"But the moment they find out that you are MSM ": a qualitative investigation of HIV prevention experiences among men who have sex with men (MSM) in Ghana's health care system.

BACKGROUND: The prevalence of HIV in Ghana is 1.3%, compared to 17% among men who have sex with men (MSM). There is limited empirical data on the current health care climate and its impact on HIV prevention services for Ghanaian MSM. The purposes of this study were to investigate (1) MSM's experiences using HIV prevention resources, (2) what factors, including health care climate factors, influenced MSM's use of prevention resources and (3) MSM self-identified strategies for improving HIV/sexually transmitted infection (STI) prevention among MSM in Ghanaian communities. METHODS: We conducted 22 focus groups (n = 137) with peer social networks of MSM drawn from three geographic communities in Ghana (Accra, Kumasi, Manya Krobo). The data were examined using qualitative content analysis. Interviews with individual health care providers were also conducted to supplement the analysis of focus group findings to provide more nuanced illuminations of the experiences reported by MSM. RESULTS: There were four major findings related to MSM experiences using HIV prevention resources: (1) condom quality is low, condom access is poor, and condom use is disruptive, (2) inaccurate information undermines HIV testing (3), stigma undermines HIV testing, and (4) positive attitudes towards HIV prevention exist among MSM. The main healthcare climate factors that affected prevention were that MSM were not free to be themselves, MSM were not understood by healthcare providers, and that MSM did not feel that healthcare providers cared about them. To improve HIV prevention MSM suggested increased education tailored to MSM should be provided to enable self-advocacy and that education and awareness are needed to protect human rights of MSM in Ghana. CONCLUSION: MSM in Ghana are exposed to negative health care climates. Health care spaces that are unsupportive of MSM's autonomy undermine the uptake of prevention measures such as condoms, HIV testing, and accurate sexual health education. These findings contribute to knowledge to inform development of HIV prevention interventions for MSM in Ghana, such as culturally appropriate sexual health education, and digital technology to connect individuals with resources supportive of MSM.

Laying the foundation for iCANmeditate: A mixed methods study protocol for understanding patient and oncologist perspectives on meditation.

BACKGROUND: People with cancer experience heightened levels of stress and anxiety, including psychological or physical. In recent years, digitally delivered complimentary therapies, such as meditation, have gained attention in cancer research and advocacy communities for improving quality of life. However, most digital meditation resources are commercially available and are not tailored to the unique needs of cancer patients (addressing fears of recurrence). As such, this study lays the foundation to co-design a publicly available digital meditation program called iCANmeditate that contains cancer-specific meditation content. AIMS: To understand: (1) cancer patients' perceptions and practices of meditation, as well as their needs in addressing the stress that accompanies their cancer diagnosis and (2) current knowledge of meditation and prescribing trends amongst oncologists in Canada. METHODS AND ANALYSIS: A mixed-methods design comprised of online patient and oncologist surveys and interviews with patients will be used. Survey data analysis will use multivariate logistic regressions to examine predictors of: (1) interest in using a meditation app among patients and (2) prescribing meditation among oncologists. Patient interviews will gather insights about the contexts of daily living where meditation would be most beneficial for people with cancer; this data will be analyzed thematically. DISCUSSION: The results of this study will inform iterative co-design workshops with cancer patients to build the digital meditation program iCANmeditate; interview results will be used to develop vignettes or "personas" that will supply the initial stimulus material for the iterative co-design workshops. Once the program has been finalized in partnership with cancer patient participants, a usability and pilot study will follow to test the functionality and efficacy of the tool. Results from the oncologist survey will form the basis of knowledge mobilization efforts to facilitate clinical buy-in and awareness of the benefits of meditation to cancer patients.

Practice recommendations regarding parental presence in NICUs during pandemics caused by respiratory pathogens like COVID-19.

