Perspectives of stakeholders on the implementation of a dietary and exercise intervention for postpartum mothers with a history of gestational diabetes mellitus (GDM): a community-based qualitative study.

Women with a history of Gestational diabetes mellitus (GDM) have a high risk of developing Type 2 diabetes mellitus (T2DM) in their future life. Lifestyle interventions are known to reduce this progression. The success of a lifestyle intervention mainly depends on its feasibility. Therefore, this study aimed to evaluate the feasibility of a lifestyle intervention programme aimed to attenuate the development of T2DM in mothers with a history of GDM. This qualitative phenomenological study was carried out in selected Medical offices of Health (MOH) areas in Sri Lanka. Postpartum mothers with a history of GDM who have undergone a comprehensive, supervised lifestyle intervention program for 1 year, their family members, and public health midwives (PHM) were recruited for this study. Focus group discussions (FGD) were carried out with mothers and PHM while In-depth interviews (IDI) were conducted with family members. Framework analysis was used for the analysis of data. A total of 94 participants (45 mothers, 40 healthcare workers, and 9 family members) participated in FGDs and IDIs to provide feedback regarding the lifestyle intervention. Sixteen sub-themes emerged under the following four domains; (1) Feelings and experiences about the lifestyle intervention programme for postpartum mothers with a history of GDM (2) Facilitating factors (3) Barriers to implementation and (4) Suggestions for improvement. Spouse support and continued follow-up were major facilitating factors. The negative influence of healthcare workers was identified as a major barrier to appropriate implementation. All participants suggested introducing continuing education programmes to healthcare workers to update their knowledge. The spouse's support and follow-ups played a pivotal role in terms of the success of the programme. Enhancing awareness of the healthcare workers is also essential to enhance the effectiveness of the programme. It is imperative to introduce a formal intervention programme for the postpartum management of mothers with a history of GDM. It is recommended that the GDM mothers should be followed up in the postpartum period and this should be included in the national postpartum care guidelines.

"So Many Other Things Improve" with Transdiagnostic Treatment for Sleep and Circadian Problems: Interviews with Community Providers on Treating Clients with Serious Mental Illness.

Community mental health centers (CMHCs) offer invaluable, publicly-funded treatment for serious mental illness (SMI). Unfortunately, evidence-based psychological treatments are often not delivered at CMHCs, in part due to implementation barriers, such as limited time, high caseloads, and complex clinical presentations. Transdiagnostic treatments may help address these barriers, because they allow providers to treat symptoms across multiple disorders concurrently. However, little research has investigated CMHC providers' experiences of delivering transdiagnostic treatments "on the ground," particularly for adults with SMI. Thus, the aim of the present study was to assess CMHC providers' perspectives on delivering a transdiagnostic treatment - the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) - to adults diagnosed with SMI. In the context of a larger parent trial, providers were randomized to deliver a standard version of TranS-C (Standard TranS-C) or a version adapted to the CMHC context (Adapted TranS-C). Twenty-five providers from the parent trial participated in a semi-structured interview (n = 10 Standard TranS-C; n = 15 from Adapted TranS-C). Responses were deductively and inductively coded to identify themes related to Proctor's taxonomy of implementation outcomes. Four novel "transdiagnostic take homes" were identified: (1) transdiagnostic targets, such as sleep, can be perceived as motivating and appropriate when treating SMI, (2) strategies to bolster client motivation/adherence and address a wider range of symptom severity may improve transdiagnostic treatments, (3) balancing feasibility with offering in-depth resources is an important challenge for transdiagnostic treatment development, and (4) adapting transdiagnostic treatments to the CMHC context may improve provider perceptions of implementation outcomes.

Integrating Health and Disability Data Into Academic Information Systems: Workflow Optimization Study.

Background: Integrating health information into university information systems holds significant potential for enhancing student support and well-being. Despite the growing body of research highlighting issues faced by university students, including stress, depression, and disability, little has been done in the informatics field to incorporate health technologies at the institutional level. Objective: This study aims to investigate the current state of health information integration within university systems and provide design recommendations to address existing gaps and opportunities. Methods: We used a user-centered approach to conduct interviews and focus group sessions with stakeholders to gather comprehensive insights and requirements for the system. The methodology involved data collection, analysis, and the development of a suggested workflow. Results: The findings of this study revealed the shortcomings in the current process of handling health and disability data within university information systems. In our results, we discuss some requirements identified for integrating health-related information into student information systems, such as privacy and confidentiality, timely communication, task automation, and disability resources. We propose a workflow that separates the process into 2 distinct components: a health and disability system and measures of quality of life and wellness. The proposed workflow highlights the vital role of academic advisors in facilitating support and enhancing coordination among stakeholders. Conclusions: To streamline the workflow, it is vital to have effective coordination among stakeholders and redesign the university information system. However, implementing the new system will require significant capital and resources. We strongly emphasize the importance of increased standardization and regulation to support the information system requirements for health and disability. Through the adoption of standardized practices and regulations, we can ensure the smooth and effective implementation of the required support system.

