What are the barriers towards cervical cancer screening for vulnerable women? A qualitative comparative analysis of stakeholder perspectives in seven European countries.

OBJECTIVES: The aim of this study was to map and compare stakeholders' perceptions of barriers towards cervical cancer screening for vulnerable women in seven European countries. DESIGN: In Collaborative User Boards, stakeholders were invited to participate to identify barriers towards participation in cervical cancer screening. SETTING: The study is nested in the European Union-funded project CBIG-SCREEN which aims to tackle inequity in cervical cancer screening for vulnerable women (www.cbig-screen.eu). Data collection took place in Bulgaria, Denmark, Estonia, France, Italy, Portugal and Romania. PARTICIPANTS: Participants represented micro-level stakeholders covering representatives of users, that is, vulnerable women, meso-level stakeholders covering healthcare professionals and social workers, and macro-level stakeholders covering programme managers and decision-makers. METHODS: Across the seven countries, 25 meetings in Collaborative User Boards with a duration of 2 hours took place between October 2021 and June 2022. The meetings were video recorded or audio recorded, transcribed and translated into English for a qualitative framework analysis. RESULTS: 120 participants took part in the Collaborative User Boards. Context-specific barriers were related to different healthcare systems and characteristics of vulnerable populations. In Romania and Bulgaria, the lack of a continuous screening effort and lack of ways to identify eligible women were identified as barriers for all women rather than being specific for women in vulnerable situations. The participants in Denmark, Estonia, France, Italy and Portugal identified providers' lack of cultural and social sensitivity towards vulnerable women as barriers. In all countries, vulnerable women's fear, shame and lack of priority to preventive healthcare were identified as psychological barriers. CONCLUSION: The study provides an overview of stakeholders' perceived barriers towards vulnerable women's cervical cancer screening participation in seven European countries. The organisation of healthcare systems and the maturity of screening programmes differ between countries, while vulnerable women's psychological barriers had several similarities.

Survey of current policies towards widening cervical screening coverage among vulnerable women in 22 European countries.

BACKGROUND: This study aimed to investigate the status of cervical cancer screening (CCS) implementation in Europe by investigating national or regional policies towards broadening coverage of CCS amongst vulnerable subgroups of the population at high risk for CC. METHODS: A web-based survey was conducted between September 2021 and February 2022 with CCS programme managers and experts to identify and rank six population subgroups at high risk considered most vulnerable to CC and to map existing policies that addressed the coverage of CCS towards population sub-groups at risk. RESULTS: A total of 31 responses were received from experts covering 22 European countries. The results of this survey suggest that whilst many countries identify lower coverage of CCS amongst population subgroups at high risk of CC as a public health problem, few countries have developed dedicated policies towards broadening coverage among these subgroups. The six countries who reported having done so were concentrated in the Northern or Western European regions, suggesting the existence of geographical disparities within the continent. A key challenge in this respect is the difficulty to categorize subgroups of the target population; many individuals are burdened by intersectionality thereby resting in multiple categories, which may hinder the effectiveness of interventions targeted to reach specific subgroups. CONCLUSION: A greater clarity on the conceptualization of vulnerability can help countries to develop and subsequently implement strategies to increase coverage to subgroups of the target population currently underserved with regards to CCS.

Non-formal patient handover education for healthcare professionals: a scoping review.

OBJECTIVE: The objective of this scoping review was to identify, organize and present the underpinning learning theories, theoretical frameworks, didactics, content and evaluation methods used in existing literature on non-formal patient handover learning programs for healthcare professionals to highlight existing gaps in evidence. INTRODUCTION: Clinicians are aware that the professional patient handover between healthcare settings poses a safety risk for patients. Learning programs for healthcare professionals improve patient handovers; however, there has been little formal exploration of the content of patient handover learning programs that elicit efficacious, non-formal learning activities. This scoping review therefore sought to investigate the concept of non-formal patient handover learning. INCLUSION CRITERIA: This scoping review considered studies that included healthcare professionals from any healthcare profession examining non-formal patient handover learning in a variety of settings. Both qualitative and quantitative studies, as well as conference abstracts and reviews, were considered. METHODS: An extensive search of multiple databases was undertaken. We considered studies published from 2000 onwards in English, Norwegian, Swedish and Danish. Data extraction was undertaken using an extraction tool developed specifically for this scoping review. The results of the review are presented in narrative form supported by tables. RESULTS: Fourteen studies were included. Study populations mostly comprised nurses or inter-professional groups of healthcare professionals, and non-formal learning program evaluation was performed in the context of intra-hospital handover, handover between hospital and other healthcare settings, and handover in the provision of pre-hospital and emergency services. Non-formal patient handover learning programs lacked reporting on the use of underpinning learning theory. The content of handover learning programs was informed by theoretical frameworks, checklists, mnemonics and frameworks developed based on observations in clinical practice or expert knowledge. Regardless of the type of handover, communication was the most-reported theme. The most-reported didactic was simulation. Pre- and post-intervention evaluation was the most-reported design. Evaluation methods varied from questionnaires and tests to observations and thematic analysis. Outcomes were reported on level 1-3, using Kirkpatrick's hierarchical model. No studies reported on patient outcomes. CONCLUSIONS: Gaps in knowledge were identified in the limited number of studies, comprising lack of transparency in the design of patient handover learning programs, notably concerning underpinning learning theories and learning objectives, lack of studies covering multiple settings, lack of knowledge regarding the impact of time on learning, lack of studies of any long-term impact, and lack of studies reporting on patient outcomes. Further research on non-formal handover learning programs is needed to enhance the transparency of program design and coherence in use of educational components from underpinning learning theories to evaluation methods. Few studies manage to document outcomes at the patient level.

