), perceived vulnerability and family dynamics. Students expressed uncertainty as to their ability to make judgements about honest communication with patients with dementia and their families. CONCLUSION: Dementia adds additional complexity to clinical judgements about the acceptability of deception in practice. Medical students have a number of unmet learning needs with regard to communicating with patients with dementia and their families. Existing ethical frameworks may provide a helpful starting point for education about dementia care.