Content validity of the Leicester Cough Questionnaire in adults with refractory or unexplained chronic cough: a qualitative interview study.

BACKGROUND: Chronic cough, a cough lasting >8 weeks, includes refractory chronic cough (RCC) and unexplained chronic cough (UCC). Patient-reported outcome (PRO) measures are needed to better understand chronic cough impacts that matter most to patients. The 19-item Leicester Cough Questionnaire (LCQ), an existing PRO measure of chronic cough, assesses impacts of cough across physical, psychological, and social domains. However, the content validity of the LCQ evaluating these concepts in patients with RCC/UCC had not been established. OBJECTIVES: To evaluate the content validity of the LCQ in patients with RCC/UCC. DESIGN: A cross-sectional, qualitative interview study. METHODS: First, previously completed qualitative interview results in adults with RCC/UCC (N = 30) were evaluated and mapped to LCQ concepts. Next, a clinical cough expert reviewed each LCQ item and assessed the salience of its concepts for patients with RCC/UCC. Finally, semistructured interviews-including both concept elicitation and cognitive debriefing-were conducted in adults with RCC/UCC (N = 20) to elicit a comprehensive set of participant experiences and to assess the appropriateness of using the LCQ in this population. RESULTS: Concepts reported in the past and present qualitative interviews were included across all LCQ items, and most impacts reported to be the "most bothersome" were assessed in the LCQ. In the current study, all participants indicated that reduced cough frequency would be an important treatment target. During cognitive debriefing, each LCQ item was endorsed by ⩾70% of participants. Additionally, participants were generally able to understand, recall, and select a response for each LCQ item. All participants and the clinical expert indicated that the LCQ was appropriate and assessed the impacts most relevant to patients with RCC/UCC. CONCLUSION: Our findings support the content validity of the LCQ and demonstrate that this measure is fit-for-purpose and includes important cough impacts in adults with RCC/UCC.

The Richness of Reports Provided by Children in Israel: Examination of the Impact of Social Affiliations.

Forensic interviews following child sexual abuse (CSA) are of central importance to the children, their families and all those involved. Moreover, the legal system expects rich, forensically relevant reports from the children. The current study focuses on the impact of children's social affiliation on the richness of their reports, and how question types contribute to rich reports. The sample included 314 forensic interviews conducted in Israel between 2015 and 2018. The findings revealed a relationship between child characteristics (gender), abuse characteristics (perpetrator identity, abuse type, abuse frequency) and social affiliation with report richness. Furthermore, question types (free recall prompts, summaries, directive, option-posing, suggestive) moderated the relationship between the child's characteristics, abuse characteristics, and social affiliation with report richness, when these effects were not equal. The findings emphasized that contextual observation of sexually abused children may promote better services for them and, in addition, stressed the importance of advancing future training and practical guidelines for practitioners.

Implementing healthy food policies in health sector settings: New Zealand stakeholder perspectives.

BACKGROUND: In 2016, a voluntary National Healthy Food and Drink Policy was released to improve the healthiness of food and drinks for sale in New Zealand health sector organisations. The Policy aims to role model healthy eating and demonstrate commitment to health and well-being of hospital staff and visitors and the general public. This study aimed to understand the experiences of hospital food providers and public health dietitians/staff in implementing the Policy, and identify tools and resources needed to assist with the implementation. METHODS: A maximum variation purposive sampling strategy (based on a health district's population size and food outlet type) was used to recruit participants by email. Video conference or email semi-structured interviews included 15 open-ended questions that focused on awareness, understanding of, and attitudes towards the Policy; level of support received; perceived customer response; tools and resources needed to support implementation; and unintended or unforeseen consequences. Data was analysed using a reflexive thematic analysis approach. RESULTS: Twelve participants (eight food providers and four public health dietitians/staff) were interviewed; three from small (< 100,000 people), four from medium (100,000-300,000 people) and five from large (> 300,000 people) health districts. There was agreement that hospitals should role model healthy eating for the wider community. Three themes were identified relating to the implementation of the Policy: (1) Complexities of operating food outlets under a healthy food and drink policy in public health sector settings; (2) Adoption, implementation, and monitoring of the Policy as a series of incoherent ad-hoc actions; and (3) Policy is (currently) not achieving the desired impact. Concerns about increased food waste, loss of profits and an uneven playing field between food providers were related to the voluntary nature of the unsupported Policy. Three tools could enable implementation: a digital monitoring tool, a web-based database of compliant products, and customer communication materials. CONCLUSIONS: Adopting a single, mandatory Policy, provision of funding for implementation actions and supportive tools, and good communication with customers could facilitate implementation. Despite the relatively small sample size and views from only two stakeholder groups, strategies identified are relevant to policy makers, healthcare providers and public health professionals.