Aim: To co-create parental presence practice recommendations across Canadian NICUs during pandemics caused by respiratory pathogens such as COVID-19. Methods: Recommendations were developed through evidence, context, Delphi and Values and Preferences methods. For Delphi 1 and 2, participants rated 50 items and 20 items respectively on a scale from 1 (very low importance) to 5 (very high). To determine consensus, evidence and context of benefits and harms were presented and discussed within the Values and Preference framework for the top-ranked items. An agreement of 80% or more was deemed consensus. Results: After two Delphi rounds (n = 59 participants), 13 recommendations with the highest rated importance were identified. Consensus recommendations included 6 strong recommendations (parents as essential caregivers, providing skin-to-skin contact, direct or mothers' own expressed milk feeding, attending medical rounds, mental health and psychosocial services access, and inclusion of parent partners in pandemic response planning) and 7 conditional recommendations (providing hands-on care tasks, providing touch, two parents present at the same time, food and drink access, use of communication devices, and in-person access to medical rounds and mental health and psychosocial services). Conclusion: These recommendations can guide institutions in developing strategies for parental presence during pandemics caused by respiratory pathogens like COVID-19.

"To Be or Not to Be"-Cardiopulmonary Resuscitation for Hospitalized People Who Have a Low Probability of Benefit: Qualitative Analysis of Semi-structured Interviews.

Purpose: Our aim was to understand the decision making of patients in hospital who wanted cardiopulmonary resuscitation despite low probability of benefit. Methods: We included patients admitted to general medical wards who had a low chance of surviving in-hospital cardiopulmonary resuscitation (CPR) and had an order in the chart to administer CPR. We developed an interview guide to explore participants' decision-making process, sources of information, and emotions associated with this decision. Results: We developed 3 themes from the data. 1) "Life is worth living . . . for now": Participants describe their enjoyment of life and desire to carry on in their current state. 2) "Making sense of CPR outcomes": Participants saw CPR outcomes as binary, either they live, or they die; deciding not to receive CPR means choosing death. Participants were optimistic they would survive CPR and cited personal experience and TV as information sources. 3) "Decision process": Participants did not engage in shared decision making. Instead, they were asked a binary yes/no question with no reflection on their values or discussion about harms or benefits. Limitations: The probability of successful CPR in our sample is unknown. Findings may be different in a population who is imminently dying but still requesting CPR. Conclusions: Participants chose CPR because they perceived life as worth living and CPR as a chance worth taking. Participants did not want to be left in a severely debilitated state but did not have accurate information about this risk. Implications: Decision making about CPR in-hospital can be improved if it is grounded in accurate risk understanding and the patient's values and wishes.

Mental health interventions and supports during COVID- 19 and other medical pandemics: A rapid systematic review of the evidence.

BACKGROUND: Novel coronavirus pneumonia (COVID-19) is a global reminder of the need to attend to the mental health of patients and health professionals who are suddenly facing this public health crisis. In the last two decades, a number of medical pandemics have yielded insights on the mental health impact of these events. Based on these experiences and given the magnitude of the current pandemic, rates of mental health disorders are expected to increase. Mental health interventions are urgently needed to minimize the psychological sequelae and provide timely care to affected individuals. METHOD: We conducted a rapid systematic review of mental health interventions during a medical pandemic, using three electronic databases. Of the 2404 articles identified, 21 primary research studies are included in this review. RESULT: We categorized the findings from the research studies using the following questions: What kind of emotional reactions do medical pandemics trigger? Who is most at risk of experiencing mental health sequelae? What works to treat mental health sequelae (psychosocial interventions and implementation of existing or new training programs)? What do we need to consider when designing and implementing mental health interventions (cultural adaptations and mental health workforce)? What still needs to be known? CONCLUSION: Various mental health interventions have been developed for medical pandemics, and research on their effectiveness is growing. We offer recommendations for future research based on the evidence for providing mental health interventions and supports to those most in need.

Characterizing the Structure and Functions of Social Networks of Men Who Have Sex with Men in Ghana, West Africa: Implications for Peer-Based HIV Prevention.

Men who have sex with men (MSM) in Ghana are at an increased risk of contracting HIV. Understanding the social networks of MSM may support the development of HIV prevention strategies for this unique population. This article explores the structure and function of the social networks of MSM from 22 focus groups drawn from two urban and one rural setting in Ghana. Gaining insights into the characteristics of these networks will allow health care providers to design HIV prevention efforts and increase access to these programs.