Design-based research in designing the model for educating simulation facilitators.

The purpose of this article is to introduce the concept of design-based research, its appropriateness in creating education-based models, and to describe the process of developing such a model. The model was designed as part of the Nurse Educator Simulation based learning project, funded by the EU's Lifelong Learning program (2013-1-DK1-LEO05-07053). The project partners were VIA University College, Denmark, the University of Huddersfield, UK and Metropolia University of Applied Sciences, Finland. As an outcome of the development process, "the NESTLED model for educating simulation facilitators" (NESTLED model) was generated. This article also illustrates five design principles that could be applied to other pedagogies.

Educational interventions that address handover skills of healthcare professionals: a scoping review protocol.

OBJECTIVES: The objective of this scoping review is to identify, organize and present existing literature on training interventions on handovers for healthcare professionals to highlight the existing gaps in evidence to inform future research in this field. More specifically the objectives are to.

Developing and testing transferability and feasibility of a model for educators using simulation-based learning - A European collaboration.

BACKGROUND: There is a pragmatic and often inconsistent approach of embedding simulation-based learning into nursing programmes. This paper details a European collaboration that designed a model for educator facilitation for educators utilizing simulation-based education. OBJECTIVES: The objectives of the study were to develop a model to educate the educators who deliver simulation-based learning and to test to which extent this model could be transferred to education providers in different national settings. METHODS: This model, its transferability and feasibility, was tested across three European countries. Educators from three Schools of Nursing participated in the study. Design-based Research was used as an overall methodology. Data were collected by the use of pre- and post-programme questionnaires and focus groups. RESULTS: The content of the NESTLED model is consistent with the needs of the participants. The testing also demonstrated that the model is transferable across-countries. Additionally, the participants' preferences regarding amount of time and pre-reading for the different sessions vary depending on the background and level of seniority of the individual participant. CONCLUSION: The testing of the NESTLED model demonstrated that participants gained confidence and knowledge from undertaking the programme. Delivering the NESTLED model across-countries was found to be feasible, but flexibility is required in terms of logistical delivery of the programme.

Towards identifying nurse educator competencies required for simulation-based learning: A systemised rapid review and synthesis.

OBJECTIVES: This paper presents the results of a systemised rapid review and synthesis of the literature undertaken to identify competencies required by nurse educators to facilitate simulation-based learning (SBL). DESIGN: An international collaboration undertook a protocol-based search, retrieval and critical review. DATA SOURCES: Web of Science, PubMed, CINAHL Plus, PsycInfo, ERIC, the Cochrane Library and Science Direct. The search was limited to articles published in English, 2002-2012. REVIEW METHODS: The search terms used: nurse*, learn*, facilitator, simula*, lecturer, competence, skill*, qualificat*, educator, health care, "patient simulation", "nursing education" and "faculty". The search yielded 2156 "hits", following a review of the abstracts, 72 full-text articles were extracted. These were screened against predetermined inclusion/exclusion criteria and nine articles were retained. Following critical appraisal, the articles were analyzed using an inductive approach to extract statements for categorization and synthesis as competency statements. RESULTS: This review confirmed that there was a modest amount of empirical evidence on which to base a competency framework. Those papers that provided descriptions of educator preparation identified simulation-based workshops, or experiential training, as the most common approaches for enhancing skills. SBL was not associated with any one theoretical perspective. Delivery of SBL appeared to demand competencies associated with planning and designing simulations, facilitating learning in "safe" environments, expert nursing knowledge based on credible clinical realism, reference to evidence-based knowledge and demonstration of professional values and identity. CONCLUSIONS: This review derived a preliminary competency framework. This needs further development as a model for educators delivering SBL as part of nursing curricula.