Understanding and using experiences of social care to guide service improvements: translating a co-design approach from health to social care.

Background: Local authorities need to find new ways of collecting and using data on social care users' experiences to improve service design and quality. Here we draw on and adapt an approach used in the healthcare improvement field, accelerated experience-based co-design, to see if it can be translated to social care. We use loneliness support as our exemplar. Objectives: To understand how loneliness is understood and experienced by members of the public and characterised by social care and voluntary sector staff; to identify service improvements around loneliness support; to explore whether accelerated experience-based co-design is effective in social care; and to produce new resources for publication on Socialcaretalk.org. Design and methods: Discovery phase: in-depth interviews with a diverse sample of people in terms of demographic characteristics with experience of loneliness, and 20 social care and voluntary staff who provided loneliness support. Production of a catalyst film from the public interview data set. Co-design phase: exploring whether the accelerated experience-based co-design approach is effective in one local authority area via a series of three workshops to agree shared priorities for improving loneliness support (one workshop for staff, another for people with experience of local loneliness support, and a third, joint workshop), followed by 7-monthly meetings by two co-design groups to work on priority improvements. A process evaluation of the co-design phase was conducted using interviews, ethnographic observation, questionnaires and other written material. Results: Accelerated experience-based co-design demonstrated strong potential for use in social care. Diverse experiences of participants and fuzzy boundaries around social care compared to health care widened the scope of what could be considered a service improvement priority. Co-design groups focused on supporting people to return to pre-pandemic activities and developing a vulnerable passenger 'gold standard' award for taxi drivers. This work generated short-term 'wins' and longer-term legacies. Participants felt empowered by the process and prospect of change, and local lead organisations committed to take the work forward. Conclusions: Using an exemplar, loneliness support, that does not correspond to a single pathway allowed us to comprehensively explore the use of accelerated experience-based co-design, and we found it can be adapted for use in social care. We produced recommendations for the future use of the approach in social care which include identifying people or organisations who could have responsibility for implementing improvements, and allowing time for coalition-building, developing trusted relationships and understanding different perspectives. Limitations: COVID-19 temporarily affected the capacity of the local authority Project Lead to set up the intervention. Pandemic work pressures led to smaller numbers of participating staff and had a knock-on effect on recruitment. Staff turnover within Doncaster Council created further challenges. Future work: Exploring the approach using a single pathway, such as assessing eligibility for care and support, could add additional insights into its transferability to social care. Trial registration: This trial is registered as Current Controlled Trials ISRCTN98646409. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128616) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 27. See the NIHR Funding and Awards website for further award information.

Local councils need to find new ways of using people's experiences of social care to improve services. We explored whether a way of improving health services can improve social care services. 'Experience-based co-design' is a complicated name. It means working with people who use health or social care services to improve that service, and interviewing people as part of this process. Accelerated experience-based co-design uses existing interviews instead of new interviews. To see if the approach works in social care, we chose the topic of loneliness because many of us experience loneliness. We worked with Doncaster City Council because it has been focusing on loneliness. We interviewed 37 people across England and recorded what they said about loneliness. We made a film about their experiences that showed examples of good or poor care. We call these touch points. We held three workshops in Doncaster. Workshop 1 was with people who work in social care as paid workers or volunteers, and workshop 2 was with people who use social care services. In both workshops, people made a list of types of support that needed improvement. Both groups attended workshop 3, watched the film and decided what to focus on from the two lists. Two groups were set up to work on improving support for loneliness in Doncaster. Each group met seven times. One focused on taxi services, and the other group focused on supporting people to do activities they did before the pandemic. A researcher attended these meetings and talked with everyone involved to see how this approach worked. At the end, there was a celebration event. We found that loneliness is complicated. We found the approach to improving support does work in social care, but it needs some changes because social care is not like health care. We suggest ways the approach can be done differently.

