Facilitators and barriers to implementing complex community-based interventions for addressing acute malnutrition in low- and lower-middle income countries: A scoping review.

Background: Community-based nutrition interventions have been established as the standard of care for identifying and treating acute malnutrition among children 6-59 months in low- and lower-middle-income countries. However, limited research has examined the factors that influence the implementation of the community-based component of interventions that address severe acute malnutrition and moderate acute malnutrition among children. Aim: The objective of this review was to identify and describe the facilitators and barriers in implementing complex community-based nutrition interventions to address acute malnutrition among children in low- and lower-middle-income countries. Methods: This review used a systematic search strategy to identify existing peer-reviewed literature from three databases on complex community-based interventions (defined as including active surveillance, treatment, and education in community settings) to address severe acute malnutrition and moderate acute malnutrition in children. Results: In total, 1771 sources were retrieved from peer-reviewed databases, with 38 sources included in the review, covering 26 different interventions. Through an iterative deductive and inductive analysis approach, three main domains (household and interpersonal, sociocultural and geographical; operational and administrative) and eight mechanisms were classified, which were central to the successful implementation of complex community-based interventions to address acute child malnutrition. Conclusion: Overall, this review highlights the importance of addressing contextual and geographical challenges to support participant access and program operations. There is a need to critically examine program design and structure to promote intervention adherence and effectiveness. In addition, there is an opportunity to direct resources towards community health workers to facilitate long-term community trust and engagement.

Making Lemonade out of Lemons: Dialectical Behavior Therapy via Telehealth During a Pandemic.

The COVID-19 pandemic has created a burden on healthcare systems and increased demand for mental healthcare at a time when in-person services are limited. Many programs offering dialectical behavior therapy (DBT) for complex clients have pivoted to telehealth in order to increase access to critical mental healthcare. There is, however, limited research on the provision of telehealth treatment for clients with complex psychopathology more broadly, or the telehealth implementation of DBT more specifically. The aim of this study was to examine the use of telehealth services and related clinician attitudes and experiences in the context of DBT. We examined the degree of telehealth platform adoption among DBT clinicians, as well as changes in stress and self-care strategies. A supplemental aim was to gather clinicians' recommendations for providing DBT via telehealth. Participants included N = 99 DBT practitioners (79.8% female; 20.2% male). Qualitative and quantitative methods were used for data analysis. Findings show that telehealth DBT has been widely adopted among DBT clinicians, and that clinicians' attitudes to telehealth DBT are cautiously optimistic. Participants described three main areas of stress associated with DBT via telehealth provision, as well as lost and novel self-care strategies.

Can peers improve student retention? Exploring the roles peers play in midwifery education programmes in Canada.

PROBLEM: Peer support is understudied as a factor that can impact midwifery student retention. BACKGROUND: Retention of midwifery students is essential for creating a sustainable maternity care workforce. Research shows that peer support positively influences students' experiences, but it needs more focus on the role peers play in student retention. AIM: We aimed to examine how peer support can facilitate midwifery students' retention by exploring the role peers play in students' experiences and identifying the types of support students offer each other. METHODS: We conducted 31 semi-structured interviews with students attending Midwifery Education Programmes across Canada. Data were analysed inductively, following the constructivist grounded theory method. FINDINGS: While motivated and engaged peers improved students' learning experiences and desire to remain in their program, peers who created an overly competitive academic environment hindered learning. Students also noted that a lack of diversity, particularly of Black and Indigenous peers, limited their ability to learn about culturally safe care. Most students felt a sense of community and relied on one another for emotional, academic, and instrumental support. DISCUSSION: Peer support has mostly positive effects on student learning and should be formalized by midwifery educators to improve retention. Reducing pressure to succeed, targeting recruitment of students who are Black, Indigenous, and People of Colour, and establishing formal mentorship programmes could enhance the role peers play in student retention. CONCLUSION: While retention of students is a complex issue, positive interactions with peers can create a stimulating learning environment and increase students' desire to stay in their programme.

"They hold your fate in their hands": Exploring the power dynamic in the midwifery student-preceptor relationship.

AIM: To examine (1) what role preceptors play in students' learning; (2) how student-preceptor relationships can impact students' views of the profession and their decision to leave the program; and (3) what strategies can be used to improve the preceptor-student relationship to facilitate student retention. RESEARCH DESIGN AND PARTICIPANTS: We used a qualitative methodological approach utilising semi-structure interviews with 31 midwifery students across Canada. Participants were recruited from all midwifery education programs and were in various stages of their educational journey. The interviews were conducted in English and French. Inductive analysis followed Charmaz's guidelines moving from line-by-line to focused coding and development of analytical categories. FINDINGS: The results show that positive relationships with preceptors boosted students' confidence and contributed to the constructive learning experiences among trainees. Students pointed out that their best learning experiences were facilitated by preceptors who created a safe space to make mistakes and were knowledgeable and invested in students' learning. Students also suggested that power imbalance is embedded in student-preceptor relationships and can negatively impact students' learning experiences and their decision to stay in the program. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: It is important to consider how to mitigate the power imbalance embedded in preceptor-student relationship. Offering more training to preceptors, oversight of preceptors' mentorship skills by midwifery educators, and creation of ombudsperson's position might mitigate some of the power differential and facilitate students' ability to complete midwifery training.

Women's Perceptions and Experiences of Breastfeeding: a scoping review of the literature.

BACKGROUND: Despite public health efforts to promote breastfeeding, global rates of breastfeeding continue to trail behind the goals identified by the World Health Organization. While the literature exploring breastfeeding beliefs and practices is growing, it offers various and sometimes conflicting explanations regarding women's attitudes towards and experiences of breastfeeding. This research explores existing empirical literature regarding women's perceptions about and experiences with breastfeeding. The overall goal of this research is to identify what barriers mothers face when attempting to breastfeed and what supports they need to guide their breastfeeding choices. METHODS: This paper uses a scoping review methodology developed by Arksey and O'Malley. PubMed, CINAHL, Sociological Abstracts, and PsychInfo databases were searched utilizing a predetermined string of keywords. After removing duplicates, papers published in 2010-2020 in English were screened for eligibility. A literature extraction tool and thematic analysis were used to code and analyze the data. RESULTS: In total, 59 papers were included in the review. Thematic analysis showed that mothers tend to assume that breastfeeding will be easy and find it difficult to cope with breastfeeding challenges. A lack of partner support and social networks, as well as advice from health care professionals, play critical roles in women's decision to breastfeed. CONCLUSION: While breastfeeding mothers are generally aware of the benefits of breastfeeding, they experience barriers at individual, interpersonal, and organizational levels. It is important to acknowledge that breastfeeding is associated with challenges and provide adequate supports for mothers so that their experiences can be improved, and breastfeeding rates can reach those identified by the World Health Organization.