Designing a Culturally Relevant Digital Skin Cancer Prevention Intervention for Hispanic Individuals: Qualitative Exploration.

BACKGROUND: In the past 2 decades, melanoma incidence among Hispanic individuals has risen by 20%. The mortality rate of Hispanic individuals is higher than that for non-Hispanic White individuals. Skin cancer can largely be prevented with regular sun protection, and skin cancer outcomes can be improved through early detection, for example, by skin self-examination. Alarmingly, Hispanic individuals are less aware of the symptoms and harms of skin cancers, tend to have misperceptions regarding the risks and benefits of skin cancer prevention behaviors, and engage in less sun protection behaviors than non-Hispanic White individuals. OBJECTIVE: This study aimed to use a community-engaged approach and conduct both group and individual interviews among Hispanic individuals and relevant key stakeholders to explore the potential design of a mobile-based skin cancer prevention intervention for Hispanic individuals. METHODS: This study used a qualitative design (focus groups and individual interviews). Participants were recruited from local community organizations' social media, local events, and contact lists (eg, email). Zoom interviews were conducted to examine whether Hispanic individuals would be interested in a mobile-based skin cancer intervention and to explore their preferences and suggestions to inform skin cancer prevention intervention design. RESULTS: Five focus groups (2 in Spanish and 3 in English) among self-identified Hispanic individuals (n=34) and 15 semistructured, in-depth individual interviews among key stakeholders (health care providers and community leaders; eg, dermatologist, nurse practitioner, licensed social worker, and church leader) were conducted. The main themes and subthemes emerging from the group discussions and individual interviews were organized into the following categories: intervention platform, delivery frequency and format, message design, engagement plan, and activities. WhatsApp and Facebook were identified as suitable platforms for the intervention. Messages including short videos, visuals (eg, images and photographs), and simple texts messages were preferred. Recommendations for message design included personalized messages, personal stories and narratives, culturally relevant design (eg, incorporating family values), and community-trusted sources. Potential engagement and retention recommendations were also discussed. Additional details and exemplar quotes of each theme and subtheme are described. CONCLUSIONS: This study provides important insights and directions for the design of a mobile, digital skin cancer intervention to modify Hispanic individuals' sun protection and skin self-examination behaviors to help improve skin cancer outcomes. Insights gathered from community leaders and health care providers provided valuable additions to the community-derived data. Leveraging popular digital platforms among Hispanic individuals such as WhatsApp or Facebook could be a promising approach to skin cancer prevention. Recommendations from the community included the use of concise videos, illustrative images, clear text messages, tailored communications, narratives featuring personal experiences, designs that reflect cultural significance, and information from sources that are trusted by the community, which provided useful strategies for future intervention design among Hispanic individuals.

Physicians and nurses experiences of providing care to patients within a mobile care unit - a qualitative interview study.

INTRODUCTION: There is a growing need for alternative forms of care to address citizen demands and ensure a competent healthcare workforce across municipalities and regions. One of these forms of care is the use of mobile care units. The aim of the current study was to describe physicians and nurses experiences of providing care to patients within a mobile care unit in Sweden. METHOD: Data were collected between March 2022 and January 2023 through qualitative interviews with 14 physicians and nurses employed in various mobile care units in different regions in Sweden. These interviews were transcribed verbatim and subjected to content analysis, with the study adhering to the Standards for Reporting Qualitative Research (SRQR). RESULTS: The analysis resulted in two main categories: "Unlocking the potential of mobile care", and "The challenges of moving hospitals to patients' homes"; and seven subcategories. The respondents viewed mobile care at home as highly advantageous, positively impacting both patients and caregivers. They believed their contributions enhanced patients' well-being, fostering a welcoming atmosphere. They also noted receiving more quality time for each patient, enabling thorough assessments, and promoting a person-centered approach, which resulted in more gratifying mutual relationships. However, they experienced that mobile care also had challenges such as geographical limitations, limited opening hours and logistical complexity, which can lead to less equitable and efficient care. CONCLUSIONS: Physicians and nurses in mobile care units emphasized positive outcomes, contributing to patient well-being through a person-centered approach. They highlighted increased quality time, comprehensive assessments, and overall satisfaction, praising the mobile care unit's unique continuity for enhancing safety and fostering meaningful relationships in the patient's home environment. In order for mobile care to develop and become a natural part of healthcare, challenges such as geographical limitations and logistics need to be addressed.

Hope, passion and perseverance: experiences of internationally educated nurses pursuing nursing authorisation in Norway-a qualitative study.

BACKGROUND: The global nursing shortage is driving nursing professionals to migrate from their home countries to other regions of the world, leading to increased diversity in healthcare settings and nursing education across Europe. Although research on the experiences of internationally educated nurses has gained more attention in Norway, a substantial gap remains in understanding the challenges these nurses face when participating in bridging programs and seeking authorisation as registered nurses in the host country. METHODS: The aim of the present study is to gain knowledge about the experiences of students in a digitised bridging program for nurses, related to being a nurse educated outside the European Union and a student with a Norwegian as a second language and migrant/refugee background. Oslo Metropolitan University initiated a decentralised education programme in 2021, offering a bridging programme for individuals with a nursing education from countries outside the European Union. This programme was conducted in a decentralised, gathering-based, and predominantly digitised format. The study has a qualitative descriptive design and includes a purposive sample of eight former nursing students enrolled in the programme. Data were collected through individual semistructured interviews conducted between November and December 2023. The data were analysed by employing thematic analysis. The study is reported in accordance with the COnsolidated criteria for REporting Qualitative research (COREQ). RESULTS: Analyses revealed a main theme-the participants' ability to persist in their goal over the long term, maintaining their interest, overcoming challenges, working hard and finishing tasks rather than giving up. This theme is supported by three themes: (i) 'Navigating bureaucratic challenges - The struggle with authorisation and overwhelming requirements, (ii) 'An emotional journey - The ups and downs of participating in the program', and (iii) 'Achieving recognition - The journey to authorisation and professional confidence'. CONCLUSIONS: The study underscores the numerous challenges encountered by internationally educated nurses seeking registered nurse' recognition in Norway. Despite these challenges, the participants displayed remarkable hope, passion and perseverance, remaining committed to their goal of becoming registered nurses in Norway.

Valuation of the EQ-5D-3L in Jordan.

BACKGROUND: In Jordan, no national value set is available for any preference-accompanied health utility measure. OBJECTIVE: This study aims to develop a value set for EQ-5D-3L based on the preferences of the Jordanian general population. METHODS: A representative sample of the Jordanian general population was obtained through quota sampling involving age, gender, and region. Participants aged above 18 years were interviewed via videoconferencing using the EuroQol Valuation Technology 2.1 protocol. Participants completed ten composite time trade-offs (cTTO) and ten discrete choice experiments (DCE) tasks. cTTO and DCE data were analyzed using linear and logistic regression models, respectively, and hybrid models were applied to the combined DCE and cTTO data. RESULTS: A total of 301 participants with complete data were included in the analysis. The sample was representative of the general population regarding region, age, and gender. All model types applied, that is, random intercept model, random intercept Tobit, linear model with correction for heteroskedasticity, Tobit with correction for heteroskedasticity, and all hybrid models, were statistically significant. They showed logical consistency in terms of higher utility decrements with more severe levels. The hybrid model corrected for heteroskedasticity was selected to construct the Jordanian EQ-5D-3L value set as it showed the best fit and lowest mean absolute error. The predicted value for the most severe health state (33333) was - 0.563. Utility decrements due to mobility had the largest weight, followed by anxiety/depression, while usual activities had the smallest weight. CONCLUSION: This study provides the first EQ-5D-3L value set in the Middle East. The Jordanian EQ-5D-3L value set can now be used in health technology assessments for health policy planning by the Jordanian health sector's decision-makers.

Relevant factors affecting nurse staffing: a qualitative study from the perspective of nursing managers.

Objective: To understand the current situation of nursing manpower allocation, explore the factors affecting nurse staffing, improve nurse staffing level, and provide reference for better formulation of nursing human resources staffing standards. Methods: A descriptive research method was used to conduct semi-structured interviews with 14 nursing managers. The data were analyzed and refined by content analysis. The sample size was subject to content saturation. Results: Nine themes and twenty sub-themes of influencing factors for nursing staffing were identified across four levels: hospital level, department level, patient level, and nurse level. Conclusion: Hospital and department managers need to comprehensively consider the factors of affecting nurse staffing. Adopting multidimensional optimization measures, improving relevant systems, optimizing nurse structure, and establishing flexible and mobile nurse database to cope with public emergencies, so as to effectively improve nurse staffing and nursing service quality.

Understanding how and why travel mode changes: analysis of longitudinal qualitative interviews.

BACKGROUND: Encouraging alternatives to the car such as walking, cycling or public transport is a key cross-sector policy priority to promote population and planetary health. Individual travel choices are shaped by individual and environmental contexts, and changes in these contexts - triggered by key events - can translate to changes in travel mode. Understanding how and why these changes happen can help uncover more generalisable findings to inform future intervention research. This study aimed to identify the mechanisms and contexts facilitating changes in travel mode. METHODS: Prospective longitudinal qualitative cohort study utilising semi-structured interviews at baseline (in 2021), three- and six-month follow up. Participants were residents in a new town in Cambridgeshire, UK, where design principles to promote walking, cycling and public transport were used at the planning stage. At each interview, we followed a topic guide asking participants about previous and current travel patterns and future intentions. All interviews were audio recorded and transcribed. Data analysis used the framework approach based on realist evaluation principles identifying the context and mechanisms described by participants as leading to travel behaviour change. RESULTS: We conducted 42 interviews with 16 participants and identified six mechanisms for changes in travel mode. These entailed increasing or reducing access, reliability and financial cost, improving convenience, increasing confidence and raising awareness. Participants described that these led to changes in travel mode in contexts where their existing travel mode had been disrupted, particularly in terms of reducing access or reliability or increasing cost, and where there were suitable alternative travel modes for their journey. Experiences of the new travel mode played a role in future travel intentions. IMPLICATIONS: Applying realist evaluation principles to identify common mechanisms for changes in travel mode has the potential to inform future intervention strategies. Future interventions using mechanisms that reduce access to, reduce reliability of, or increase the financial cost of car use may facilitate modal shift to walking, cycling and public transport when implemented in contexts where alternative travel modes are available and acceptable.

Obstetrics and Gynecology Residency Geographic Match Location Patterns: Comparison of Pre and Post Virtual Interviews.

OBJECTIVE: To evaluate the impact of virtual interviews on geographic trends for applicants and programs in the obstetrics and gynecology (OBGYN) resident match. DESIGN: Cross-sectional study of a random 50% sample of all OBGYN residency programs listed by the Accreditation Council for Graduate Medical Education (ACGME) for the 2023 to 2024 academic year. Data collected from each program included geographic location, number of residents per year, and total number of residents. Residents were categorized into 4 mutually exclusive geographic match categories: matched into the same institution, matched into same state (but different institution), matched into the same US Census region but a different state/institution, or matched into a different US Census region. RESULTS: A total of 148 of 295 (50.2%) residency programs were included (known total number of residents = 2,928 from four US census regions and Puerto Rico). Most programs were considered small (≤16 residents; n = 52, 35.1%). In general, 43.9% (1148 of 2617) residents matched in a different region from their medical school training. For the primary outcome, no differences in the geographic placement in the previrtual (2020) and virtual application cycles (2021-2023) were observed (p = 0.51). When analyzed by program size or program region, there was no difference in the geographic placement in the previrtual and virtual application cycles. CONCLUSIONS: This study suggests that the virtual interview process did not demonstrate an impact on geographical placement of OBGYN residents, regardless of the size of the residency program or the program's geographic region.

General Surgery Residency Applicant Perspectives on Alternative Residency Interview Models with Implementation of an Optional Second Look Day.

OBJECTIVE: In response to Covid-19, the Association of American Medical Colleges (AAMC) recommended for residency interviews to take place virtually. Benefits of virtual interviews include substantial cost saving and scheduling flexibility. However, it is more difficult to understand program culture and there is concern that more emphasis will be placed on board examination scores and class rank. Programs are split in their decision to keep virtual interviews in the future. This study aims to provide more clarification on students' perspectives and explore the role of an optional second look day to bridge the gap left by the lack of in-person interaction. DESIGN: This cross-sectional study surveyed applicants at our general surgery residency program during the 2022 to 2023 cycle. An optional second look day event was held after submission of the program's rank list. The first survey was sent to all applicants who interviewed with the residency program and asked to pick an interview style that they favored (in person vs virtual) and then asked to rate factors that impacted their decision. It also asked if an optional second look day event was made available, what factors would applicants consider to be important in their decision to attend. The second survey was sent to applicants who attended second look day and asked applicants to state importance of factors that led to their decision to attend. RESULTS: About 50/110 completed the first survey. Applicants preferred virtual over in-person interviews (52% vs 28%). Those who chose virtual selected factors of time commitment and financial burden to be very important compared to those who chose in-person. Applicants who preferred in-person interviews placed most importance on avoiding technical issues and having personal interactions such as: with attending surgeons, with residents, assessment of program culture, visiting facilities, and visiting the town. Applicants were asked to pick important factors if they were to attend an optional second look day after their virtual interview. The following factors were chosen as very important: time commitment, financial burden, interaction with program leadership, interaction with attending surgeons, interaction with residents, visiting facilities, and visiting the town. We then held a second look event after the submission of our rank list. 34/110 attended and 17 complete the survey. Cost and time commitment were not as important to this group who actually attended; they chose in-person interactions with leadership and residents and assessing the program culture to be most important. CONCLUSION: This study aimed to determine the best interview method based on student perceptions. We also piloted an optional second look day to determine whether or not it fills the gaps left by the suspension of in-person interviews. We recommend continuing with virtual interviews as this is what applicants prefer. It alleviates the financial burden of travel and allows for better time management. However, the significance of in-person interactions cannot be ignored. We propose that second look days should be incorporated after submission of the program's rank list to allow applicants the opportunity for in-person interactions, exploration of the town, and enhance their overall interviewing experience.

"Staying connected": Speech-language pathologists' perspectives on the communication needs of people with primary progressive aphasia and their family members.

PURPOSE: The research objectives were to explore the communication needs pertaining to (a) people with primary progressive aphasia (PwPPA); (b) family members of PwPPA; and (c) the different variants of primary progressive aphasia (PPA), from the perspectives of speech-language pathologists (SLPs). METHOD: This investigation used a qualitatively driven concurrent mixed methods research design. Data collection involved semi-structured interviews and mixed methods questionnaires with 14 SLPs. Qualitative content analysis of interview and questionnaire data was used to identify codes and categories related to the research objectives. Quantitative analysis of questionnaire data involved single item summaries and cross item tabulations. RESULT: Analysis revealed eight categories of communication need pertaining to PwPPA and six pertaining to their family members. Results regarding communication needs according to variant of PPA revealed limited findings. CONCLUSION: SLPs perceived several important areas of communication need for PwPPA and their family members, highlighting key clinical implications for proactive communication care across the continuum of care. Future research can build on the current findings and integrate the perspectives of PwPPA and their family members on this topic, to develop interventions and explore models of service delivery to meet their progressive and complex communication needs.

Types and aspects of support that young carers need and value, and barriers and enablers to access: the REBIAS-YC qualitative study.

Background: Many children and young people in England provide support to family members who are disabled, have mental or physical ill health, or misuse drugs or alcohol. Providing care can negatively impact children and young people's education, employment, health and social participation, with associated costs. Support is needed to prevent and reduce these negative impacts. The study sought to provide new knowledge and address prior research gaps regarding how best to support young carers from their perspective and that of the people they care for. Objectives: To address the following questions: What types, components or features of services and other support are seen as helpful, valued, and acceptable to young people who look after someone at home and the people they support? Conversely, what is found to be less or unhelpful? What additional support is perceived as needed? What are the barriers experienced by young and young adult carers in seeking and accessing services for themselves or the person they support? What are the barriers and facilitators for practitioners in providing support and services perceived as valued, helpful and needed by young and young adult carers and the people they support? Design and setting: In-depth qualitative methodology using focus groups, in-depth semistructured interviews and workshops in four localities in England. Participants: One hundred and thirty-three carers aged 9-25 years with a range of caring and life circumstances and sociodemographic characteristics. Seventeen adult care recipients (parents) with a range of physical and/or mental healthcare and support needs. Nineteen practitioners from schools, colleges, young carers organisations, voluntary sector services, mental health services, the National Health Service, adult social care and local authority adult and children's social care commissioners. Results: The types and aspects of support that young carers and their families need, and value when received, include: support that reduces or removes their practical and emotional caring responsibilities; support to mitigate the negative impacts of care and help with other life issues; information and advice about services and wider resources and support; someone trusted available to talk to; greater awareness, recognition and understanding; and choice, flexibility, and co-development of plans and solutions. We found a great deal of unmet need for support, and variation in type and quality of support received, including geographically. Limitations: Potential limitations are that we were not able to engage with, or recruit, young carers from some intended subgroups, meaning some perspectives are missing. Partly because of COVID-19 measures during the study, we mainly recruited through young carers organisations and their family projects, although this was balanced by recruitment through schools and extensive outreach and engagement by the collaborating organisations prior to the project starting. Conclusions: Action is now needed to consistently and sustainably implement the types of support that young carers and the people they care for say they need and value. Future work: Future work should include more research from the perspectives of young carers and the people they care for, especially from particularly marginalised groups; and research to understand what works and how to improve implementation of the support needed and valued. Study registration: This study is registered as Current Controlled Trials ISRCTN13478876. https://doi.org/10.1186/ISRCTN13478876. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129645) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 36. See the NIHR Funding and Awards website for further award information.

Many children and young people in England provide support to family members who are disabled, have mental or physical ill health, or misuse drugs or alcohol. They are sometimes called young or young adult carers. Providing care often brings satisfaction and a sense of pride but can also have negative effects on young people's lives. The study aimed to find out their views about what would best support them and the people they care for. The study asked two important questions: (1) What are the difficulties faced by young carers and the people they support in seeking, accessing and receiving the right type of support at the right times? (2) What services and support do they find helpful, what support would they like, and what needs would it meet? To answer these questions, we held group discussions (focus groups) and in-depth interviews with 133 young carers with a range of caring and life circumstances and 17 parents receiving help from a young carer. We also held workshops with 19 practitioners who are involved in identifying, supporting and funding services for young carers and their families. They told us that the types of support that they and their families need, and value when received, include: support for the people they care for, so they are providing less practical and emotional care support to help with any negative impacts of providing care and with other life issues information and advice about services, wider resources and support someone trusted to talk to greater awareness, recognition and understanding choice, flexibility and working together to develop plans and solutions We found a great deal of unmet need for support, and variation in the type and quality of support received, including across geographical areas. Action is now needed to consistently and sustainably implement the types of support that young carers and their families say they need and value.

[Training pharmacy students to conduct targeted interviews on oral anticoagulants: Development and evaluation of training using healthcare simulation]. / Formation des étudiants en pharmacie conduisant des entretiens ciblés sur les anticoagulants oraux : élaboration et évaluation d'une formation par la simulation en santé.

OBJECTIVES: Pharmaceutical care for patients receiving oral anticoagulants (OACs) should be performed by trained healthcare professionals to prevent adverse effects and improve patient adherence. Before meeting patients, all pharmacy students in our department (in a one-year hospital internship program) experienced a theoretical training for several years. It was decided to add a practical component based on simulation training. The study reports the simulation program conception and the assessment of the simulation-based training for pharmacy students involved in conducting interviews with patients receiving ACOs. METHODS: Organization and content of the training course were defined by two hospital pharmacists and one pharmacy resident. Skills' assessment was measured in pharmacy students in 3 steps: (1) initial assessment by individual interview, (2) group training by simulation, (3) final assessment by individual interview. Student satisfaction was also assessed at the end of the training. RESULTS: Four scenarios and one assessment form were developed and 16 pharmacy students experienced the training. An improvement in skills after the simulations courses was observed in all parts of the process: the pre-interview (mean +15%), the interview itself (+16%) and the post-interview (+18%). All students felt more comfortable and motivated to conduct interviews and recommended that this training be continued. CONCLUSIONS: The study underlines the impact of the simulation training on students' skills and their satisfaction with the overall training program. The simulation training is now fully added to the program. Further studies should explore the skills improvement in real life during the first patient interview.

One More Tool in the Tool Belt: A Qualitative Interview Study Investigating Patient and Clinician Opinions on the Integration of Psychometrics Into Routine Testing for Disorders of Gut-Brain Interaction.

Introduction Disorders of gut-brain interaction (DGBIs) encompass a common group of disorders characterised by chronic gastrointestinal symptoms. Psychological comorbidities are common in patients with DGBIs and are linked with poorer patient outcomes. Consequently, assessing and managing mental wellbeing may lead to improvements in symptoms and quality of life. Methods This study aimed to explore patients' and clinicians' opinions on integrating psychometrics into routine DGBI testing. Semi-structured interviews were conducted with 16 patients with gastroduodenal DGBI and 19 clinicians who see and treat these patients. Interviews were analysed using inductive, reflexive thematic analysis. Results Three key clinician themes were developed: (1) psychology as part of holistic care, emphasising the importance of a multidisciplinary approach; (2) the value of psychometrics in clinical practice, highlighting their potential for screening and expanding management; and (3) navigating barriers to utilising psychometrics, addressing the need for standardisation to maintain the therapeutic relationship. Four key patient themes were developed: (1) the utility of psychometrics in clinical care, reflecting the perceived benefits; (2) openness to psychological management, indicating patients' willingness to explore psychological treatments; (3) concerns with psychological integration, addressing potential stigma and fear of labelling; and (4) the significance of clinician factors, emphasising the importance of clinician bedside manner, knowledge and collaboration. Conclusions These themes demonstrate that patients and clinicians see value in integrating psychometrics into routine DGBI testing. Despite potential barriers, psychometrics advance patient and clinician understanding and facilitate multidisciplinary management. Recommendations for navigating challenges were provided, and considering these, patients and clinicians supported the use of psychometrics as screening tools for patients with DGBIs.